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软组织松解术治疗脑瘫患儿痉挛性髋关节半脱位

Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy.

作者信息

Presedo Ana, Oh Chang-Wug, Dabney Kirk W, Miller Freeman

机构信息

Department of Orthopaedics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, 1600 Rockland Road, Wilmington, DE 19803, USA.

出版信息

J Bone Joint Surg Am. 2005 Apr;87(4):832-41. doi: 10.2106/JBJS.C.01099.

Abstract

BACKGROUND

Spastic hip subluxation and dislocation are common problems in children with cerebral palsy. Soft-tissue releases have proved to be beneficial in the prevention of spastic hip dislocation. A protocol for treatment based on patient age, hip abduction, and hip migration percentage was established in 1988. The purpose of this study was to assess the outcome in sixty-five children treated according to this protocol and followed for a minimum of eight years.

METHODS

The medical records and radiographs of sixty-five children, from an original series of seventy-four patients, who met the inclusion criteria were available for review. Forty-seven children had spastic quadriplegia and were unable to walk; eighteen children had spastic diplegia and were able to walk independently or with assistive devices. The mean age at the time of the surgery was 4.4 years. Open adductor tenotomy and psoas muscle recession or iliopsoas tenotomy were performed on 129 hips, which were followed for a mean of 10.8 years. The mean age at the time of follow-up was fifteen years. Hips were grouped according to the hip migration percentage preoperatively, at one year postoperatively, and at the time of final follow-up. The final outcome for the patient was defined according to the worse hip. An analysis was performed to identify potential factors influencing outcome.

RESULTS

Thirty-two patients (49%) had a good result, eleven (17%) had a fair result, three (4%) had a poor result, and nineteen (30%) had a failure. The mean hip migration percentage was 34% preoperatively and 18% at the time of final follow-up. Nineteen patients required subsequent osseous reconstructive procedures, and eleven required repeat soft-tissue releases. The migration percentage at one year postoperatively was the most predictive of the final outcome (p = 0.001). Patients who had been able to walk preoperatively had a better long-term outcome (p = 0.01). Neither the preoperative hip migration percentage nor the age at surgery significantly affected the outcome.

CONCLUSIONS

Soft-tissue release was effective for long-term prevention of hip dislocation in 67% (forty-three) of sixty-five children with spastic hip subluxation. Two preoperative factors that were related to a favorable outcome were a spastic diplegic pattern of involvement and the ability to walk. The hip migration percentage at one year postoperatively was a good predictor of final outcome.

摘要

背景

痉挛性髋关节半脱位和脱位是脑瘫患儿的常见问题。软组织松解已被证明对预防痉挛性髋关节脱位有益。1988年制定了一项基于患者年龄、髋关节外展和髋关节移位百分比的治疗方案。本研究的目的是评估按照该方案治疗并随访至少8年的65例患儿的治疗效果。

方法

从最初的74例患者中筛选出符合纳入标准的65例患儿的病历和X光片进行回顾性分析。47例患儿为痉挛性四肢瘫,无法行走;18例患儿为痉挛性双瘫,能够独立行走或借助辅助器械行走。手术时的平均年龄为4.4岁。对129个髋关节进行了开放性内收肌切断术和腰大肌后移术或髂腰肌切断术,平均随访10.8年。随访时的平均年龄为15岁。根据术前、术后1年和最终随访时的髋关节移位百分比对髋关节进行分组。根据最差的髋关节确定患者的最终治疗效果。进行分析以确定影响治疗效果的潜在因素。

结果

32例患者(49%)治疗效果良好,11例(17%)效果尚可,3例(4%)效果较差,19例(30%)治疗失败。术前平均髋关节移位百分比为34%,最终随访时为18%。19例患者需要后续的骨性重建手术,11例需要重复软组织松解术。术后1年的移位百分比对最终治疗效果的预测性最强(p = 0.001)。术前能够行走的患者长期治疗效果更好(p = 0.01)。术前髋关节移位百分比和手术年龄均未显著影响治疗效果。

结论

软组织松解对65例痉挛性髋关节半脱位患儿中的67%(43例)长期预防髋关节脱位有效。与良好治疗效果相关的两个术前因素是痉挛性双瘫受累模式和行走能力。术后1年的髋关节移位百分比是最终治疗效果的良好预测指标。

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