Morin C, Ursu C, Delecourt C
Institut Calot, Rue du Dr Calot, 62600 Berck sur Mer, France.
Institut Calot, Rue du Dr Calot, 62600 Berck sur Mer, France.
Orthop Traumatol Surg Res. 2016 Nov;102(7):845-849. doi: 10.1016/j.otsr.2016.07.010. Epub 2016 Sep 30.
The everyday life of a non-ambulatory adolescent or young adult with cerebral palsy can be severely impaired by a painful or stiff hip. The usual surgical solutions such as proximal femoral resection (PFR) are not entirely satisfactory for pain relief, and are mutilating.
A retrospective study assessed the impact of total hip replacement (THR) on such impairment, on the hypothesis that it is more effective than PFR in relieving pain, without aggravating disability.
The surgical technique consisted in implanting a dual-mobility prosthesis with uncemented acetabular component and cemented femur, after upper femoral shaft shortening and short hip-spica cast immobilization. Forty THRs were performed in 33 patients, including 31 with multiple disability. Follow-up assessment focused on change in functional status, pain, and range of motion.
Mean follow-up was 5 years. Pain was more or less entirely resolved. Improvement in range of motion was less striking, and there was no significant change in functional status. There were 2 general, 2 septic and 10 mechanical complications, 6 of which required surgical revision.
In non-ambulatory cerebral palsy, THR provided much better alleviation of pain than found with PFR treatment. It should be reserved for patients able to withstand fairly long surgery and with femur size compatible with implantation of a femoral component, however small.
IV, retrospective study.
患有脑瘫的非行走青少年或青年的日常生活可能会因髋关节疼痛或僵硬而严重受损。诸如股骨近端切除术（PFR）等常规手术解决方案在缓解疼痛方面并不完全令人满意，而且具有致残性。
一项回顾性研究评估了全髋关节置换术（THR）对这种损伤的影响，其假设是该手术在缓解疼痛方面比PFR更有效，且不会加重残疾。
手术技术包括在股骨上段缩短和短髋人字石膏固定后，植入带有非骨水泥髋臼组件和骨水泥股骨的双动式假体。对33例患者进行了40次全髋关节置换术，其中31例患有多种残疾。随访评估重点关注功能状态、疼痛和活动范围的变化。
平均随访时间为5年。疼痛或多或少完全得到缓解。活动范围的改善不太明显，功能状态没有显著变化。有2例全身并发症、2例感染性并发症和10例机械性并发症，其中6例需要手术翻修。
在非行走型脑瘫患者中，全髋关节置换术在缓解疼痛方面比股骨近端切除术治疗效果好得多。然而，该手术应仅适用于能够耐受较长手术时间且股骨尺寸与股骨组件植入相匹配（无论多小）的患者。
IV级，回顾性研究。
