年長児先天股脱にたいする転子下骨切り術の臨床的研究

抄録

In the examinations conducted on 62 grown-up children (69 joints) housed at the Kojika-en (Hospital and home for crippled children), who had been treated by subtrochanteric osteotomy for congenital dislocation of the hip (CDH) during the period from 1956 to 1962, the following results were obtained.
1) Their postoperative values that can be considered as excellent and good amounted to 15 joints (21.7%), those classed as fair 32 joints (46.4%), those as tolerable 18 joints (26.1%), and those poor 4 joints (5.8%),
2) Roentgenograms of those with good postoperative results revealed that the angle of the osteotomy was preserved well for a long time, and the ratio a/A (where a stands for ischium center line-femoral shaft median line; and A for body median line-ischium center line) did not increase, and in addition, the center of hip-movement was at lesser trochanter.
3) The diminution of the angle of osteotomy proved to be especially marked in younger ohildren and the reoperation was performed in some.
4) In the analysis of walking gaits with moving pictures, it was found to be difficult to eliminate completely both walking with gluteus maximus and medius gait, but most of them could carry on activity of daily life.
5) Dysfunction of gluteus muscles has a great bearing on prognosis.
6) Bilateral subtrochanteric osteotomy, if conducted after a careful study of the case and cut at an appropriate angel, will bring moderately good results.
7) From anatomical viewpoint, it can be safely said that the subtrochanteric osteotomy is an useful treatment for old CDH and it is such a nature that can solve this difficult problem sufficiently.