Cottrill Ethan J, Johnson Deanna C, Silberstein Charles E
Division of Pediatric Orthopaedics, The Johns Hopkins Children's Center, Baltimore, MD, USA.
Department of Physical Therapy, Kennedy Krieger Institute, Baltimore, MD, USA.
J Pediatr Rehabil Med. 2019;12(3):263-269. doi: 10.3233/PRM-180553.
To identify factors associated with success of corrective bony hip surgery among patients with cerebral palsy (CP).
A retrospective review was conducted of medical records of patients diagnosed with CP and hip displacement who underwent surgery from 2004 to 2016 at the authors' institution and who had a one-year minimum follow-up. Patient age, sex, Gross Motor Function Classification System (GMFCS) level, surgical procedure(s), type and extent of CP, presence of preoperative and postoperative hip pain, and hip migration percentages (MPs) were recorded. Surgical success was defined as a postoperative MP ⩽ 30% and no hip pain at final follow-up.
Thirty-eight patients (55 hips) met the inclusion criteria. Mean age at surgery was 10.2 years (range, 2-24 years). Mean MP (standard deviation) improved from 64 ± 29% preoperatively to 22 ± 30% at a mean 1.7-year follow-up (p< 0.001). The absence of preoperative hip pain (p= 0.014), surgery after age 5 (p= 0.041), and a milder preoperative MP (p< 0.001) were significantly associated with surgical success.
In patients with CP and hip displacement, early preventative correction of hip displacement after age 5 may improve clinical outcomes, though future studies are needed to provide more definitive clinical direction.
确定与脑瘫（CP）患者髋部矫正手术成功相关的因素。
对2004年至2016年在作者所在机构接受手术且至少随访一年的诊断为CP和髋关节移位的患者的病历进行回顾性研究。记录患者的年龄、性别、粗大运动功能分类系统（GMFCS）水平、手术方式、CP的类型和程度、术前和术后髋部疼痛的情况以及髋关节移位百分比（MPs）。手术成功定义为术后MP≤30%且在最后随访时无髋部疼痛。
38例患者（55髋）符合纳入标准。手术时的平均年龄为10.2岁（范围2 - 24岁）。平均MP（标准差）从术前的64±29%改善至平均1.7年随访时的22±30%（p<0.001）。术前无髋部疼痛（p = 0.014）、5岁后手术（p = 0.041）以及术前MP较轻（p<0.001）与手术成功显著相关。
在CP和髋关节移位患者中，5岁后早期预防性矫正髋关节移位可能改善临床结局，不过需要未来的研究提供更明确的临床指导。
