[Bilateral ankylosing paraarticular ossifications of the hip joint with involvement of the sciatic nerve].
In December 1997 a 48 year-old man was treated by resection of the bilateral paraarticular ankylosing ossifications that developed after 6 weeks of unconsciousness after necrotic pancreatitis. The ossifications on the posterior part of the hip joint involved a highly separated sciatic nerve. There was a bilateral osseous ankylosis of the hip joint and total denervation of sciatic nerve. In April 1999 the ossifications on the right side were removed. The splitted sciatic nerve was in two osseous channels. The head of the femur was vital and immediately following the operation, flexion of the hip joint was possible to 90 degrees. The same procedure was performed on the left hip joint in October 1999. In April 2000, a re-occurance of the paraarticular ossification on the ventral part of the right hip joint was removed from an ilioinquinal approach. In June 2002 the patient was able to stand and walk without crutches. ROM of the knee joints improved bilaterally to 120 degrees of flexion. The flexion of the right hip joint is 70 degrees and in the left hip is 80 degrees. 3 years after decompression of both sciatic nerves involved in heterotopic bone established significant reinervation. The motor function of the proximal femoral muscles and the function of the tibial nerve was renewed. Complete motor denervation syndrom persists in common peroneal nerve. Sensitive inervation was renewed as in n. tibialis as in common peroneal nerve except acral parts of the foot a toes. Concerning function of the sciatic nerves, the overall results can be assessed as partially succesfull because of partial denervation syndrome of sciatic nerves. In definite clinical improvement the recovery of the neurologic status is very important besides the mechanical improvement of range of motion of the hip joint.
Stĕdrý
V
V
Ortopedická klinika IPVZ a 1. LF UK, Praha.
Zvĕrina
E
E
Chomiak
J
J
D000844:Ankylosis / Q000150:complications / Q000601:surgery*; D003128:Coma / Q000150:complications; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications / Q000601:surgery*; D009999:Ossification, Heterotopic / Q000150:complications / Q000601:surgery*; D011859:Radiography; D020127:Recovery of Function; D020426:Sciatic Neuropathy / Q000150:complications / Q000601:surgery*