Blumetti Francesco C, Wu Jenny Chia Ning, Barzi Federica, Axt Matthias W, Waugh Mary-Clare, Selber Paulo
Orthopaedic Department.
Kids Research Institute.
J Pediatr Orthop. 2019 Apr;39(4):209-216. doi: 10.1097/BPO.0000000000000919.
Outcomes after orthopaedic interventions in patients with dystonic cerebral palsy (DCP) are historically regarded as unpredictable. This study aims to evaluate the overall outcome of orthopaedic surgery in children with DCP.
Children with DCP who underwent lower limb orthopaedic surgery with a minimum follow-up of 12 months were included. Data collected included age at time of surgery, surgical procedures performed, Gross Motor Function Classification System (GMFCS) level, and Barry Albright Dystonia Scale (BADS) score. The cohort was divided into 2 groups. Group 1 (GMFCS levels I to III), mean age 12 years 7 months and group 2 (GMFCS levels IV to V), mean age 10 years 7 months. Group 1 had surgery aimed at deformity correction to improve gait and mobility, and group 2 for the management or prevention of hip displacement. Outcome measures analyzed were: the incidence of unpredictable results related to surgery and early recurrence of deformity in both groups. Functional mobility scale scores were evaluated for group 1 and hip migration percentage for group 2. Linear mixed models were used to take into account repeated measures over time and correlations between measurements from the same patient.
Group 1 (n=18); had low BADS scores and were considered to have mild dystonia. Three children experienced unpredictable results, 2 had early recurrence of deformity, 3 had a decline, and 1 child improved in the functional mobility scale.Group 2 (n=19); had high BADS scores and were considered to have moderate to severe dystonia. Nine surgical events involved bony procedures and 15 were soft tissue surgery only. One surgical event lead to unpredictable results and 2 children had early recurrence of deformity. Postoperatively, a linear trend of increasing migration percentage [0.49% (95% confidence interval, 0.23-0.74; P=0.0002)] was seen up to 21 months. There was no significant change after 21 months [-0.08% (95% confidence interval, -0.24 to +0.041; P=0.18)].
This study suggests that unpredictable results and early recurrence of deformity following orthopaedic surgery in children with DCP are not as common as previously regarded. Furthermore, functional mobility and hip morphology can be improved.
Level IV-this is a case-series.
痉挛型脑性瘫痪（DCP）患者接受骨科干预后的结果在历史上被认为是不可预测的。本研究旨在评估DCP患儿骨科手术的总体结果。
纳入接受下肢骨科手术且至少随访12个月的DCP患儿。收集的数据包括手术时的年龄、所进行的手术操作、粗大运动功能分类系统（GMFCS）水平和巴里·奥尔布赖特肌张力障碍量表（BADS）评分。该队列分为两组。第1组（GMFCS I至III级），平均年龄12岁7个月；第2组（GMFCS IV至V级），平均年龄10岁7个月。第1组手术旨在矫正畸形以改善步态和活动能力，第2组手术旨在处理或预防髋关节脱位。分析的结果指标为：两组中与手术相关的不可预测结果的发生率和畸形的早期复发情况。对第1组评估功能活动量表评分，对第2组评估髋关节移位百分比。使用线性混合模型来考虑随时间的重复测量以及同一患者测量值之间的相关性。
第1组（n = 18）；BADS评分低，被认为患有轻度肌张力障碍。3名儿童出现不可预测的结果，2名儿童畸形早期复发，3名儿童功能活动量表评分下降，1名儿童评分改善。第2组（n = 19）；BADS评分高，被认为患有中度至重度肌张力障碍。9例手术涉及骨手术，15例仅为软组织手术。1例手术导致不可预测的结果，2名儿童畸形早期复发。术后，直至21个月，髋关节移位百分比呈线性增加趋势[0.49%（95%置信区间，0.23 - 0.74；P = 0.0002）]。21个月后无显著变化[-0.08%（95%置信区间，-0.24至 +0.041；P = 0.18）]。
本研究表明，DCP患儿骨科手术后不可预测的结果和畸形的早期复发并不像以前认为的那么常见。此外，功能活动能力和髋关节形态可以得到改善。
IV级——这是一个病例系列研究。
