Church Chris, Lennon Nancy, Pineault Kevin, Abousamra Oussama, Niiler Tim, Henley John, Dabney Kirk, Miller Freeman
Gait Laboratory, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
J Pediatr Orthop. 2017 Oct/Nov;37(7):447-453. doi: 10.1097/BPO.0000000000000701.
Excessive hip internal rotation is frequently seen in children with cerebral palsy (CP). Femoral derotational osteotomy (FDO) is effective in the short term, but factors associated with long-term correction remain unclear. The purposes of this study were to define the incidence of persistence and recurrence of hip internal rotation following FDO in ambulatory children with CP and to evaluate factors that influence outcome.
Following IRB approval, kinematic and passive range of motion (PROM) variables were retrospectively evaluated in children with spastic CP who had FDO to correct hip internal rotation as part of clinical care at a children's specialty hospital. Children included had a preoperative evaluation (Vpre), a short-term postoperative evaluation (Vshort, 1 to 3 y post), and, in some cases, a long-term postoperative evaluation (Vlong, ≥5 y post). Age at surgery, physical exam measures, and kinematics variables were evaluated as predictors for dynamic and static recurrence.
Kinematic hip rotation improved from 14±12 degrees (Vpre; internal positive) to 4±13 degrees (Vshort) and relapsed to 9±15 degrees long term (P<0.05 Vpre/Vshort/Vlong; 99 limbs). Hip PROM midpoint improved from 23±9 degrees (Vpre) to 8±11 degrees (Vshort) and relapsed to 14±13 degrees (P<0.01 Vpre/Vshort/Vlong). Persistent hip internal rotation was noted in 41% (kinematics) and 18% (PROM) of limbs at Vshort (105 children, 178 limbs). Of limbs that showed initial improvement at Vshort (62 children, 95 limbs), recurrence was seen in 40% (kinematic hip rotation) and 39% (hip midpoint) at Vlong. Comparing children who had recurrent hip internal rotation and those who maintained long-term correction, we saw higher levels of spasticity and lower gait velocity in the recurrent group (P<0.05).
Although FDO is an accepted treatment in children with CP, persistence and recurrence of hip internal rotation can occur. Recurrence is associated with spasticity and slower gait velocity. Predictor variables may be useful for surgeons during preoperative discussions of expected outcome with families of FDO candidates.
Level III.
脑性瘫痪（CP）患儿常出现髋关节内旋过度。股骨去旋转截骨术（FDO）在短期内有效，但与长期矫正相关的因素仍不清楚。本研究的目的是确定能行走的CP患儿FDO术后髋关节内旋持续存在和复发的发生率，并评估影响预后的因素。
经机构审查委员会（IRB）批准，对在一家儿童专科医院接受FDO以矫正髋关节内旋作为临床治疗一部分的痉挛型CP患儿的运动学和被动活动范围（PROM）变量进行回顾性评估。纳入的患儿进行了术前评估（Vpre）、术后短期评估（Vshort，术后1至3年），部分患儿还进行了术后长期评估（Vlong，术后≥5年）。将手术年龄、体格检查指标和运动学变量作为动态和静态复发的预测因素进行评估。
髋关节运动学内旋角度从术前的14±12度（Vpre；内旋为正）改善到术后短期的4±13度（Vshort），长期复发至9±15度（Vpre/Vshort/Vlong比较，P<0.05；99条肢体）。髋关节PROM中点角度从术前的23±9度（Vpre）改善到术后短期的8±11度（Vshort），长期复发至14±13度（Vpre/Vshort/Vlong比较，P<0.01）。术后短期时，41%（运动学）和18%（PROM）的肢体存在持续性髋关节内旋（105名患儿，178条肢体）。在术后短期显示出初始改善的肢体中（62名患儿，95条肢体），术后长期时，40%（髋关节运动学内旋）和39%（髋关节中点）出现复发。比较髋关节内旋复发的患儿和维持长期矫正的患儿，我们发现复发组的痉挛程度更高，步态速度更低（P<0.05）。
尽管FDO是CP患儿公认的治疗方法，但髋关节内旋仍可能持续存在和复发。复发与痉挛和较慢的步态速度有关。预测变量可能有助于外科医生在术前与FDO候选患儿家属讨论预期结果时使用。
三级。
