骨盆倾斜型臀肌挛缩症

臀肌挛缩症是指各种原因引起的臀肌及其筋膜挛缩,导致髋关节功能受限,表现出特有症状、体征的临床症候群。１９７０年Valderrama犤１犦首先报告本病,国内马承宣犤２犦于１９７８年系统报告了此类病例。至今国内外已有大量文献报道。早期的报道多集中在臀大肌、臀筋膜等软组织病变方面,认为该病不会导致骨质变化,X线摄片骨盆和髋关节无异常改变犤２犦。随着对该病认识的加深,近年来重症臀肌挛缩症,尤其是骨盆倾斜型臀肌挛缩症日益引起重视。作者参考了国内外有关文献,综述如下：病因臀肌挛缩症的病因比较复杂,至今尚无明确的致病因…     

臀肌松解术治疗臀肌挛缩导致膝骨性关节炎52例临床分析

目的：探讨臀肌挛缩松解术对预防臀肌挛缩症导致膝骨性关节炎发生的临床疗效与意义。方法：回顾性分析2008年1月至2010年6月收治的臀肌挛缩导致膝骨性关节炎患者52例,男15例,女37例;年龄15～45岁,平均35岁;左侧18例,右侧30例,双侧4例。本组52例均进行臀肌挛缩松解术。术后采用Lysholm膝关节功能评分对患者术前、术后客观结果进行评估。结果：52例均获随访,时间12～37个月,平均15个月,Lysholm膝关节功能评分由术前平均（68.12±0.78）分改善为术后末次随访时的（91.23±0.47）分,术后评分提高（t=31.269,P〈0.01）。结论：臀肌松解术能有效缓解臀肌挛缩症及膝骨性关节炎的症状。臀肌挛缩症的患者,早期治疗可以有效防止臀肌挛缩对膝关节的力学影响,减缓膝关节的早期退变,预防膝骨性关节炎。     

Gluteal fibrosis.

Five cases of gluteal fibrosis are presented. The anatomical extent of the gluteal involvement explains the clinical picture. Reports of gluteal fibrosis and fibrosis elsewhere suggest that the lesion was the same in all five patients. Intramuscular injections were a possible etiological factor. All the reported sites were those usually used for administration of intramuscular injections. Because the use of intramuscular injection is so common in Spain another factor is necessary to explain the involvement in only a small number of children.     

Limited hip abduction in the infant

This article addresses two important questions: What is the relationship between limited abduction and hip dysplasia in infants? Does untreated limited abduction in the infant ultimately lead to developmental dysplasia of the hip? In the authors' population of 683 babies, limitation of abduction had a sensitivity for the diagnosis of hip dysplasia of 69%, a specificity of 54%, a positive predictive value of 43%, and a negative predictive value of 78%. In the group with sonographically proven hip dysplasia, 70 of 226 babies (31%) showed no limitation of abduction, and in the group without dysplasia 210 of 457 (46%) showed manifest limitation of abduction. One hundred thirty-six babies with limited abduction but a normal sonographic examination were left untreated. They were re-examined at an average age of 5+3 years (range 2+0-9+5). All had developed normally, both clinically and radiographically.     

Nonprogressive abduction contracture of the shoulder joint. A case report

Nonprogressive abduction contracture of the shoulder joint in a 32-year-old woman became clinically obvious only when the shoulder became painful following minor trauma. The tether in the deltoid muscle appears to have been present from an early age, but had been well compensated by abnormal scapular posture. No etiological factors could be discovered, but there was an unsubstantiated family history of similar problems. Only one comparable case has been found in the literature, and this unusual presentation seems not to have been described previously. The patient responded well to conservative treatment.     

Extension-abduction contracture of the spastic hip

Patients with cerebral palsy and fixed hip extension are often unable to sit and therefore lose social and educational opportunities. At Texas Scottish Rite Hospital (Dallas, TX, U.S.A.), 29 patients had hip extension-abduction contractures. Eleven patients with mild involvement were managed with physical therapy. Six patients had moderate involvement and required wheelchair modification to maintain sitting. Twelve patients demonstrated severe contractures that required major soft tissue releases and often femoral shortening osteotomies to regain flexion. Patients with athetosis or rigidity were identified as those most likely to develop extension-abduction contractures either spontaneously or following adductor releases.     

Bilateral intradeltoid ossification: a cause of glenohumeral abduction contracture

A case of bilateral glenohumeral abduction contracture is presented. Two features are unique: intradeltoid ossification and progressive deformity without recent trauma. A review of the literature is given.     

Sonographic follow-up of hip dysplasia treated with an abduction brace

121 children with cdh, which haven been treated between June 84 and December 85 in our out-patient-ward with Aktivspreizhose (abduction-pants), have been followed by ultrasound examination. Reliability of hip ultrasonography, duration of treatment and results have been evaluated. At the beginning of treatment the diagnosis were: 24.8% type IIa, 29.6% type IIb, 13.2% type IIG or IID and 5.8% type IIIa according to Graf; in 6.6% of the cases cdh was diagnosed only by x-rays. Hip ultrasonography was highly reliable according to quality controls in comparison to x-rays and short-ended the duration of treatment. With the exception of 3 children (1 Myelodysplasia, 2 start of treatment after the 6 months of life) all children with "Aktivspreizhose" treatment showed anatomic healing. Duration of treatment was 4.2 months on the average, 3.5 months when treatment started in the first 3 months of life, and 4.7 months, when started after the first 3 months of life. X-ray-controls at the end of treatment showed mild forms of femoral head necrosis (type I and II) in two cases, which healed completely according to follow up controls. For the treatment of cdh in babies the Aktivspreizhose is the optimal therapy, especially when started in the first 3 months of life. A general legal orthopaedic clinical and ultrasound screening of babies hip in the first week of life should be introduced.     

Rotation-abduction contracture of the hip joint]

The paper presents the rotation-abduction contracture of the hip, a problem of growing magnitude in recent years. The anatomy of the hip joint, the perils related to muscle physiology, the symptoms of the disease, the etiology and means of surgical treatment according to Fernandez de Valderrama and Esteve de Miguel are discussed. The results of surgical treatment of 12 patients at the Orthopedic Department of Wroclaw. The presented procedure has been used in our center since 1993, and the results encourage further use of this technique.     

Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy

Background:

Spontaneous hip lateralization complicates the management of non-ambulatory children with cerebral palsy (CP). It can be diagnosed early using radiographs, but it involves standardization of positioning and exposure to radiation. Hence, the aim of this study was to assess the utility of Combined hip abduction angle (CHAA) in the clinical setting to identify those children with CP who were at greater risk to develop spontaneous progressive hip lateralization.

Materials and Methods:

One hundred and three children (206 hips) with CP formed our study population. There were 48 boys and 55 girls aged 2–11 years (mean 5.03 years). 61 children were Gross Motor Function Classification System (GMFCS) level 5, while 42 were GMFCS level 4. Clinical measurements of CHAA were statistically correlated with radiographic measurements of Reimer''s migration percentage (MP) for bivariate associations using χ² and t tests.

Results:

CHAA is evaluated against MP which is considered as a reliable measure of hip subluxation. Thus, for CHAA, sensitivity was 74.07% and specificity was 67.35%. False-positive rate was 32.65% and false-negative rate was 25.93%.

Conclusions:

Our study shows that correlation exists between CHAA and MP, which has been proved to be useful for hip screening in CP children at risk of hip dislocation. CHAA is an easy, rapid, cost-effective clinical test which can be performed by paraclinical health practitioners (physiotherapists) and orthopedic surgeons.