Kamisan N, Thamkunanon V
Department of Paediatric Orthopaedic, Tunku Azizah Hospital, Kuala Lumpur, 50586, Malaysia.
Department of Paediatric Orthopaedic, Queen Sirikit National Institute of Child Health, Khwaeng Thung Phaya Thai, Khet Ratchathewi, Bangkok, 10400, Thailand.
J Orthop. 2020 Jul 8;20:367-373. doi: 10.1016/j.jor.2020.06.017. eCollection 2020 Jul-Aug.
To evaluate the post-operative outcomes of the hips in CP patients with unilateral hip subluxation treated with bilateral and unilateral hip reconstruction.
A retrospective review was performed of all diplegic and quadriplegic patients with unilateral hip displacement treated with either bilateral or unilateral hip reconstructive surgery. Radiographic parameters [migration percentage (MP), pelvic obliquity angle (POA) and migration percentage difference (MPD)] and changes in functional ability (sitting, standing and walking) were evaluated and compared between the 2 groups. Failure was defined as post-operative MP>40%, POA>5° and MPD>30%.
Eighteen patients had unilateral hip reconstruction and 42 patients had bilateral hip reconstruction. Mean age of 87 months and 90 months and means follow-up of 38 months and 40 months respectively. Post-operative MP was significant in both groups. However, of 18 patients in unilateral hip reconstruction group, 33.3% of patients had contralateral hip subluxation and 22.2% of patients had hip failure on the operated hip; compared to only one of 42 patients had hip failure and no contralateral hip problem in the other group. For assessment of pelvic symmetry, MPD was significantly improved in both group but POA was only significant in bilateral group. Overall functional improvement was significant in patients with bilateral hip reconstruction compared to unilateral group.
Bilateral hip reconstruction in unilateral displacement had shown to have better outcome in correcting unstable hip and pelvic asymmetry, thus provide good sitting balance and improvement in overall functional outcome.
评估采用双侧和单侧髋关节重建治疗的单侧髋关节半脱位脑瘫（CP）患者术后髋关节的预后情况。
对所有接受双侧或单侧髋关节重建手术治疗的单侧髋关节移位的双瘫和四肢瘫患者进行回顾性研究。评估并比较两组患者的影像学参数[移位百分比（MP）、骨盆倾斜角（POA）和移位百分比差异（MPD）]以及功能能力（坐、站和行走）的变化。失败定义为术后MP>40%、POA>5°和MPD>30%。
18例患者接受单侧髋关节重建，42例患者接受双侧髋关节重建。平均年龄分别为87个月和90个月，平均随访时间分别为38个月和40个月。两组术后MP均有显著变化。然而，在单侧髋关节重建组的18例患者中，33.3%的患者对侧髋关节半脱位，22.2%的患者手术侧髋关节出现失败；相比之下，另一组42例患者中只有1例出现髋关节失败，且无对侧髋关节问题。对于骨盆对称性评估，两组MPD均有显著改善，但POA仅在双侧重建组有显著改善。与单侧重建组相比，双侧髋关节重建患者的整体功能改善显著。
单侧移位患者进行双侧髋关节重建在纠正不稳定髋关节和骨盆不对称方面显示出更好的效果，从而提供良好的坐位平衡并改善整体功能预后。
