Gillette Children's Specialty Healthcare, USA; University of Minnesota - Twin Cities, Department of Orthopaedic Surgery, USA.
Gillette Children's Specialty Healthcare, USA.
Gait Posture. 2014 Feb;39(2):778-83. doi: 10.1016/j.gaitpost.2013.10.016. Epub 2013 Oct 27.
Excessive femoral anteversion is common among children with cerebral palsy, and is, frequently treated by a femoral derotational osteotomy (FDO). It is important to understand surgical, indications for FDO, and the impact of these indications on the treatment outcomes. The Random Forest algorithm was used to objectively identify historical surgical indications in a large retrospective, cohort of 1088 limbs that had previously undergone single-event multi-level surgery. Treatment, outcome was based on transverse plane kinematics obtained from three-dimensional gait analysis. The, classifier effectively identified the historic indications (accuracy = .85, sensitivity = .93, specificity = .69, positive predictive value = .86, negative predictive value = .82), and naturally divided limbs into four, clusters: two homogeneous +FDO clusters (with/without significant internal hip rotation during gait), one homogeneous -FDO cluster, and a mixed cluster. Concomitant surgeries were similar among the, clusters. Limbs with excessive anteversion and internal hip rotation during gait had excellent outcomes, in the transverse plane. Limbs with excessive anteversion but only mild internal hip rotation had good, outcomes at the hip level; but a significant number of these limbs ended up with an excessive external, foot progression angle. The Random Forest algorithm was highly effective for identifying and, organizing historic surgical indications. The derived criteria can be used to give surgical decision making, guidance in a majority of limbs. The results suggest that limbs with anteversion and significant, internal hip rotation during gait benefit from an FDO, but limbs with excessive anteversion and only, mild internal hip rotation are at risk of developing an excessive external foot progression angle.
股骨过度前倾角在脑瘫儿童中很常见，通常通过股骨旋转截骨术（FDO）来治疗。了解 FDO 的手术适应证及其对治疗结果的影响非常重要。我们使用随机森林算法客观地识别了先前接受过单次多节段手术的 1088 例肢体的大型回顾性队列中的历史手术适应证。治疗结果基于三维步态分析获得的矢状面运动学。该分类器有效地识别了历史适应证（准确性=0.85，敏感性=0.93，特异性=0.69，阳性预测值=0.86，阴性预测值=0.82），并自然地将肢体分为四个聚类：两个同质的+FDO 聚类（步态时存在/不存在显著的内髋旋转），一个同质的-FDO 聚类和一个混合聚类。聚类之间的伴随手术相似。在矢状面，步态时存在过度前倾角和内髋旋转的肢体具有极好的结果。在髋关节水平，具有过度前倾角但仅存在轻度内髋旋转的肢体具有良好的结果；但这些肢体中有相当一部分最终出现了过度的外足行进角。随机森林算法非常有效地识别和组织了历史手术适应证。得出的标准可用于指导大多数肢体的手术决策。结果表明，步态时存在前倾角和显著内髋旋转的肢体受益于 FDO，但存在过度前倾角和仅轻度内髋旋转的肢体存在发展为过度外足行进角的风险。
