骨髓发育不良和脑瘫儿童配对队列中的胫骨旋转截骨术

Stasikelis Peter J, Creek Aaron T, Wack Linda I

Shriners Hospitals for Children, Greenville, SC.

J Pediatr Orthop. 2018 Sep;38(8):440-442. doi: 10.1097/BPO.0000000000000888.

BACKGROUND

The purpose of this study is to examine the frequency of complications in children with myelodysplasia (MD) undergoing tibial rotational osteotomies with a matched cohort of children with cerebral palsy (CP). It was postulated that because of the unique health issues facing children with MD more complications would be observed.

METHODS

A retrospective chart review was performed to identify children with MD who underwent primary tibial rotational osteotomy between 1997 and 2012 and had a minimum 2-year follow-up. The 15 children thus identified were matched for age, body mass index, and functional ability with 15 children with CP. Outcome measures were complications that occurred within a year of osteotomy or hardware removal. Major complications were defined as nonunions or malunions, hardware failures, deep infections, fractures, and stage III or IV decubiti. Recurrence of rotational deformity requiring revision osteotomy at any time was also defined as a major complication. Minor wound problems healing within 6 weeks with only local care were considered minor complications.

RESULTS

Fifteen children with MD, who underwent 21 tibial derotational osteotomies, were available for review with a mean 7-year follow-up. The 15 children with CP underwent 22 tibial derotational osteotomies with a mean of 6 years of follow-up. In each cohort there were 3 children classified as GMFCS I, 3 children as GMFCS II, 4 children as GMFCS III, and 5 as GMFCS IV. Three (20%) of the children with MD experienced major complications (1 infected nonunion and 2 children who experienced bilateral malunions requiring revisions). One child with a major complication was classified as GMFCS II and the other 2 as GMFCS IV. None of the children with CP experienced a major complication.

CONCLUSIONS

The majority of children in both groups experienced good results, but children with MD have more frequent major complications. More frequent complications were seen in children with less functional ability.

LEVEL OF EVIDENCE

Level III-prognostic study, case-control study.

背景

本研究的目的是通过与一组相匹配的脑瘫（CP）患儿对比，研究脊髓发育不良（MD）患儿在接受胫骨旋转截骨术时并发症的发生频率。据推测，由于MD患儿面临独特的健康问题，将会观察到更多的并发症。

方法

进行一项回顾性病历审查，以确定在1997年至2012年间接受初次胫骨旋转截骨术且至少有2年随访期的MD患儿。最终确定的15例MD患儿在年龄、体重指数和功能能力方面与15例CP患儿相匹配。观察指标为截骨术或取出内固定装置后一年内发生的并发症。主要并发症定义为骨不连或畸形愈合、内固定失败、深部感染、骨折以及III期或IV期压疮。任何时候需要再次截骨术的旋转畸形复发也定义为主要并发症。仅通过局部护理在6周内愈合的轻微伤口问题被视为轻微并发症。

结果

15例MD患儿接受了21次胫骨去旋转截骨术，可进行回顾性分析，平均随访7年。15例CP患儿接受了22次胫骨去旋转截骨术，平均随访6年。每个队列中，有3例患儿被分类为粗大运动功能分级系统（GMFCS）I级，3例为GMFCS II级，4例为GMFCS III级，5例为GMFCS IV级。3例（20%）MD患儿发生了主要并发症（1例感染性骨不连和2例双侧畸形愈合需要再次手术的患儿）。1例发生主要并发症的患儿被分类为GMFCS II级，另外2例为GMFCS IV级。CP患儿中无一例发生主要并发症。