Wen Jie, Liu Hong, Xiao Sheng, Li Xin, Fang Ke, Tang Zhongwen, Cao Shu, Li Fanling
Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
J Pediatr Orthop B. 2020 Nov;29(6):523-529. doi: 10.1097/BPB.0000000000000695.
Hip subluxation in ambulant children with cerebral palsy may lead to limited walking and pain. This study aimed to introduce the indications and methods of femoral varus osteotomy combined with Pemberton osteotomy in treating spastic hip subluxation to evaluate the interim clinical result and outcome and to discuss its corrective mechanism and orthopedic effect. A total of 23 children with spastic hip subluxation, who underwent femoral varus osteotomy combined with Pemberton osteotomy were selected. The clinical effects were evaluated according to the migration percentage, acetabular index, proximal femur neck shaft angle (NSA), and Melbourne Cerebral Palsy Hip Classification System (MCPHCS). The median migration percentage was 55 (50, 75) before operation, 20 (0, 30) at postoperative 1 year, and 22 (5, 32) at last follow-up. The median acetabular index was 30° (25°, 40°) before operation, 20°(15°, 26°) at postoperative 1 year, and 20° (15°, 25°) at last follow-up. The median NSA was 145 (138, 153) before operation, 117 (107, 126) at postoperative 1 year, and 118 (110, 125) at last follow-up. The MCPHCS grade 4 counts 23 (100%) before operation, grade 3 counts 20 (87.0%), grade 2 counts 2 (8.7%) and grade 1 counts 1 (4.3%) at postoperative 1 year, and grade 4 counts 1 (4.3%), grade 3 counts 21 (91.3%) and grade 1 counts 1 (4.3%) at last follow-up. Femoral varus osteotomy combined with Pemberton osteotomy is a good surgical treatment for children with Gross Motor Function Classification System levels I and II and migration percentage greater than 50%.
能行走的脑瘫儿童髋关节半脱位可能导致行走受限和疼痛。本研究旨在介绍股骨内翻截骨术联合彭伯顿截骨术治疗痉挛性髋关节半脱位的适应证和方法，评估中期临床结果和疗效，并探讨其矫正机制和矫形效果。共选取23例接受股骨内翻截骨术联合彭伯顿截骨术治疗的痉挛性髋关节半脱位患儿。根据移位百分比、髋臼指数、股骨近端颈干角（NSA）和墨尔本脑瘫髋关节分类系统（MCPHCS）评估临床效果。术前移位百分比中位数为55（50，75），术后1年为20（0，30），末次随访时为22（5，32）。术前髋臼指数中位数为30°（25°，40°），术后1年为20°（15°，26°），末次随访时为20°（15°，25°）。术前NSA中位数为145（138，153），术后1年为117（107，126），末次随访时为118（110，125）。术前MCPHCS 4级有23例（100%），术后1年3级有20例（87.0%），2级有2例（8.7%），1级有1例（4.3%），末次随访时4级有1例（4.3%），3级有21例（91.3%），1级有1例（4.3%）。股骨内翻截骨术联合彭伯顿截骨术是治疗粗大运动功能分类系统I级和II级且移位百分比大于50%的儿童的一种良好手术治疗方法。
