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тХЙЯЮЖХЪ БЕПРКСФМНЦН ЙНЛОНМЕМРЮ?
послал Nikolaj Wolfson 07 Декабрь 2004, 10:37
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Hello Leonid:
I would treat Paget▓s as any other arthritic joint.
In my experience there is no problem using press fit cup. Make sure you have large sizes. The acetabulum is in protrusio (medialized). When you bring it out with a large cup and use femoral component with appropriate size neck you will lengthen this patient▓s leg. Concern: sciatic nerve. While traditional 2.5 cm lengthening is the maximal amount without risking much sciatic nerve (reference?), in situation like this, when shortening took place gradually, even larger amount of lengthening can be done safely. Take into account 2 factors when you deal with the short extremity:
1. Shortening is due to the flexion contracture of the hip, and when you release it you will lengthen the extremity
2. Fixed pelvic obliquity: check it before the operation. If you do not take it into account, while the pelvic x ray may look very accurate the functional leg length is not the same.
If you have electodiagnostic tools you may use them during the operation to monitor condition of the sciatic nerve.
Good luck,
Nikolaj Wolfson, MD, FRCSC
West Virginia
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