Gillette Children's Specialty Healthcare, 200 University Avenue East, Saint Paul, MN, 55101, United States; University of Minnesota, Orthopedic Surgery, 2450 Riverside Ave, Minneapolis, MN, 55454, United States.
Gillette Children's Specialty Healthcare, 200 University Avenue East, Saint Paul, MN, 55101, United States.
Gait Posture. 2021 Jun;87:184-191. doi: 10.1016/j.gaitpost.2021.04.029. Epub 2021 Apr 22.
It is unknown how a femoral derotation osteotomy (FDO) during childhood affects functional outcomes in adulthood among individuals with bilateral cerebral palsy (CP).
How do long-term functional outcomes after an FDO compare to matched individuals who did not have an FDO? How do outcomes change over time?
We queried the gait laboratory database for individuals who underwent an external FDO in childhood and were currently ≥25 years old. Participants returned for a long-term analysis (gait, physical examination, functional tests, imaging, questionnaires). The matched non-FDO group included only individuals in Gross Motor Function Classification System levels I-II, yielding three groups (non-FDO I-II, FDO I-II, FDO III-IV).
Sixty-one adults (11 non-FDO, 34 FDO I-II, 16 FDO III-IV) returned 13-25 years after baseline (non-FDO) or surgery (FDO). The non-FDO and FDO I-II groups were matched at baseline on most variables, except the FDO group had weaker hip abductors. At long-term, groups were similar on gait variables (median long-term hip rotation [primary outcome], non-FDO: -4°, FDO I-II: -4°, FDO III-IV: -5°), hip abduction test, fear of falling, and most pain measures despite anteversion being 29° greater in the non-FDO group. The FDO I-II group reported more falls than the non-FDO group. All groups improved on hip rotation, foot progression, and hip abductor strength. Speed and step length decreased/tended to decrease for all three groups. Hip abduction moment and gait deviation index did not change. Improvements in the FDO groups were maintained from short- to long-term.
These results challenge the notion that an FDO is necessary to correct mean stance hip rotation for higher functioning individuals since nearly identical results were achieved by adulthood in the non-FDO I-II group. However, an FDO provides improvement earlier and maintenance from short- to long-term. This should factor into the shared decision-making process.
儿童期股骨旋转移位截骨术（FDO）如何影响双侧脑瘫（CP）患者成年后的功能结局尚不清楚。
FDO 后的长期功能结果与未行 FDO 的匹配个体相比如何？结果如何随时间变化？
我们查询了步态实验室数据库，以寻找在儿童期接受过外部 FDO 且目前年龄≥25 岁的个体。参与者返回进行长期分析（步态、体格检查、功能测试、影像学、问卷调查）。匹配的非 FDO 组仅包括 GMFCS 水平 I-II 的个体，产生了三组（非 FDO I-II、FDO I-II、FDO III-IV）。
61 名成年人（11 名非 FDO、34 名 FDO I-II、16 名 FDO III-IV）在基线（非 FDO）或手术（FDO）后 13-25 年返回。非 FDO 和 FDO I-II 组在大多数变量上在基线时匹配，除了 FDO 组的髋关节外展肌较弱。在长期随访中，各组在步态变量（主要结果为长期髋关节旋转中位数）、髋关节外展试验、跌倒恐惧和大多数疼痛测量方面相似，尽管非 FDO 组的前倾角大 29°。FDO I-II 组报告的跌倒次数多于非 FDO 组。所有组的髋关节旋转、足推进和髋关节外展肌力量均得到改善。所有三组的速度和步长均下降/有下降趋势。髋关节外展力矩和步态偏差指数没有变化。FDO 组的改善从短期到长期均保持。
这些结果挑战了这样一种观点，即对于功能较高的个体，FDO 是纠正平均站立髋关节旋转所必需的，因为在非 FDO I-II 组中，到成年后几乎可以达到相同的结果。然而，FDO 提供了更早的改善和从短期到长期的维持。这应该成为共同决策过程的一部分。
