|
KMID : 0361619750100020191
|
|
Journal of the Korean Orthopaedic Association
1975 Volume.10 No. 2 p.191 ~ p.199
|
|
|
The Treatment of fixed Pelvic Obliquity in Paralytic scoliosis
|
|
李錫玄/Lee, Suck-Hyun
安珍煥/石世一/Ahn, Jin Whan/Suk, Se Il
|
|
|
Abstract
|
|
|
The fixed pelvic obliquity, which constitutes a part of deformity present above and/or below the iliac crest, had remained out of interest until Dr. Mayer(1931) drew attention to its deteriorating, role in body mechanics. But it was Dr. Irwin (1941. 1947) who developed the successful theory of pathogenesis of fixed pelvic obliquity. He believed that the most of the pelvic obliquities arise from contractures distal to the pelvis and ;few from unilateral weakness of lateral trunk muscles. He concluded that surgical release of the contractures below iliac crest by means of simple fasciotomy folio-wed by cast correction or proximal femur osteobomy would be sufficient for their correction. But in cases that pelvic obliquity, is ever present with paralytic scoliosis for considerable period and so fixed, problems met with will be much more intricated than usually expected. Our cumulated experiences of those cases has brought out the consideration that Irwin´s idea is not uniformly fit for longstanding severe cases.
The following conclusions were obtained by giving analysis on 4 cases of severe fixed pelvic obliquity associated witlf paralytic scoliosis who were treated in recent years in Department of Orthopedic Surgery, Seoul National University Hospital.
1. The thought that pelvic obliquities are mostly due to contractures below iliac crest was not always suitable. Which contracture above or below iliac crest is the primary one was uncertain in severely fixed cases. t
2. It was not opposite but~same side as that of abduction contracture of hip, of which lateral trunk muscle contractures prevent effective correction of fixed pelvic obliquity.
This point was not mentioned by Dr. Irwin, or if ever by someone else, forms a different idea from those ones previously reported. ,
3. It dues convinced that the improvements or corrections of pelvic obliquities by soft tissue release alone are apt to recur in growing children. Continuous physical therapy and adequate application of Milwaukee brace was necessitated under careful observation in such cases.
4. If pelvic obliquity in paralytic scoliosis is longstanding and fixed, extensive spinal fusion using Harrington rod and sacral bar will finally be mandatory even in younger groups.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
  
|
|