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Iliopsoas transfers in children with myelomeningocele
Insights
Iliopsoas transfers effectively reduced paralytic hips in children with myelomeningocele, though not all hips achieved normal hip function. Combined with osteotomy, the procedure showed more consistent positive outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Spinal cord injury research
Background:
- Myelomeningocele often leads to hip instability and dislocation.
- Paralytic hips in children require effective surgical interventions for improved function.
- Neural deficits at the fourth lumbar level impact hip musculature and stability.
Purpose of the Study:
- To evaluate the long-term effectiveness of iliopsoas transfers in treating paralytic hips in children with myelomeningocele.
- To assess hip reduction and functional outcomes following this surgical procedure.
- To compare outcomes with and without combined varus osteotomy.
Main Methods:
- Retrospective analysis of 32 paralytic hips in 17 children with myelomeningocele.
- Surgical treatment involved iliopsoas transfers, with some patients also undergoing varus osteotomy.
- Long-term follow-up (4-14 years) included radiographic assessment and muscle function evaluation.
Main Results:
- All 32 hips achieved reduction after iliopsoas transfer.
- Nineteen hips demonstrated a center-edge angle greater than 25 degrees, indicating improved stability.
- Combined varus osteotomy with transfer yielded more consistent positive results.
- Transferred iliopsoas muscles showed significant activity in abduction and extension against gravity.
Conclusions:
- Iliopsoas transfer is a valuable surgical option for managing paralytic hips in myelomeningocele.
- The procedure improves hip reduction and stability but does not fully normalize hip anatomy or function.
- Combining iliopsoas transfer with varus osteotomy enhances treatment consistency and outcomes.
Abstract:
Thirty-two paralytic hips in seventeen children with myelomeningocele and a neural deficit at the fourth lumbar level were treated with iliopsoas transfers. Four to fourteen years later, all of the hips were reduced and nineteen had a center-edge angle of more than 25 degrees. This result was more consistent in the hips of the ten patients who had had a combined varus osteotomy and transfer. All but three of the transferred muscles were active: twenty-one had abduction and fifteen had extension against gravity. We concluded that the procedure has value, but that it does not produce a normal hip.