Al-Ghadir Muaz, Masquijo Julio Javier, Guerra Luis A, Willis Baxter
Department of Pediatric Orthopaedics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
J Pediatr Orthop. 2009 Oct-Nov;29(7):779-83. doi: 10.1097/BPO.0b013e3181b76968.
Although evidence is increasing that the most effective treatment for the severely subluxated or dislocated hips is a one-stage comprehensive approach there are few studies that compare the results with the traditional approach (varus derotational osteotomy, VDRO). The purpose of this study is to evaluate the clinical and radiologic outcome after one-stage reconstruction versus VDRO alone.
We retrospectively analyzed 52 hips in 39 consecutive patients with spastic cerebral palsy treated from January 1997 to January 2007. Group A (36 hips) was treated with a VDRO and San Diego osteotomy and group B (16 hips) with VDRO alone. Mean age was 8.1+/-3.6 years. Mean follow-up was 4.4 years. Evaluation was performed according to clinical criteria (hip range of motion, pain, and sitting comfort) and radiographic parameters [center-edge angle, acetabular index, neckshaft angle, and Reimer's Index (MI)].
There were no delayed unions, avascular necrosis of the femoral head, or postoperative infections in either group. There was significant decrease in pain and improvement of the center-edge angle and acetabular index in the combined approach. Of the patients who had VDRO alone 25% needed revision procedures and none of the combined group needed other procedures.
The clinical and radiologic results obtained by the one-stage procedure were far better than doing VDRO alone justifying a more extensive approach. Consideration should be given to performing the combined procedure in cerebral palsy patients with hip subluxation or dislocation.
尽管越来越多的证据表明，对于严重半脱位或脱位的髋关节，最有效的治疗方法是一期综合治疗，但很少有研究将其结果与传统方法（内翻旋转截骨术，VDRO）进行比较。本研究的目的是评估一期重建与单纯VDRO术后的临床和影像学结果。
我们回顾性分析了1997年1月至2007年1月期间连续治疗的39例痉挛性脑瘫患者的52个髋关节。A组（36个髋关节）采用VDRO和圣地亚哥截骨术治疗，B组（16个髋关节）仅采用VDRO治疗。平均年龄为8.1±3.6岁。平均随访时间为4.4年。根据临床标准（髋关节活动范围、疼痛和坐姿舒适度）和影像学参数[中心边缘角、髋臼指数、颈干角和赖默指数（MI）]进行评估。
两组均无延迟愈合、股骨头缺血性坏死或术后感染。联合治疗组疼痛明显减轻，中心边缘角和髋臼指数得到改善。仅接受VDRO治疗的患者中有25%需要翻修手术，而联合治疗组中无一例需要其他手术。
一期手术获得的临床和影像学结果远优于单纯VDRO，证明采用更广泛的方法是合理的。对于髋关节半脱位或脱位的脑瘫患者，应考虑采用联合手术。
