青壮年期両側末期股関節症に対する骨盤骨切り術と筋解離術の限界

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  • Clinical results of pelvic osteotomy and muscle release for bilateral severe coxarthrosis.

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Five patients underwent muscle release around the hip joint, according to O'Malley's method as modified by Itami, for treatment of bilateral severe coxarthrosis. However, the procedure was done only for the unilateral hip. Average follow-up period after surgery was 8.2±3.4 years. Though this procedure relieved pain, favorable results were limited because of insufficient improvement of ADL, ROM and gait ability. There was no additional surgery, even in the contralateral hip, in any of the cases.<BR>Twelve hip joints of eight patients underwent pelvic osteotomy, such as Chiari osteotomy, for treatment of bilateral severe coxarthrosis with acetabular dysplasia. Four contralateral hip joints underwent arthrodesis, muscle release, and shelf operation in addition to varus osteotomy of the femoral head, and bipolar total hip arthroplasy in each. Four patients underwent pelvic osteotomy bilaterally. Average follow-up period after surgery was 9.8±1.7 years. Six hip joints which received this procedure in patients less than 39 years of age obtained good results 10 years after surgery. However, two hips of six hip joints which received this procedure in patients more than 40 years of age had to be replaced with a total hip prosthesis, one 3 years and the other 10 years after surgery. Therefore, in bilateral severe coxarthrosis with acetabular dysplasia in patients more than 47 years of age total hip arthroplasty should be a first choice for improvement of ADL, ROM, and gait abil-ity. Thereafter, pelvic osteotomy can be done for preservation of the joint.

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