リーメンビューゲル法による先天股脱の長期治療成績

抄録

From 1962 to 1965, 110 patients with congenital dislocation of the hip (CDH) and congenital subdislocation of the hip (CSdH) were treated only by the Pavlik harness. Of 89 of these patients (104 hips) who were examined at prepuberty (13-14 years old) by Dr. Ichimura of our department, 57 (69 hips) were examined at the age of 17-20 years in the present study. Clinical and roentgenographic results of the patients were analyzed, and were compared with the results of children, examined at the age of 17 and 18 years, who underwent treatment by the L₁, method. According to Miki's function criteria of the hip, 84.6% of the CDH cases and 92.6% of the CSdH cases were rated as A. In a roentgenographic evaluation of the cases according to Severin's criteria, 69.0% of the CDH cases and 77.0% of the CSdH cases were rated as group 1. The patients treated by the Pavlik harness had better clinical and roentgenographic than the patients treated by the L₁ method. The preadolescent CE angle (CE) and Sharp's angle (S) were analyzed to predict the course up to the age of 17 to 20 years, and the discriminant Z=-0.055+0.011X₁(CE)-0.003X₂(S) was confirmed. Children with a CE angle greater than 20 degrees and a Sharp's angle less than 49 degrees at the age of 13 years are predicted to have a good outcome. Children with a CE angle less than 20 degrees and a Sharp's angle greater than 50 degrees should be followed up to the age of 20 years because of unsatisfactory roentgenologic signs.