年長児先天股脱にたいする転子下骨切り術の遠隔成績

抄録

In the present study, clinical and roentgenologic assessment of subtrochanteric osteotomies (Froelich, Iino, and Schanz) for irreducible congenital dislocation of the hip was carried out in 25 joints of 19 cases which were followed out of 34 cases. They were the patients with highly congenital dislocation of the hips but without any previous treatment and operated at the Kojikaen (Hospital and Home for the Crippled Children in Kochi Prefecture) from 1956 to 1962, while the short term follow-up study was made by Dr. Y. Kato in 1964. The results were summarized as follows.
1) Postoperative evaluation of 19 cases according to Kato's method confirmed that there were no cases in excellent, 8 cases (42.1%) in good, 8 cases (42.1%) in fair, 2 cases (10.5%) in tolerable and one case (5.3%) in poor. Good and fair cases were clinically satisfactory but one poor case was re-operated by resection angulation osteotomy (Milch) due to severe coxalgia.
2) In the roentgenologic examinations, most of the cases showed that the osteotomized angles increased up to the corrected angles at the time immediately after the operation, although decrease of the angles was detected at the short term evaluation by Dr. Kato. The recovery of the osteotomized angles can be related to the satisfactory results in the clinical courses during the long term of about 15 years (mean).
3) There were no cases with disability in ADL because of deformities or instabilities in the knee joints regardless of different levels of the osteotomies.
5) It can be concluded that the subtrochanteric osteotomy is indicated for the patients with highly congenital dislocation of the hips especially at the ages from 10 to 20 years old. Resection angulation osteotomy (Milch) seemed to be most useful for the treatment of such old cases with severely congenital dislocation of the hips.