Department of Orthpaedic Surgery, Washington University School of Medicine.
Department of Orthopedic Surgery, Pediatric and Adolescent Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
J Pediatr Orthop B. 2022 Mar 1;31(2):182-187. doi: 10.1097/BPB.0000000000000847.
Femoral head avascular necrosis (AVN) is a complication of hip reconstruction in children with cerebral palsy (CP) with uncertain incidence. The purpose of this study was to establish the rate of AVN in children undergoing hip reconstruction and to identify the factors associated with AVN. Medical records and radiographs of patients aged 1-18 with a diagnosis of CP who have undergone hip reconstruction over a 9-year period (2010-2018) with at least 1-year follow-up were reviewed. Age at time of surgery, sex, Gross Motor Function Classification System (GMFCS), procedure(s), preoperative migration percentage (MP), and signs of AVN on anterioposterior pelvis radiographs at routine follow-up visits (3 months, 6 months, and years 1-9, annually) according to the Bucholz-Ogden (BO) and Kalamchi-MacEwen (KM) classification systems were recorded. Univariate analysis was used to test for significance. Three hundred forty-nine hips in 209 patients met our inclusion criteria. Eleven hips (rate; 3%), in 11 patients, developed AVN. Classification of AVN was found to consist of: class I-4 (36%), class II-1 (9%), class III-[BO: 4 (36%)] [KM: 3 (27%)], and Class IV-[BO: 2 (18%)] [KM: 3 (27%)]. Average follow-up was of 3.5 years. The AVN cohort displayed older age (11.0 ± 2.8 vs. 8.1 ± 3.4; P = 0.005). Open reduction was associated with increased AVN, occurring in 9% of the hips (P = 0.004). No significant association was found between preoperative MP, GMFCS, or acetabular osteotomy. The method of open reduction (anterior vs. medial) was not significantly associated with AVN (P = 0.4471). In this large series, the observed rate of AVN was 3%, associated with open reductions at time of hip reconstruction. If possible, closed reduction would be preferred at time of hip reconstruction in children with CP to lower the risk of AVN. Level of evidence: III.
股骨头缺血性坏死（AVN）是脑瘫（CP）儿童髋关节重建的一种并发症，其发病率尚不确定。本研究旨在确定儿童髋关节重建后发生 AVN 的比例，并确定与 AVN 相关的因素。对 2010 年至 2018 年间接受髋关节重建手术且至少有 1 年随访的 1-18 岁 CP 患儿的病历和 X 线片进行回顾性研究。记录手术时的年龄、性别、粗大运动功能分类系统（GMFCS）、手术类型、术前迁徙百分比（MP）以及根据 Bucholz-Ogden（BO）和 Kalamchi-MacEwen（KM）分类系统在常规随访（3 个月、6 个月和 1-9 年，每年）时前后骨盆 X 线片上的 AVN 征象。采用单因素分析检验显著性。209 例患儿的 349 髋符合纳入标准。11 例（11 髋，发生率为 3%）患儿发生 AVN。AVN 分类为：Ⅰ级-4 髋（36%）、Ⅱ级-1 髋（9%）、Ⅲ级-BO：4 髋（36%）、KM：3 髋（27%）和Ⅳ级-BO：2 髋（18%）、KM：3 髋（27%）。平均随访时间为 3.5 年。AVN 组的年龄较大（11.0±2.8 岁 vs. 8.1±3.4 岁；P=0.005）。切开复位与 AVN 发生率增加相关，发生于 9%的髋关节（P=0.004）。术前 MP、GMFCS 或髋臼截骨术与 AVN 无显著相关性。切开复位的方法（前侧 vs. 内侧）与 AVN 无显著相关性（P=0.4471）。在本大规模系列研究中，AVN 的观察发生率为 3%，与髋关节重建时切开复位有关。如果可能的话，CP 患儿髋关节重建时应首选闭合复位，以降低 AVN 的风险。证据等级：III。
