Motion Analysis Center, Shriners Hospitals for Children.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
J Pediatr Orthop. 2021 Apr 1;41(4):221-226. doi: 10.1097/BPO.0000000000001760.
Hip dysplasia in the nonambulatory child with spastic cerebral palsy (CP) is a common condition not always effectively treated with conservative measures even when recognized early. Optimal surgical intervention strategies and timing are not clear from previous studies. Contralateral hips with less severe subluxation in these patients also often undergo surgery and little is known of outcomes of these less severe hips. This study aims to clarify treatment factors related to long term success following hip surgery for subluxation in nonambulatory children with CP.
A total of 183 nonambulatory subjects with CP and a minimum of 2-year follow-up were included. All subjects underwent varus rotational osteotomy of the femur; other surgical factors considered were addition of pelvic osteotomy (PO), capsulorrhaphy, and soft tissue releases. Additional factors studied were age at index surgery, sex, and unilateral versus bilateral surgery. Severely subluxated (SS) hips, defined as having >50% migration, were studied separately from contralateral nonsevere hips. Surgeries were deemed successful if final follow-up indicated a migration of <25%; patients with any revision surgeries or >25% migration were categorized as failures.
A 60% success rate was found in SS hips and a 68% success rate in nonsevere hips. Age at index surgery did not influence success rates in SS hips. In the nonsevere hips, success was associated with index surgery at older age. The addition of a PO was the only concomitant procedure demonstrated to improve outcomes. In SS hips, those with a successful outcome were 2.5 times more likely to have had a PO. The addition of capsulorrhaphy had a negative effect on the entire group, reducing odds of success to 0.8. No other factors were significant.
The findings from this multicenter retrospective study suggest that PO be added to varus rotational osteotomies in patients with severe hip subluxation. Surgery should be undertaken for severe dysplasia without concern for age. The addition of capsulorrhaphy does not improve rate of success.
Level III-retrospective comparative study.
痉挛性脑瘫（CP）非行走患儿髋关节发育不良是一种常见疾病，即使早期发现，也不能通过保守治疗有效治疗。以前的研究对最佳手术干预策略和时机尚不清楚。这些患者对侧髋关节伴较轻的半脱位通常也需要手术，但对这些较轻髋关节的结果知之甚少。本研究旨在阐明与脑瘫非行走患儿髋关节半脱位手术后长期成功相关的治疗因素。
共纳入 183 例至少随访 2 年的非行走 CP 患儿。所有患儿均行股骨内旋截骨术；其他手术因素包括骨盆截骨术（PO）、关节囊切开术和软组织松解术。研究的其他因素包括索引手术时的年龄、性别以及单侧与双侧手术。严重半脱位（SS）髋关节，定义为有> 50%的迁移，与对侧非严重髋关节分开研究。如果最终随访表明迁移<25%，则认为手术成功；任何翻修手术或> 25%的迁移的患者归类为失败。
SS 髋关节的成功率为 60%，非严重髋关节的成功率为 68%。索引手术时的年龄并不影响 SS 髋关节的成功率。在非严重髋关节中，手术年龄较大与成功相关。PO 的附加是唯一显示能改善结果的伴随手术。在 SS 髋关节中，有成功结果的髋关节更有可能接受 PO。关节囊切开术的附加有负面影响，使成功率降低至 0.8。其他因素没有意义。
这项多中心回顾性研究的结果表明，在严重髋关节半脱位的患者中，应在股骨内旋截骨术上加行 PO。对于严重的髋关节发育不良，应在不考虑年龄的情况下进行手术。关节囊切开术不能提高成功率。
III 级-回顾性比较研究。
