Canavese Federico, Marengo Lorenza, de Coulon Geraldo
Department of Pediatric Surgery, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
Department of Pediatric Orthopedic Surgery, University Hospital of Geneva, 6 Rue Willy Donzé, Geneva, 1205, Switzerland.
Eur J Orthop Surg Traumatol. 2017 May;27(4):513-519. doi: 10.1007/s00590-017-1902-3. Epub 2017 Jan 12.
This retrospective study evaluated mid-to-long-term outcome of a minimally invasive percutaneous pelvic osteotomy (PPO) approach combined with varus derotational shortening osteotomy (VDRSO) and soft tissue release in children with severe CP.
A retrospective review was performed of all patients presenting with a diagnosis of CP with hip subluxation or dislocation treated surgically by simultaneous soft tissue release, VDRSO, and PPO between 2002 and 2015. Eligible patients included those with a diagnosis of spastic quadriplegia or CP GMFCS level IV or V with unilateral or bilateral hip subluxation or dislocation and surgical treatment of the deformity by simultaneous soft tissue release, VDRSO and PPO. All anterior-posterior (AP) radiographs of the pelvis were reviewed and Reimers migration percentage (MP) and acetabular angle (AA) were measured.
In total, 54 children and adolescents (34 boys, 20 girls) with CP GMFCS level IV and V were treated during study period: 38 (70.4%) classified GMFCS level IV and 16 (29.6%) classified GMFCS level V. A total of 64 consecutive hips underwent simultaneous PPO associated with VDRSO. Overall, at the time of chart and radiograph review, mean age was 9.1 ± 3.3 years (range 4-16.5) and mean follow-up was 43.9 ± 19.5 months (range 3-72). Mean migration percentage improved from 66.8 ± 19.8% (range 33-100) preoperatively to 8.1 ± 16.5% (range 0-70) at last follow-up. Mean acetabular angle improved from 32.7° ± 7.1° (range 20-50) preoperatively to 14° ± 6.7° (range 0-27) at last follow-up. Only one case of bone graft dislodgment was observed. We did not observe any cases of avascular necrosis of the femoral head. All operated hips were pain free at the time of last follow-up.
PPO through a less invasive surgical approach offers a valuable alternative to standard techniques as it gives similar outcome but with less muscle stripping and less time in surgery.
III.
本回顾性研究评估了微创经皮骨盆截骨术（PPO）联合内翻旋转短缩截骨术（VDRSO）及软组织松解术治疗重度脑瘫患儿的中长期疗效。
对2002年至2015年间接受手术治疗的所有诊断为脑瘫合并髋关节半脱位或脱位的患者进行回顾性分析。入选患者包括诊断为痉挛性四肢瘫或脑瘫粗大运动功能分级系统（GMFCS）IV级或V级、伴有单侧或双侧髋关节半脱位或脱位，并通过同时进行软组织松解、VDRSO和PPO手术治疗畸形的患者。回顾了所有骨盆前后位（AP）X线片，测量Reimers移位百分比（MP）和髋臼角（AA）。
在研究期间共治疗了54例脑瘫GMFCS IV级和V级的儿童及青少年（34例男孩，20例女孩）：38例（70.4%）为GMFCS IV级，16例（29.6%）为GMFCS V级。共有64个髋关节同时接受了PPO联合VDRSO手术。总体而言，在病历和X线片复查时，平均年龄为9.1±3.3岁（范围4 - 16.5岁），平均随访时间为43.9±19.5个月（范围3 - 72个月）。平均移位百分比从术前的66.8±19.8%（范围33 - 100）改善至末次随访时的8.1±16.5%（范围0 - 70）。平均髋臼角从术前的32.7°±7.1°（范围20 - 50）改善至末次随访时的14°±6.7°（范围0 - 27）。仅观察到1例骨移植移位病例。未观察到股骨头缺血性坏死病例。所有接受手术的髋关节在末次随访时均无疼痛。
通过微创外科手术方法进行的PPO是标准技术的一种有价值的替代方法，因为它能提供相似的疗效，但肌肉剥离更少，手术时间更短。
III级。
