Boyer Elizabeth, Novacheck Tom F, Rozumalski Adam, Schwartz Michael H
Gillette Children's Specialty Healthcare, Center for Gait and Motion Analysis, St. Paul, USA.
Gillette Children's Specialty Healthcare, Center for Gait and Motion Analysis, St. Paul, USA; University of Minnesota, Department of Orthopaedic Surgery, Minneapolis, USA.
Gait Posture. 2016 Oct;50:223-228. doi: 10.1016/j.gaitpost.2016.09.004. Epub 2016 Sep 8.
Excessive femoral anteversion is common in cerebral palsy (CP), is often associated with internal hip rotation during gait, and is frequently treated with a femoral derotational osteotomy (FDO). Concerns exist regarding long-term maintenance of surgical outcomes. Past studies report varying rates of recurrence, but none have employed a control group.
We conducted a retrospective analysis examining long-term (∼5 years) changes in anteversion and hip rotation following FDO in children with CP. We included a control group that was matched for age and exhibited excessive anteversion (>30°) but did not undergo an FDO. Anteversion, mean stance hip rotation, and rates of problematic remodeling and recurrence were assessed (>15° change and final level outside of normal limits).
The control group was reasonably well matched, but exhibited 9° less anteversion and 3° less internal hip rotation at the pre time point. At a five year follow-up, the FDO group had less anteversion than the control group (20° vs. 35°, p<0.05). The mean stance phase hip rotation did not differ between the groups (4° vs. 5°, p=0.17). Over one third of limbs remained excessively internal in both groups (FDO: 34%, Control: 37%). Rates of problematic recurrence and remodeling were low (0%-11%).
An FDO is an effective way to correct anteversion in children with CP. Long-term hip rotation is not fully corrected by the procedure, and is not superior to a reasonably well matched control group. Rates of problematic recurrence and remodeling are low, and do not differ between the groups.
股骨前倾过大在脑瘫（CP）中很常见，常与步态中髋关节内旋有关，且常采用股骨旋转截骨术（FDO）进行治疗。人们对手术效果的长期维持存在担忧。过去的研究报告了不同的复发率，但均未设立对照组。
我们进行了一项回顾性分析，研究CP患儿接受FDO后前倾和髋关节旋转的长期（约5年）变化。我们纳入了一个对照组，该组年龄匹配且存在前倾过大（>30°）但未接受FDO。评估了前倾、平均站立期髋关节旋转以及问题性重塑和复发率（变化>15°且最终水平超出正常范围）。
对照组匹配良好，但在术前时间点前倾少9°，髋关节内旋少3°。在五年随访时，FDO组的前倾小于对照组（20°对35°，p<0.05）。两组间平均站立相髋关节旋转无差异（4°对5°，p=0.17）。两组中超过三分之一的肢体仍过度内旋（FDO组：34%，对照组：37%）。问题性复发和重塑率较低（0%-11%）。
FDO是纠正CP患儿前倾的有效方法。该手术不能完全纠正长期的髋关节旋转问题，且并不优于匹配良好的对照组。问题性复发和重塑率较低，两组间无差异。
