Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. Within the medical community, there is controversy surrounding AMC in terms of the ideal surgical approach and age for performing a reduction of dislocated hips. The purpose of this retrospective study was to evaluate the clinical outcomes of early open reduction of infant hip dislocation with arthrogryposis multiplex congenita following a modified Smith-Petersen approach that preserves the rectus femoris. From 2010 to 2017, we performed this procedure on 28 dislocated hips in 20 infants under 12 months of age with AMC. The clinical and radiology data were reviewed retrospectively. The mean age at surgery was 6.9 ± 5.1 months, with a mean follow-up of 42.4 ± 41.1 months. After open reduction, the average hip acetabular index (AI), the international hip dysplasia institute classification (IHDI), and the hip range of motion significantly improved (all P < 0.001). After the surgery, 16 patients were community walkers, and four patients were home walkers. Three hips in two patients required secondary revision surgery for residual acetabular dysplasia with combined pelvic osteotomy and femoral osteotomy. Seven of the hips that had been operated on showed signs of avascular necrosis (AVN). Among them, four were degree II, two were degree III, and one was degree IV. Multiple linear regression analysis demonstrated that greater age (in months) heightened the risk for secondary revision surgery (P = 0.032). The modified Smith-Petersen approach preserving the rectus femoris is an encouraging and safe option for treating hip dislocation in young AMC patients (before 12 months). If surgery takes place at less than 12 months of age for patients with AMC, this earlier open reduction for hip dislocation may reduce the chances of secondary revision surgery. IV, retrospective non-randomized study.

中文翻译：

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使用改良的Smith-Petersen方法在多发性先天性关节炎中早期开放复位髋关节脱位

多发性先天性关节炎（AMC）是一种罕见的多关节挛缩症候群。在医学界内，围绕AMC的争议在于理想的手术方法和年龄，以减少髋关节脱位。这项回顾性研究的目的是评估经过改良的保留股直肌的史密斯-彼得森方法后，早期开放复位合并多发性先天性关节炎的婴儿髋关节脱位的临床疗效。从2010年至2017年，我们对20例12个月以下的AMC婴儿的28例髋关节脱位进行了此手术。对临床和放射学资料进行回顾性回顾。手术的平均年龄为6.9±5.1个月，平均随访时间为42.4±41.1个月。切开复位后，平均髋臼指数（AI）根据国际髋关节发育不良学会分类（IHDI），髋关节的运动范围明显改善（所有P <0.001）。手术后，有16名患者是社区步行者，有4名患者是家庭步行者。两名患者的三个髋部需要进行二次翻修手术，以治疗残留的髋臼发育不良并合并骨盆截骨术和股骨截骨术。接受过手术的髋关节中有七个显示出无血管坏死（AVN）的迹象。其中，二是四级，二是三级，一是四级。多元线性回归分析表明，较大的年龄（以月为单位）增加了二次翻修手术的风险（P = 0.032）。改良的史密斯-彼得森方法保留股直肌是治疗年轻AMC患者（12个月前）髋关节脱位的令人鼓舞和安全的选择。如果AMC患者的手术年龄小于12个月，则这种较早的髋关节脱位复位术可能会减少二次翻修手术的机会。四，回顾性非随机研究。