RESUMO
The safest and easiest technique of performing a total hip replacement (THR) in neglected high congenitally dislocated hip (CDH) is still debatable. To find the best method, a prospective randomised trial comparing four different techniques was undertaken. A total of 48 THRs were performed on 40 patients with CDH. Average age was 40.6 years and average follow-up was 42 months. Four different techniques (n=12 each) were used: 1) THR into neo-acetabulum in a single operation, 2) THR into real acetabulum as a one stage procedure, 3) Campbell release operation followed by THR into real acetabulum after three weeks of traction, 4) THR with proximal femoral shortening. Even though shortening and one stage THR is technically more demanding we believe it superior to the other techniques. (Hip International 2002; 12: 308-13).
RESUMO
There are no detailed descriptions of the neural structures that may be seen during surgical interventions of the pelvis. Anatomic dissections were performed to see which nerves are endangered in approaches to the anterior sacroiliac joint for plate fixations. Sixty cadavers were dissected bilaterally. Fifty-one were male and nine were female. L4 and L5 nerve roots were followed along the sacroiliac joint from the intervertebral foramen to the entrance into the lesser pelvis. Measurements were made between the nerves and sacroiliac joint from the proximal end of the joint to the pelvic brim. The L4 nerve root and the lumbosacral trunk (and not the L5 nerve root) were the nerves most susceptible to injury because of their course and proximity to the sacroiliac joint. As a result, during the anterior approach and fixation of the sacroiliac joint with plates, extreme care should be taken to identify the L4 nerve root or lumbosacral trunk or both at the anteroinferior third of the joint because the distance between the nerve and the joint is less than 1 cm.