University of North Carolina at Chapel Hill, Chapel Hill, NC.
University of California San Diego Medical Center.
J Pediatr Orthop. 2020 Nov/Dec;40(10):608-614. doi: 10.1097/BPO.0000000000001595.
Bilateral hip reconstructions with osteotomies are commonly required in patients with severe cerebral palsy (CP) and dysplasia. These procedures can be performed by staging each hip surgery, separated by weeks to months, or by addressing both hips in a single-event surgery. The optimal timing of such surgery is yet to be determined. The purpose of this study was to retrospectively compare major complications between the staged and single-event approaches.
Medical records of patients who underwent bilateral hip osteotomies, with at least one side including a pelvic osteotomy, were retrospectively reviewed. Subjects were identified who had a diagnosis of nonambulatory CP (defined by Gross Motor and Functional Classification System level IV or V), and at least 1 year of clinical follow-up. All hips were treated by 1 of 7 surgeons: 2 surgeons who always performing single-event surgery and 5 who always perform staged surgeries. Complications were stratified by the Modified Clavien-Dindo Classification (grades 1 to 5). The primary outcome was major complications (grade ≥3), while minor complications, readmissions, reoperations, and resource utilization outcomes were investigated secondarily.
Sixty-five patients met our inclusion criteria: 35 received single-event surgery and 30 received staged surgery. The staged group had a higher rate of major complications per patient (0.30 vs. 0; P=0.013). Unplanned readmissions and reoperations were likewise increased in the staged group. Minor complication rates were high in both groups, with no differences observed between staged and single-event approaches (3.27 per patient vs. 2.91; P=0.952). There were no complications causing permanent disability or death. The total length of stay (6.2 vs. 4.0 d; P<0.001) and mean nonsurgical operating room time (65.7 vs. 45.6 min; P<0.001) were increased in the staged group versus the single-event group.
The staged approach to bilateral hip reconstructions in the nonambulatory CP population was associated with a higher rate of major complications compared with a single-event approach. Minor complications were similar for both approaches. Both approaches can have an acceptable safety profile with no observed grade 4 or 5 complications.
Level III.
在严重脑瘫（CP）和发育不良的患者中，通常需要双侧髋关节切开复位术。这些手术可以通过分期进行，每侧手术间隔数周或数月，也可以在单次手术中同时处理双侧髋关节。这种手术的最佳时机尚未确定。本研究旨在回顾性比较分期和单次手术方法的主要并发症。
回顾性分析接受双侧髋关节切开复位术的患者病历，至少一侧包括骨盆切开复位术。确定患有非步行 CP（定义为运动功能分类系统 IV 或 V 级）并至少有 1 年临床随访的患者。所有髋关节均由 7 位外科医生中的 1 位治疗：2 位外科医生始终进行单次手术，5 位外科医生始终进行分期手术。并发症采用改良 Clavien-Dindo 分级（1-5 级）分层。主要结局为主要并发症（≥3 级），次要结局为次要并发症、再入院、再次手术和资源利用情况。
65 名患者符合纳入标准：35 名接受单次手术，30 名接受分期手术。分期组患者的每位患者主要并发症发生率更高（0.30 比 0；P=0.013）。分期组患者的未计划再入院和再次手术率也有所增加。两组患者的轻微并发症发生率均较高，分期和单次手术组之间无差异（每位患者 3.27 比 2.91；P=0.952）。没有导致永久性残疾或死亡的并发症。分期组的总住院时间（6.2 比 4.0 d；P<0.001）和非手术手术室时间（65.7 比 45.6 min；P<0.001）均长于单次手术组。
与单次手术相比，非步行 CP 人群的双侧髋关节重建分期手术与更高的主要并发症发生率相关。两种方法的轻微并发症相似。两种方法均具有可接受的安全性，无观察到 4 级或 5 级并发症。
III 级。
