Treatment of Congenital Dislocation of the Hip with Colonna's Capsular Arthroplasty
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概要
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Since 1955 we had performed Colonna's capsular arthroplasty in 55 cases involving 66 joints of congenital dislocation of the hip and reviewed a follow-up study conductcd on 61 joints of 51 cases: 7 cases over 7 years after the operation, 21 cases over 5 yeas, 15 cases over 3 years and 8 cases over one year.Among the cases ranging from three years and six months old to 26 years old of age at the time of operation, 24 cases were elder than 10 years of age for whom Colonna himself did not indicate this operation.End-result of 51 cases was as follows ; excellent-24 cases (39.2%), good-7 (13.7%), fair-6 (11, 7%), poor-12 (23.3%) and bad-6 (11, 7%). Of six bad cases two were caused by postoperative infection and another two by complication with enchondral dysostosis.Unilateral cases under 10 years of age at the time of operation and bilateral cases under 8 years were 29 (33 joints). Result of them was as follows ; excellent-19 (70.30, good-3 (11.1%), fair-1 (3.7%), poor-0 and bad-2 (7.4%). The causes of two bad cases was postoperative infection.Result of 24 cases elder than 10 years at the time of operation was following ; excellent-1, good-4, fair-5, poor 10 and bad-4. The cause of two of four bad cases was enchondral dysostosis, Even in this group 5 cases showed excellent or good results without any discomfort in their daily lives, contrary to Colonna's insistence, so that we concluded that this operation could be indicated for elder children when the dislocation and the deformity or atrophy of the femoral head would not be so severe.Several attempts have been made to overcome technical difficulties as follows.1) According to Colonna's original procedure plaster cast was applied for 4 weeks after operation, but we did only for one or two weeks in order to restore the wide range of joint movement.After removal of the stitches skin traction was applied at once, and active exercise of joint was begun to practise at the end of the third week after operation. We believe these procedures are essential to have good results.2) Colonna allowed the patients to walk at 3 months after operation, but we did at 6-8 weeks for 18 cases of younger children without any disadvantages for end-result. We believe however, it is better to allow weight-bearing after longer period for elder patients.3) In 15 cases (17 joints), in whom newly moulded acetabulum was shallow and unable to cover the femoral head enough, we performed acetabuloplasty, modified to Spitzi operation, with capsular arthroplasty and obtained very good result.4) All of four cases in which fascia lata or OMS membrane were used to cover the femoral head because of the lack of the inherent capsule showed good results, while 15 cases with reshape of the highly deformed or too large head showed bad results except one case.As whole, the degree of dislocation seemed to have not so much corelation to the endresult of the operation. It was found, however, the result for the fourth degreed dislocation by Gaugele was always bad and in the elder patients, the lesser the degree of dislocation, the better the result.
- 一般社団法人 国立医療学会の論文
一般社団法人 国立医療学会 | 論文
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