Larsson Maria, Hägglund Gunnar, Wagner Philippe
Department of Orthopaedics, University Hospital, Lund University, 221 85 Lund, Sweden.
J Child Orthop. 2012 Jun;6(2):145-51. doi: 10.1007/s11832-012-0401-7. Epub 2012 Apr 26.
Varus osteotomy of the proximal femur (VOPF) is one treatment option to prevent hip dislocation in children with cerebral palsy (CP). It is questioned whether the osteotomy should be performed in the displaced hip only, or if it should be performed bilaterally to prevent later displacement of the contralateral hip. CPUP is a register and healthcare programme for children with CP that was initiated in 1994 in southern Sweden. In the programme, range-of-motion and radiographic examination of the hips is performed regularly. These data have been analysed preoperatively and for 5 years postoperatively in children treated with unilateral VOPF.
Children with CP living in the counties of Skåne and Blekinge in the south of Sweden, who were treated with unilateral VOPF at least 5 years ago, were included in the study. The degree of hip displacement and the range of hip motion were analysed preoperatively and after 5 years. Repeat hip operations after the index operation were recorded.
Twenty-four children fulfilled the inclusion criteria. Mean age at index operation was 7.6 (2.8-13.2) years. No child died within 5 years postoperatively, and no child was lost from follow-up. At follow-up after 5 years, 2 of the 24 children had been operated on with VOPF in the contralateral hip. The range of motion in both hips decreased, but the difference between the index hip and the contralateral hip did not change significantly.
Children with CP and unilateral hip displacement have a low risk of later contralateral displacement after being operated on with unilateral VOPF. This supports healthcare programmes that advocate unilateral VOPF in children with unilateral hip displacement.
股骨近端内翻截骨术（VOPF）是预防脑瘫（CP）患儿髋关节脱位的一种治疗选择。目前存在疑问的是，截骨术是否应仅在脱位的髋关节上进行，还是应双侧进行以防止对侧髋关节日后脱位。CPUP是一项针对CP患儿的登记和医疗保健计划，于1994年在瑞典南部启动。在该计划中，会定期对髋关节进行活动范围和影像学检查。已对接受单侧VOPF治疗的患儿术前及术后5年的这些数据进行了分析。
纳入至少在5年前接受单侧VOPF治疗、居住在瑞典南部斯科讷和布莱金厄郡的CP患儿。分析术前及5年后的髋关节脱位程度和髋关节活动范围。记录初次手术后的再次髋关节手术情况。
24名儿童符合纳入标准。初次手术时的平均年龄为7.6（2.8 - 13.2）岁。术后5年内无儿童死亡，且无儿童失访。5年后随访时，24名儿童中有2名对侧髋关节接受了VOPF手术。双髋的活动范围均减小，但患侧髋关节与对侧髋关节之间的差异无显著变化。
单侧髋关节脱位的CP患儿接受单侧VOPF手术后，对侧髋关节日后脱位的风险较低。这支持了在单侧髋关节脱位患儿中提倡单侧VOPF的医疗保健计划。
