Koch A, Jozwiak M, Idzior M, Molinska-Glura M, Szulc A
University of Medical Sciences, ul. 28 czerwca 1956r 135/147 61-545 Poznan, Poland.
Poznan University of Medical Sciences, ul. Dąbrowskiego 79 (second floor), 60-529 Poznan, Poland.
Bone Joint J. 2015 Feb;97-B(2):270-6. doi: 10.1302/0301-620X.97B2.34280.
We investigated the incidence and risk factors for the development of avascular necrosis (AVN) of the femoral head in the course of treatment of children with cerebral palsy (CP) and dislocation of the hip. All underwent open reduction, proximal femoral and Dega pelvic osteotomy. The inclusion criteria were: a predominantly spastic form of CP, dislocation of the hip (migration percentage, MP > 80%), Gross Motor Function Classification System, (GMFCS) grade IV to V, a primary surgical procedure and follow-up of > one year. There were 81 consecutive children (40 girls and 41 boys) in the study. Their mean age was nine years (3.5 to 13.8) and mean follow-up was 5.5 years (1.6 to 15.1). Radiological evaluation included measurement of the MP, the acetabular index (AI), the epiphyseal shaft angle (ESA) and the pelvic femoral angle (PFA). The presence and grade of AVN were assessed radiologically according to the Kruczynski classification. Signs of AVN (grades I to V) were seen in 79 hips (68.7%). A total of 23 hips (18%) were classified between grades III and V. Although open reduction of the hip combined with femoral and Dega osteotomy is an effective form of treatment for children with CP and dislocation of the hip, there were signs of avascular necrosis in about two-thirds of the children. There was a strong correlation between post-operative pain and the severity of the grade of AVN.
我们调查了脑瘫（CP）合并髋关节脱位患儿在治疗过程中股骨头缺血性坏死（AVN）的发生率及危险因素。所有患儿均接受了切开复位、股骨近端及Dega骨盆截骨术。纳入标准为：以痉挛型CP为主，髋关节脱位（移位百分比，MP>80%），粗大运动功能分级系统（GMFCS）IV至V级，初次手术且随访时间>1年。本研究连续纳入81例患儿（40例女孩和41例男孩）。他们的平均年龄为9岁（3.5至13.8岁），平均随访时间为5.5年（1.6至15.1年）。影像学评估包括测量MP、髋臼指数（AI）、骨骺干角（ESA）和骨盆股骨角（PFA）。根据Kruczynski分类法对AVN的存在情况及分级进行影像学评估。79个髋关节（68.7%）出现了AVN的体征（I至V级）。共有23个髋关节（18%）被归类为III至V级。尽管髋关节切开复位联合股骨和Dega截骨术是治疗CP合并髋关节脱位患儿的一种有效治疗方式，但约三分之二的患儿出现了缺血性坏死的体征。术后疼痛与AVN分级的严重程度之间存在密切相关性。
