乳幼児先天性股関節脱臼に対するOverhead Extension法の適応と限界特に関節造影像からの考察
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概要
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Reduction with the overhead extension method was done in 100 cases or 200 joints with congenital dislocation of the hips, which were examined from November, 1959 to August, 1963. During the treatment, the appearance of the bony nuclei was observed, and simultaneously the indications and limitation of this treatment were analyzed by comparing the arthrograms of the hips which is taken before and after traction.<BR>Eighty eight female infants and 12 male infants were studied. The age of the patients ranged from 1 month and 17 days to 5 years and 7 months, but more than a half of the cases were between 4 and 6 months of age.<BR>The extent of dislocation varied from so-called"normal"joint to the second grade (Aoki) roentgenologically, and from the congruent type to the fifth type (Wachi) arthrographically.<BR>The duration of extension was as a rule 2 weeks, ranging from 11 days to 46 days. The weight for extension ranged from 1.5 to 5.5 kg (2.0-3.0 kg in 91 cases) .<BR>Generally speaking this method showed an excellent result in younger infants with mild symptoms, while it showed a poor result in older infants with severe symptoms. Deformity of the nucleus in the femoral head was recognized in 38 cases at various degrees. The bony nuclear changes disappeared after a few month in 6 joints out of 29 in which the reduction was done before the age of 9 months, however the others showed only slight changes. Perthes-like change was seen only in 4 joints among all cases studied.<BR>The following conclusion has been made through periodical observations of the arthrograms and the operative findings.<BR>1) Operative reduction is indicated when inward dislocation of the limbus either constricts the inlet of the acetabulum or fixes itself with overgrowth.<BR>2) Further shelf operation may be necessary to a few patients even though the displacement of the limbus is mild and can be reduced completely.<BR>3) With regards to the isthmus portion, not its width but its extensibility is important for determining the possibility of the reduction. No limitation for the reduction was recognized as to the age of the patients. We experienced a successful reduction on severe dislocation seen in a 5 year and 7 month old patient. No limitation is present even in early infancy, but one has to watch for the complications.<BR>The therapeutic result should be improved in congenital dislocation of the hip if this treatment is started as early as possible with an aid of arthrogram of the hip.
- 昭和大学・昭和医学会の論文