Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis.
Department of Orthopedic Surgery, Children's Mercy Kansas City, Kansas City, MO.
J Pediatr Orthop. 2021 Jan;41(1):e7-e13. doi: 10.1097/BPO.0000000000001635.
Treatment of symptomatic hip dysplasia in skeletally mature patients with spastic cerebral palsy (CP) can be challenging. This study examines our technical experience with the Bernese periacetabular osteotomy (PAO) in combination with adjunctive procedures in the treatment of this complex hip deformity.
Sixteen consecutive patients (18 hips) with symptomatic CP hip dysplasia were treated with a PAO and variable adjunctive procedures and retrospectively reviewed. Two patient (2 hips) were excluded due to insufficient follow-up. The average age at the time of surgery was 17.7 years (range: 13 to 28 y). We compared the preoperative to postoperative changes in radiographic parameters as well as early outcomes as measured by patient assessment of hip pain and function using the modified Harris Hip Score (mHHS).
The average time of follow-up was 3.3 years (range: 2.0 to 6.3 y). Tönnis angles decreased from a median of 30 degrees (range: 18 to 45 degrees) preoperatively to a median of 6 degrees (range: -9 to 21 degrees) postoperatively. Lateral center-edge angles increased from a median of -8 degrees (range: -28 to 15 degrees) to a median of 32 degrees (range: 19 to 38 degrees). Anterior center-edge angles increased from a median of 2 degrees (range: -22 to 39 degrees) to a median of 35 degrees (range: 22 to 47 degrees). The extrusion index decreased from a median of 57% preoperatively (range: 35% to 73%) to a median of 21% (range: 11% to 36%) postoperatively.The median mHHS was 62 (range: 37 to 81) preoperatively and 85 (range: 65 to 100) postoperatively. Notably, the pain component of the mHHS improved from 20 (range: 0 to 44) to 42 (range: 30 to 44). Tönnis osteoarthritis grade preoperatively was either 0 (11 hips) or 1 (5 hips) and remained unchanged in 11 hips and increased by 1 grade in 5 hips.
It has been our experience that the Bernese PAO in combination with appropriate adjunctive treatments has provided a very satisfactory surgical approach in the treatment of CP hip dysplasia. In the adolescent and young adult with spastic CP, utilizing the Bernese PAO technique makes it possible to obtain redirection of often a very severe acetabular dysplasia. Adjunctive soft tissue procedures and a proximal femoral osteotomy are frequently necessary to maintain postoperative stability. A notable improvement in the quality of life and function directly attributable to our surgical treatment of their pre-existing problematic hip dysplasia has been consistently noted in early follow-up for our patients.
Level IV-therapeutic.
对于患有痉挛性脑瘫（CP）的骨骼成熟患者的症状性髋关节发育不良的治疗可能具有挑战性。本研究探讨了我们在使用伯尔尼髋臼周围截骨术（PAO）联合辅助手术治疗这种复杂髋关节畸形方面的技术经验。
回顾性分析了 16 例（18 髋）患有症状性 CP 髋关节发育不良的连续患者，接受了 PAO 和可变的辅助手术。由于随访时间不足，有 2 例（2 髋）患者被排除在外。手术时的平均年龄为 17.7 岁（范围：13 至 28 岁）。我们比较了术前和术后影像学参数的变化，以及使用改良 Harris 髋关节评分（mHHS）测量的髋关节疼痛和功能的早期结果。
平均随访时间为 3.3 年（范围：2.0 至 6.3 年）。Tönnis 角从术前中位数 30 度（范围：18 至 45 度）减少到术后中位数 6 度（范围：-9 至 21 度）。外侧中心边缘角从术前中位数-8 度（范围：-28 至 15 度）增加到术后中位数 32 度（范围：19 至 38 度）。前中心边缘角从术前中位数 2 度（范围：-22 至 39 度）增加到术后中位数 35 度（范围：22 至 47 度）。挤出指数从术前中位数 57%（范围：35%至 73%）减少到术后中位数 21%（范围：11%至 36%）。术前 mHHS 的中位数为 62（范围：37 至 81），术后为 85（范围：65 至 100）。值得注意的是，mHHS 的疼痛部分从 20（范围：0 至 44）增加到 42（范围：30 至 44）。术前 Tönnis 骨关节炎分级为 0（11 髋）或 1（5 髋），11 髋保持不变，5 髋增加 1 级。
我们的经验是，伯尔尼 PAO 联合适当的辅助治疗为 CP 髋关节发育不良的治疗提供了一种非常满意的手术方法。在患有痉挛性脑瘫的青少年和年轻成人中，使用伯尔尼 PAO 技术可以实现对通常非常严重的髋臼发育不良的矫正。辅助软组织手术和股骨近端截骨术通常是必要的，以维持术后稳定性。我们的手术治疗明显改善了患者的髋关节发育不良，患者的生活质量和功能得到了显著提高，这在早期随访中得到了一致的证实。
IV 级-治疗。
