Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital , Stockholm.
Department of Pediatric Orthopedics, Astrid Lindgren's Children Hospital, Karolinska University Hospital , Stockholm.
Acta Orthop. 2019 Oct;90(5):495-500. doi: 10.1080/17453674.2019.1627116. Epub 2019 Jun 18.
Background and purpose - Children with cerebral palsy (CP) have an increased risk of hip dislocation. Outcome studies after surgery to prevent hip dislocation in children with CP are usually retrospective series from single tertiary referral centers. According to the national CP surveillance program in Sweden (CPUP), hip surgery should preferably be performed at an early age to prevent hip dislocation. Preventive operations are performed in 12 different Swedish hospitals. We compared the outcomes between soft tissue release and femoral osteotomy in children with CP treated in these hospitals. Patients and methods - 186 children with CP underwent either adductor-iliopsoas tenotomy (APT) or femoral osteotomy (FO) as the primary, preventive surgery because of hip displacement. They were followed for a minimum of 5 years (mean 8 years) regarding revision surgery and hip migration. A good outcome was defined as the absence of revision surgery and a migration percentage (MP) < 50% at the latest follow-up. Logistic and Cox regression analysis were used to investigate the influence of age, sex, preoperative MP, Gross Motor Function Classification System (GMFCS) level, and CP subtype. Results - APT was performed in 129 (69%) children. After 5 years, the reoperation rate was 43%, and 2 children (2%) had an MP > 50%. For the 57 children who underwent FO, the corresponding figures were 39% and 9%. Of the potential risk factors studied, the outcome was statistically significantly associated with preoperative MP only in children who underwent APT, but not in those who underwent FO. None of the other factors were significantly associated with the outcome in the 2 procedure groups. Interpretation - Reoperation rates after preventive surgery are high and indicate the importance of continued postoperative follow-up. Age, sex, GMFCS level, and CP subtype did not influence the outcome significantly.
背景与目的-脑瘫（CP）患儿髋关节脱位风险增加。预防 CP 患儿髋关节脱位的手术疗效研究通常为单中心回顾性研究。根据瑞典全国 CP 监测计划（CPUP），髋关节手术应尽早进行，以预防髋关节脱位。预防性手术在瑞典的 12 家不同医院进行。我们比较了这些医院接受软组织松解术和股骨截骨术治疗的 CP 患儿的疗效。
患者与方法-186 例 CP 患儿因髋关节移位行内收肌松解术（APT）或股骨截骨术（FO）作为主要的预防性手术。至少随访 5 年（平均 8 年），随访内容包括翻修手术和髋关节移位。定义良好的结果为末次随访时无翻修手术且髋关节移位百分比（MP）＜50%。采用逻辑和 Cox 回归分析探讨年龄、性别、术前 MP、粗大运动功能分类系统（GMFCS）分级和 CP 亚型对疗效的影响。
结果-129 例（69%）患儿行 APT。5 年后，翻修率为 43%，2 例（2%）患儿 MP＞50%。57 例行 FO 的患儿中，相应的翻修率为 39%，9 例（1.6%）患儿 MP＞50%。在研究的潜在危险因素中，仅行 APT 的患儿术前 MP 与疗效显著相关，而行 FO 的患儿则无此相关性。2 种手术方式组的其他因素与疗效均无显著相关性。
结论-预防性手术后的翻修率较高，这表明术后持续随访的重要性。年龄、性别、GMFCS 分级和 CP 亚型对疗效无显著影响。
