Sung Ki Hyuk, Kwon Soon-Sun, Chung Chin Youb, Lee Kyoung Min, Kim Jaeyoung, Lee Seung Yeol, Park Moon Seok
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Korea.
Department of Mathematics, College of Natural Sciences, Ajou University, Suwon, Gyeonggi, Korea.
BMC Musculoskelet Disord. 2018 Apr 27;19(1):130. doi: 10.1186/s12891-018-2049-z.
Concurrent prophylactic femoral varization osteotomy (FVO) for stable hips has been performed in patients with cerebral palsy (CP) undergoing hip reconstructive surgery for the contralateral displaced hip. However, there is currently a lack of studies investigating the outcome after the prophylactic FVO in stable hip. This study investigated the outcomes after FVO in stable hips with CP and influencing factors. In addition, this study compared the outcomes with those after hip reconstructive surgery in the contralateral displaced hip.
This study included 119 CP patients with 224 hips (80 stable, 144 displaced) undergoing hip reconstructive surgery including FVO. Migration percentage (MP), neck-shaft angle (NSA), and head-shaft angle (HSA) were measured through preoperative and follow-up hip radiographs. All hips were divided into the stable (MP ≤ 33%) and displaced hip groups (MP > 33%) according to the preoperative radiographs, and the annual changes in the radiographic indices after FVO were analyzed.
In stable hip group, MP did not significantly increase over time (p = 0.057) after prophylactic FVO. In displaced hip group, MP significantly increased over time (1.6%/year, p < 0.001). MP was significantly decreased in cases of concomitant Dega pelvic osteotomy in both stable (14.5%, p < 0.001) and displaced hips (18.9%, p < 0.001).
Prophylactic FVO in the stable hip in patients with CP showed good surgical outcomes, without a risk of hip displacement throughout the follow-up duration, while hip reconstructive surgery in the displaced hip was associated with a risk of increased hip displacement.
对于因对侧髋关节脱位而接受髋关节重建手术的脑瘫（CP）患者，已开展了同期预防性股骨内翻截骨术（FVO）以治疗稳定的髋关节。然而，目前缺乏关于预防性FVO治疗稳定髋关节后疗效的研究。本研究调查了CP患者稳定髋关节行FVO后的疗效及影响因素。此外，本研究还将这些疗效与对侧脱位髋关节行髋关节重建手术后的疗效进行了比较。
本研究纳入了119例接受包括FVO在内的髋关节重建手术的CP患者，共224个髋关节（80个稳定髋关节，144个脱位髋关节）。通过术前和随访时的髋关节X线片测量移位百分比（MP）、颈干角（NSA）和头干角（HSA）。根据术前X线片将所有髋关节分为稳定髋关节组（MP≤33%）和脱位髋关节组（MP>33%），并分析FVO后影像学指标的年度变化。
在稳定髋关节组，预防性FVO后MP随时间未显著增加（p = 0.057）。在脱位髋关节组，MP随时间显著增加（每年1.6%，p < 0.001）。在稳定髋关节（14.5%，p < 0.001）和脱位髋关节（18.9%，p < 0.001）中，同期行Dega骨盆截骨术的病例MP均显著降低。
CP患者稳定髋关节的预防性FVO显示出良好的手术效果，在整个随访期间无髋关节脱位风险，而脱位髋关节的髋关节重建手术则有髋关节脱位增加的风险。
