Bayhan Ilhan A, Abousamra Oussama, Rogers Kenneth J, Bober Michael B, Miller Freeman, Mackenzie William G
Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
J Pediatr Orthop. 2019 Jul;39(6):282-288. doi: 10.1097/BPO.0000000000000945.
Coxa vara has been frequently reported in spondyloepiphyseal dysplasia congenita (SEDC), and proximal femoral osteotomy has been described as a useful treatment. The aim of this study was to discuss the clinical, radiographic, and gait outcomes after valgus extension osteotomy of the proximal femur. Changes of lumbar lordosis, associated with coxa vara correction, are reported as well as the outcome differences between different ages.
Records of children with SEDC, who were followed at our institution between 2004 and 2014, were reviewed; and children had hip surgery were identified. Hip pain and passive range of motion, radiographic neck shaft angle (NSA), and Hilgenreiner trochanteric (H-T) angle, sagittal spinopelvic parameters, and gait data were recorded. Preoperative and last follow-up data were compared. Outcomes were also compared between 3 age groups.
Of the 79 children with SEDC, 26 children (12 boys and 14 girls) had hip osteotomy in 48 hips. Mean age at surgery was 9.6 years and the mean follow-up was 5 years. Preoperative hip pain was noted in 30 hips. At the last follow-up, 3 hips were painful at the extreme range of motion. Passive range of motion, NSA, and H-T improved postoperatively. Although NSA was maintained over the follow-up, H-T deterioration was noted. Spinopelvic measurements changed significantly and gait data remained stable except pelvic tilt that reduced significantly after surgery. The changes of radiographic measurements in each age group were similar to the total group of patients.
In children with SEDC, surgical correction of coxa vara, by proximal femoral valgus osteotomy, is an effective treatment that improves hip pain and range of motion in addition to the radiographic alignment of the proximal femur and the sagittal spinopelvic alignment. Children are expected to maintain their level of function after surgery and to have good results over the midterm regardless of their age at surgery.
Level IV-therapeutic study.
先天性脊柱骨骺发育不良（SEDC）中常报告有髋内翻，股骨近端截骨术已被描述为一种有效的治疗方法。本研究的目的是探讨股骨近端外翻截骨术后的临床、影像学和步态结果。报告了与髋内翻矫正相关的腰椎前凸变化以及不同年龄之间的结果差异。
回顾了2004年至2014年在本机构随访的SEDC患儿的记录；确定接受髋关节手术的患儿。记录髋关节疼痛和被动活动范围、影像学颈干角（NSA）和希尔根赖纳转子（H-T）角、矢状位脊柱骨盆参数和步态数据。比较术前和末次随访数据。还比较了3个年龄组之间的结果。
在79例SEDC患儿中，26例患儿（12例男孩和14例女孩）的48个髋关节接受了截骨术。手术时的平均年龄为9.6岁，平均随访时间为5年。术前30个髋关节有疼痛。在末次随访时，3个髋关节在活动极限时疼痛。被动活动范围、NSA和H-T术后均有改善。尽管随访期间NSA保持稳定，但H-T出现恶化。脊柱骨盆测量有显著变化，除术后骨盆倾斜度显著降低外步态数据保持稳定。各年龄组影像学测量的变化与患者总体组相似。
在SEDC患儿中，通过股骨近端外翻截骨术手术矫正髋内翻是一种有效的治疗方法，除了改善股骨近端的影像学对线和矢状位脊柱骨盆对线外，还能改善髋关节疼痛和活动范围。预计患儿术后能维持其功能水平，无论手术时年龄如何，中期效果良好。
IV级治疗性研究。
