Angelo da Silva Luiz Antônio, Fucs Patricia Maria de Moraes Barros
Santa Casa Medical School and Hospitals, R. Dr. Cesário Mota Junior 61, 01221-020 São Paulo/SP, Brazil.
Department of Orthopaedic and Traumatology, Irmandade da Santa Casa de São Paulo, Santa Casa Medical School and Hospitals, R. Dr. Cesário Mota Junior 61, 01221-020 São Paulo/SP, Brazil.
SICOT J. 2020;6:38. doi: 10.1051/sicotj/2020036. Epub 2020 Oct 12.
To use the measurement of migration percentage (MP) to evaluate the long-term radiographic results of soft tissue surgery as the first treatment for hip displacement in spastic bilateral cerebral palsy. A secondary objective was to identify predictive factors of stability (i.e., less than 30% of MP in the long term), after surgical correction.
In this longitudinal cohort study, we reviewed the electronic medical records and radiographs of all consecutive patients with cerebral palsy operated for the correction of hip displacement between 1984 and 2013 in a referral orthopedic public hospital in Brazil. Patients were included if they had received, as the first surgical procedure, soft-tissue release. All surgeries were bilateral and symmetrical. We used the available radiographs to evaluate the migration percentage (MP), acetabular index (AI), pelvic obliquity (PO) angle, head-shaft angle (HSA), congruence and femoral head sphericity, and function using the GMFCS (Gross Motor Function Classification System).
we included 93 patients, all operated before being 12 years old, with follow-up of 10 years in average, 73 (78%) of them with good results (MP < 30%). We found association between preoperative MP ≤ 40%, AI ≤ 25°, and postoperative symmetry with good results, with a cut-off value of 38% of MP and 27° of acetabular index being predictive.
The role of soft tissue releases remains controversial owing to small sample sizes, heterogeneity, variety range of ages, definitions used for outcome, and lack of statistical quality. Our results were better in combined tenotomies, in diparetic patients aged more than six years, and in patients with lower initial values of MP and AI. Radiographic variables had good correlation with each other and association with results, with cut-off values for MP and AI PRE.
采用移位百分比（MP）测量法评估软组织手术作为痉挛性双侧脑瘫髋关节移位首次治疗方法的长期影像学结果。次要目的是确定手术矫正后稳定性的预测因素（即长期MP小于30%）。
在这项纵向队列研究中，我们回顾了1984年至2013年期间在巴西一家转诊骨科公立医院接受髋关节移位矫正手术的所有连续性脑瘫患者的电子病历和X线片。如果患者接受的首次手术是软组织松解，则纳入研究。所有手术均为双侧且对称。我们使用现有的X线片评估移位百分比（MP）、髋臼指数（AI）、骨盆倾斜（PO）角、头干角（HSA）、股骨头与髋臼的匹配度和股骨头球形度，并使用GMFCS（粗大运动功能分类系统）评估功能。
我们纳入了93例患者，均在12岁之前接受手术，平均随访10年，其中73例（78%）效果良好（MP < 30%）。我们发现术前MP≤40%、AI≤25°以及术后对称性与良好结果之间存在关联，MP的临界值为38%，髋臼指数的临界值为27°具有预测性。
由于样本量小、异质性、年龄范围广、结果定义以及缺乏统计质量，软组织松解的作用仍存在争议。我们的结果在联合肌腱切断术、6岁以上双瘫患者以及MP和AI初始值较低的患者中更好。影像学变量之间具有良好的相关性，且与结果相关，MP和AI PRE有临界值。
