Rehbein Ignacio, Teske Viviana, Pagano Ignacio, Cúneo Alejandro, Pérez María Elena, von Heideken Johan
Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay.
Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm 17177, Sweden.
World J Orthop. 2020 Apr 18;11(4):222-231. doi: 10.5312/wjo.v11.i4.222.
Orthopedic surgery in children with cerebral palsy (CP) aims to improve function and prevent deformities. Each child's condition in CP is unique and many co-variables influence surgical decision-making including a patient's age and their functional level. Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels, particularly in countries from Latin America.
To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP.
This retrospective study included all children with CP = 245) treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database. Eighteen children (7%) were lost to follow-up due to missing medical charts. Demographics, gross motor function classification (GMFCS), and orthopedic surgeries were obtained from the medical records of 227 children. Chi-squared tests and analysis of variance were used to assess the frequency of surgery, accounting for GMFCS levels. Mean age for soft tissue bone surgery was compared with the independent samples -test.
A total of 711 surgical procedures were performed between 1998 and 2016. On average, children had 3.1 surgical procedures and the mean age at first surgery was 8.0 years. There were no significant differences in age at first surgery among GMFCS levels ( = 0.47). The most common procedures were lower leg soft tissue surgery ( = 189, 27%), hip tenotomy ( = 135, 19%), and hamstring tenotomy ( = 104, 14%). For children with GMFCS level I, the mean number of surgeries per child [1.8 (range 1-9)] differed significantly at < 0.05 in children with GMFCS levels II [3.2 (1-12)], III [3.2 (1-8)], IV [3.3 (1-13)], and V [3.6 (1-11)]. Within II, III, IV, and V, there was no significant difference in mean number of surgeries per child when comparing across the groups. The proportion of soft tissue surgery bone surgery was higher in GMFCS levels I-III (80%-85%) compared to levels IV (68%) and V (55%) ( < 0.05).
The frequency of surgical procedures per child did not increase with higher GMFCS level after level I. However, the proportion of bone surgery was higher in GMFCS levels IV-V compared to I-III.
脑瘫（CP）患儿的骨科手术旨在改善功能并预防畸形。CP患儿的病情各不相同，许多协变量会影响手术决策，包括患者的年龄及其功能水平。对于功能水平各异的CP患儿，尤其是拉丁美洲国家的患儿，不同类型骨科手术的频率鲜为人知。
评估CP患儿骨科手术类型与年龄及粗大运动功能的关系。
这项回顾性研究纳入了2010年10月至2016年5月在乌拉圭一家大学医院接受择期骨科手术的所有CP患儿（n = 245），这些患儿信息来自手术数据库。18名患儿（7%）因病历缺失而失访。从227名患儿的病历中获取人口统计学信息、粗大运动功能分类（GMFCS）和骨科手术情况。采用卡方检验和方差分析评估手术频率，并考虑GMFCS水平。采用独立样本t检验比较软组织和骨手术的平均年龄。
1998年至2016年共进行了711例手术。患儿平均接受3.1次手术，首次手术的平均年龄为8.0岁。GMFCS各水平之间首次手术的年龄无显著差异（P = 0.47）。最常见的手术是小腿软组织手术（n = 189，27%）、髋部肌腱切断术（n = 135，19%）和腘绳肌腱切断术（n = 104，14%）。GMFCS I级患儿平均每人手术次数[1.8（范围1 - 9）]与GMFCS II级[3.2（1 - 12）]、III级[3.2（1 - 8）]、IV级[3.3（1 - 13）]和V级[3.6（1 - 11）]患儿相比，差异有统计学意义（P < 0.05）。在II、III、IV和V级中，各组间患儿平均手术次数无显著差异。与IV级（68%）和V级（55%）相比，GMFCS I - III级中软组织手术与骨手术的比例更高（P < 0.05）。
I级之后，患儿手术次数频率并未随GMFCS水平升高而增加。然而，与I - III级相比，GMFCS IV - V级中骨手术的比例更高。
