Houdek Matthew T, Watts Chad D, Wyles Cody C, Trousdale Robert T, Milbrandt Todd A, Taunton Michael J
1Department of Orthopedic Surgery, Mayo Medical School, Mayo Clinic, Rochester, Minnesota.
J Bone Joint Surg Am. 2017 Mar 15;99(6):488-493. doi: 10.2106/JBJS.16.00528.
The spasticity and increased muscle tone observed in patients with cerebral palsy can lead to hip degeneration, subluxation, and pain. Currently, there is hesitation to perform total hip arthroplasty in patients with cerebral palsy because of fears of early wear and dislocation. The purpose of this study was to review the outcomes of total hip arthroplasty in patients with cerebral palsy and to compare outcomes with those of matched patients with a diagnosis of osteoarthritis.
Over a 24-year period, 39 patients undergoing a total hip arthroplasty with a diagnosis of cerebral palsy were identified. The cohort included 26 male patients (67%), and the mean patient age was 49 years. The mean follow-up was 7 years. Patients with cerebral palsy were matched 1:2 with a group of patients undergoing total hip arthroplasty for osteoarthritis.
There was no difference in the rate of reoperation, implant survival, or complications, specifically dislocation. Prior to the surgical procedure, all patients had severe or moderate pain, and postoperatively no patient had moderate or severe pain. Twenty-three patients had an improvement in their ability to independently walk, and all preoperative hip flexion contractures were corrected (n = 9). There was also a significant improvement (p < 0.0001) in functional Harris hip scores.
This study refutes previous evidence showing increased risk of complications following total hip arthroplasty in patients with cerebral palsy. Total hip arthroplasty is a durable treatment option and provides clinically important pain relief and functional improvement in patients with cerebral palsy.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
脑瘫患者中观察到的痉挛和肌张力增加可导致髋关节退变、半脱位和疼痛。目前，由于担心早期磨损和脱位，对于脑瘫患者进行全髋关节置换术存在犹豫。本研究的目的是回顾脑瘫患者全髋关节置换术的结果，并将其与诊断为骨关节炎的匹配患者的结果进行比较。
在24年期间，确定了39例诊断为脑瘫并接受全髋关节置换术的患者。该队列包括26例男性患者（67%），患者平均年龄为49岁。平均随访时间为7年。将脑瘫患者与一组因骨关节炎接受全髋关节置换术的患者按1:2进行匹配。
再次手术率、植入物生存率或并发症，特别是脱位方面没有差异。在手术前，所有患者都有重度或中度疼痛，术后没有患者有中度或重度疼痛。23例患者独立行走能力有所改善，所有术前髋关节屈曲挛缩均得到纠正（n = 9）。功能Harris髋关节评分也有显著改善（p < 0.0001）。
本研究反驳了先前的证据，即脑瘫患者全髋关节置换术后并发症风险增加。全髋关节置换术是一种持久的治疗选择，并为脑瘫患者提供临床上重要的疼痛缓解和功能改善。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
