Cobanoglu Mutlu, Chen Brian Po-Jung, Perotti Lucio, Rogers Kenneth, Miller Freeman
Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE USA.
Department of Orthopedics and Traumatology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey.
Indian J Orthop. 2020 Oct 9;55(1):176-182. doi: 10.1007/s43465-020-00271-8. eCollection 2021 Feb.
The aims of this study were to determine the risk of progressive hip subluxation in children with CP after spinal fusion for scoliosis and how frequent the hips follow-up should be scheduled.
Pelvis radiography [migration index (MI) and pelvic obliquity (PO)] of Gross Motor Function Classification System (GMFCS) levels IV and V children with CP who received spinal fusion and pelvic fixation were reviewed retrospectively. This population was categorized into three groups based on the MI at spinal fusion: G1 = 0-29%; G2 = 30-59%; and G3 = 60-100%.
Fifty children (age 7.5-15.0 years) and categorized into 3 groups (G1 = 19, G2 = 23, G3 = 8; 100 hips in total). Preoperative and last follow-up MI were 22 ± 7% and 30 ± 20% (G1), 41 ± 9% and 43 ± 22% (G2), 92 ± 15% and 97 ± 10% (G3). The MIs at spinal fusion between groups were statistically different ( < 0.001). In G1, the mean MI progression was 5% and 25% at 12 months and 62 months, respectively. In G2, the mean MI progression was 9% and 25% at 12 months and 32 months, respectively. The progression more than 10% occurred within 2 years in G1 and within 1 year in G2. There was no difference between groups based on preoperative degree of PO ( = 0.653) and correction rate in PO ( = 0.421).
In GMFCS IV and V children with the highest risk for progression occurred with increasing preoperative MI, especially over 50%. Hips should be monitored continuously after spinal fusion until hip stability is documented.
本研究旨在确定患有脑瘫（CP）的儿童在脊柱侧弯融合术后发生进行性髋关节半脱位的风险，以及应安排多频繁的髋关节随访。
对接受脊柱融合术和骨盆固定术的粗大运动功能分类系统（GMFCS）IV级和V级脑瘫儿童的骨盆X线片[移位指数（MI）和骨盆倾斜度（PO）]进行回顾性分析。根据脊柱融合时的MI将该人群分为三组：G1 = 0 - 29%；G2 = 30 - 59%；G3 = 60 - 100%。
50名儿童（年龄7.5 - 15.0岁），分为3组（G1 = 19例，G2 = 23例，G3 = 8例；共100个髋关节）。术前和末次随访时的MI分别为22±7%和30±20%（G1组）、41±9%和43±22%（G2组）、92±15%和97±10%（G3组）。各组脊柱融合时的MI差异有统计学意义（<0.001）。在G1组，12个月和62个月时的平均MI进展分别为5%和25%。在G2组，12个月和32个月时的平均MI进展分别为9%和25%。G1组中超过10%的进展发生在2年内，G2组发生在1年内。基于术前PO程度（=0.653）和PO矫正率（=0.421），各组之间无差异。
在GMFCS IV级和V级儿童中，随着术前MI增加，尤其是超过50%时，进展风险最高。脊柱融合术后应持续监测髋关节，直至证明髋关节稳定。
