脑瘫患儿马蹄足畸形手术后的复发情况：一项长期随访研究中复发易感因素的评估
Recurrence after surgery for equinus foot deformity in children with cerebral palsy: assessment of predisposing factors for recurrence in a long-term follow-up study.
作者信息
Joo Sun Young, Knowtharapu Durga N, Rogers Kenneth J, Holmes Laurens, Miller Freeman
出版信息
J Child Orthop. 2011 Aug;5(4):289-96. doi: 10.1007/s11832-011-0352-4. Epub 2011 Jun 24.
BACKGROUND
Despite the large number of studies on the recurrence after surgery for equinus foot deformity in cerebral palsy (CP) patients, only a few investigations have reported long-term recurrence rates. Furthermore, little is known on the interval between the recurrent surgeries and the factors that lead to early recurrence. This study aimed to assess the overall recurrence after surgery for equinus foot deformity in patients with CP and to assess the factors associated with recurrence. We also aimed to determine the predisposing factors for early recurrence.
METHODS
The medical records of 186 patients (308 feet) were reviewed in order to determine the recurrence after surgery for equinus foot deformity. The type of CP, type of surgery, age at surgery, functional mobility, passive dorsiflexion of the ankle at the last follow-up visit, and subsequent treatment were recorded. Kaplan-Meier survival analysis was employed, with the end point defined as reoperation.
RESULTS
The mean age at surgery was 6.8 ± 2.5 years (range, 2.2-13.1). With the mean follow-up period of 11.3 years (range, 7.2-17.7), the overall recurrence rate was 43.8%. The recurrence rate was highest among patients with hemiplegia (62.5%). The Kaplan-Meier survival without repeat surgery estimate was shown to be 88.6% at 5 years and 59.6% at 10 years. Among children with hemiplegia and diplegia, the younger children (≤8 years of age) showed a higher rate of recurrence compared with the older children (P = 0.04 and P = 0.01, respectively). In 41 feet (30.4%), reoperations were performed within 5 years after the primary surgery. Early recurrence was most prevalent among children with hemiplegia (50.0%). In children with diplegia and quadriplegia, the younger children underwent the secondary operation later than the older children (P = 0.04 and P = 0.02, respectively).
CONCLUSION
Recurrence after surgery for equinus foot deformity is common and the age at surgery has a significant influence on recurrence. Recurrence can occur at any age while the child is still growing; therefore, it is advised to follow those patients until they reach skeletal maturity.
LEVEL OF EVIDENCE
Level III, therapeutic study.
背景
尽管针对脑瘫（CP）患者马蹄足畸形手术后复发情况的研究数量众多，但仅有少数研究报告了长期复发率。此外，关于复发手术之间的间隔时间以及导致早期复发的因素，人们了解甚少。本研究旨在评估CP患者马蹄足畸形手术后的总体复发情况，并评估与复发相关的因素。我们还旨在确定早期复发的诱发因素。
方法
回顾了186例患者（308只脚）的病历，以确定马蹄足畸形手术后的复发情况。记录了CP类型、手术类型、手术年龄、功能活动能力、最后一次随访时踝关节的被动背屈情况以及后续治疗。采用Kaplan-Meier生存分析，终点定义为再次手术。
结果
手术时的平均年龄为6.8±2.5岁（范围为2.2 - 13.1岁）。平均随访期为11.3年（范围为7.2 - 17.7年），总体复发率为43.8%。偏瘫患者的复发率最高（62.5%）。Kaplan-Meier生存分析显示，5年时无再次手术的估计生存率为88.6%，10年时为59.6%。在偏瘫和双瘫儿童中，年龄较小的儿童（≤8岁）与年龄较大的儿童相比，复发率更高（分别为P = 0.04和P = 0.01）。在41只脚（30.4%）中，初次手术后5年内进行了再次手术。早期复发在偏瘫儿童中最为普遍（50.0%）。在双瘫和四肢瘫儿童中，年龄较小的儿童比年龄较大的儿童接受二次手术的时间更晚（分别为P = 0.04和P = 0.02）。
结论
马蹄足畸形手术后复发很常见，手术年龄对复发有显著影响。复发可能在儿童仍在生长的任何年龄发生；因此，建议对这些患者进行随访，直至他们达到骨骼成熟。
证据水平
III级，治疗性研究。
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