Continuous data were analyzed using the Mann-Whitney test; and categorical data, with the exact Fisher test. Comparative analyses were performed using the wilcoxon Signed Rank Test. Multivariate logistic regression analysis was performed to identify potential contributions to sustained hip flexion contracture. Dependent variables were those with a p-value < 0.05 in the univariate analysis or those with significant clinical significance. One side of the hip was randomly selected from all patients and statistically analyzed to avoid duplication of spinopelvian parameters. Statistical analyses were performed with SPSS version 21.0 (SPSS, IBM Corp., Chicago, IL); P values < 0.05 were considered statistically significant. Shortening of the flexor muscles of the hip and capsular band is observed. Hip flexion contracture leads to disruption of normal biomechanics, leading to metabolic inefficiency of standing and gait. Patients were placed in the hip flexion contracture group or in the group without significant contracture depending on the appearance of sustained hip flexion contracture after thigh lengthening. Persistent hip flexion contracture was defined as a hip flexion contracture that lasted more than 6 months after the operation despite intensive physical therapy and ultimately required soft tissue release. All soft tissue operations were performed during the consolidation phase. For soft tissue release, intramuscular recession of rectus femoris  was mainly performed.
In addition, intramuscular recession of Sartorius and Iliopsoas and partial release of the iliotibial band were often accompanied. Immediately postoperative hip flexion contractures improved only with physical therapy were not considered persistent hip flexion contractures. 4. Den Hartog JG. Flexion contracture of the hip and knee after poliomyelitis. South Med J. (1980) 73: 694-7. doi: 10.1097/00007611-198006000-00003 In these cases, the hips may develop a bending posture as a result of prolonged sitting, resulting in dysplasia, dislocation or ankylosis of the hips . So far, the literature has not directly investigated the effects of surgical treatment in relation to the relationship between hip and sagittal alignment of the spine in paraplegics caused by spinal cord injuries as well as polio.
However, higher incidences of residual soft tissue contractures in patients with failure to correct spinal deformity in SCI-related paraplegia were briefly mentioned. Moe (27) attributed the loss of surgical correction of scoliosis to the fact that initially not all severe contractures of the soft tissues of the lower limb were corrected. Mayfield et al. (10) observed that patients treated for lumbar hyperlordosis deformity were associated with secondary hip flexion contracture, and we believe that further reflection needs to be given as these contractures may be the primary pathology. Hwang et al. (14) reported uncorrected LL despite spinal surgery, and in our opinion, this could be due to untreated ITB contracture problems. At present, the literature is too scarce to draw significant conclusions about the association between hip and spine deformities related to SCI. Nevertheless, our study found a link between improvements in lordosis as a result of correction of hip deformities. Therefore, we believe that when planning surgical options for LM-related spinal deformities, special attention should be paid to each underlying hip pathology. 26.
Carreri G. A re-evaluation of the surgical treatment of severe contractures of the hip joints after poliomyelitis. Postgrad Med J. (1961) 37:201–6. doi: 10.1136/pgmj.37.426.201 Persistent hip flexion contracture developed in 13 (38%) of the 34 patients with achondroplasia after thigh lengthening. Eight (62%) of these 13 patients showed simultaneous limitation of knee flexion. Excessive thigh elongation (odds ratio [OR], 1.450; 95% confidence interval [CI] 1.064 to 1.975; p = 0.019) and forward inclination of the vertical sagittal axis (OR, 1.062; 95% CI 1.001 to 1.127; p = 0.047) contributed to sustained hip flexion contracture. 25. Hogshead HP, Ponseti IV.
Transfer of fascia lata to Eractor Spinae for the treatment of hip flexion-abdution contractures in patients with poliomyelitis and meningomyelele: evaluation of results. J Bone Joint Surg Am. (1964) 46: 1389-404. doi: 10.2106/00004623-196446070-00001 Hip flexion contracture in adult paraplegic patients is a relatively rare disease and a combined strategy of early preventive physiotherapy and local injections of Botox and tenotomy can avoid aggressive treatment in most cases. Physiotherapy is very important to prevent these complications, but if hip flexion is no longer reversible, extension exercises can even worsen lordosis due to the effect of iliopsoas. In addition, surgical treatment is aimed at maintaining the ability to sit or walk, avoid secondary skin ulcers and reduce lumbar hyperlordosis and pain. Many treatments have been suggested: tenotomy, myotomies, hip resection stents, hip and acetabular osteotomies, and total hip stents. Sometimes it is not easy to choose the right indication, and in the literature there is no clear evidence that can support the decision of surgeons [7-10]. Figure 1. Patient with hip flexion-abduction-external rotational contracture. (A) Compensatory increase in LL due to its hip contracture.
(B) Thomas test to examine the degree of actual hip flexion contracture. (C) Frog paw posture in the prone position to improve comfort and reduce the increase in lordosis. Flaccid paralysis after spinal cord injuries (CIS) can lead to various functional losses and progressive deformities of the spine and lower limbs. Inhibited muscle actions and the resulting muscle shortening cause myostatic contractures that, along with neuromuscular imbalances, gravitational loads and prolonged shortened malpositions, lead to joint deformities (1). In particular, when CIS occurs in adolescents, the challenges that arise are more problematic and different from those encountered in adulthood; A spike in abnormal stress and tension and rapid changes in the architecture of bones and joints weaken the child, and a vicious circle ensues (1-4). Keywords: spinal cord injury, paraplegics, hip flexion contracture, wood hyperlordosis, hip-spine syndrome The amount of preoperative elongation and AVS was significantly associated with sustained hip flexion contracture. Excessive thigh lengthening increased the risk of sustained hip flexion contracture (odds ratio [OR], 1.450; 95% confidence interval [CI] 1.064 to 1.975; p = 0.019). .
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