脑瘫患儿行与不行股骨外旋截骨术的骨科手术疗效

Outcomes of Orthopaedic Surgery With and Without an External Femoral Derotational Osteotomy in Children With Cerebral Palsy.

作者信息

McMulkin Mark L, Gordon Andi B, Caskey Paul M, Tompkins Bryan J, Baird Glen O

机构信息

Walter E. Griffin & Agnes M. Griffin Motion Analysis Laboratory, Shriners Hospitals for Children-Spokane, Spokane, WA.

出版信息

J Pediatr Orthop. 2016 Jun;36(4):382-6. doi: 10.1097/BPO.0000000000000465.

DOI:10.1097/BPO.0000000000000465

PMID:25851681

Abstract

BACKGROUND

Ambulatory children with cerebral palsy (CP) often present with multiple deviations in all planes including increased internal hip rotation during gait. Excessive femoral anteversion is a common cause of deviation managed surgically with an external femoral derotational osteotomy (FDO). The purpose of this study was to evaluate the gait and functional outcomes of a group of subjects with CP who underwent surgical intervention that included an FDO compared with a match group with indications of internal hip rotation that did not receive an FDO.

METHODS

For this retrospective study, subjects were identified from the Motion Analysis Laboratory database that had orthopaedic surgery including an FDO (FDO group). A control group was established from a chart review identifying subjects that had indications for an FDO, but did not have this surgery (No-FDO group). All subjects had preoperative and postoperative gait studies. Subjects categorized as Gross Motor Function Classification System (GMFCS) levels I and II in both FDO and No-FDO groups were combined for analysis. Subjects rated as GMFCS level III were analyzed separately. Preoperative to postoperative kinematic and kinetic variables, Gait Deviation Index, net oxygen cost, and PODCI scores were analyzed with paired t tests.

RESULTS

Typical sagittal plane kinematic variables improved significantly by equivalent magnitudes for both FDO and No-FDO groups (GMFCS I/II and III). Transverse plane improvements were only seen for the FDO group (GMFCS I/II and III). The Gait Deviation Index, an overall index of kinematics, improved by a significantly greater amount for the FDO group across GMFCS levels I/II and III. Net oxygen cost improved for both FDO and No-FDO for GMFCS I/II. PODCI scores improved for FDO and No-FDO in GMFCS I/II, but only the FDO group for GMFCS III.

CONCLUSIONS

For children with CP, inclusion of an FDO in the surgical intervention, when indicated, resulted in improved outcomes. Overall gait kinematic improvements were significantly greater when an FDO was included in the surgical management.

LEVEL OF EVIDENCE

Level III-retrospective comparative study.

摘要

背景

患有脑瘫（CP）的非卧床儿童在所有平面上常表现出多种偏差，包括步态期间髋内旋增加。股骨前倾过大是导致偏差的常见原因，可通过股骨外旋截骨术（FDO）进行手术治疗。本研究的目的是评估一组接受包括FDO在内的手术干预的CP患者的步态和功能结局，并与一组有髋内旋指征但未接受FDO的匹配组进行比较。

方法

在这项回顾性研究中，从运动分析实验室数据库中识别出接受过包括FDO在内的骨科手术的受试者（FDO组）。通过病历审查建立对照组，识别出有FDO指征但未进行该手术的受试者（非FDO组）。所有受试者均进行了术前和术后步态研究。将FDO组和非FDO组中分类为粗大运动功能分类系统（GMFCS）I级和II级的受试者合并进行分析。GMFCS III级的受试者单独进行分析。术前至术后的运动学和动力学变量、步态偏差指数、净氧耗和PODCI评分采用配对t检验进行分析。

结果

FDO组和非FDO组（GMFCS I/II和III）的典型矢状面运动学变量均有显著且相当程度的改善。仅FDO组（GMFCS I/II和III）在横断面有改善。步态偏差指数作为运动学的总体指标，在GMFCS I/II和III各水平上，FDO组改善程度明显更大。GMFCS I/II的FDO组和非FDO组净氧耗均有所改善。GMFCS I/II的FDO组和非FDO组PODCI评分均有改善，但GMFCS III级仅FDO组有改善。