Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
J Orthop Sci. 2022 Sep;27(5):1082-1088. doi: 10.1016/j.jos.2021.06.019. Epub 2021 Aug 3.
Guided growth at the proximal femur using one transphyseal screw corrects coxa valga and improves hip displacement in cerebral palsy. This study aimed to validate the effects of adding guided growth (GG) to soft tissue release (STR), in terms of decreasing the migration percentage (MP), compared to those with soft tissue alone.
This retrospective study comprised patients with cerebral palsy who underwent soft tissue release alone (Group STR) or soft tissue release plus guided growth (Group GG) for hip displacement (mean age, 8.1 years; mean follow-up, 4.9 years). Difference in the MP and rate of controlling MP <40% at 2 years postoperatively and rate of revision surgeries at 5 years postoperatively were compared between the groups.
The two groups were comparable in age, side, and gross motor function level, but Group GG (n = 24) had more severe hip displacement preoperatively than did Group STR (n = 64). Group GG had a significantly greater 2-year decrease in the MP (-14.8% vs. -11.8%, p < 0.05) than did Group STR. Among patients with a pre-operative MP >50%, the rate of MP <40% was greater in Group GG (73%) than in Group STR (41%). Revision surgeries, mainly repeated guided growth and soft tissue release, were comparable between the groups.
This is the first comparative study to support adding guided growth to soft tissue release, as it results in greater improvements in hip displacement than that with soft tissue release alone. Non-ambulatory patients or severe hip displacement with MP 50%-70% could benefit from this less aggressive surgery by controlling the MP under 40% without femoral osteotomy.
经股骨近端骺板引导生长结合单枚骺板螺钉固定治疗脑瘫髋脱位可纠正髋内翻并改善髋关节位置。本研究旨在通过对比软组织松解（STR）组与软组织松解联合骺板引导生长（GG）组，验证骺板引导生长在降低骨移率（MP）方面的效果，与单纯行软组织松解相比。
本回顾性研究纳入了接受单纯软组织松解（STR 组，n=64）或软组织松解联合骺板引导生长（GG 组，n=24）治疗的脑瘫髋脱位患者。比较两组患者术后 2 年 MP 差值、控制 MP<40%的比例及术后 5 年翻修手术率。
两组患者的年龄、性别和粗大运动功能分级（GMFCS）均相似，但 GG 组（n=24）术前髋关节移位程度更严重。与 STR 组相比，GG 组术后 2 年的 MP 差值更大（-14.8%比-11.8%，p<0.05）。术前 MP>50%的患者中，GG 组 MP<40%的比例（73%）明显高于 STR 组（41%）。两组患者翻修手术率相当，主要为再次行骺板引导生长和软组织松解。
本研究为首次对比研究，支持在软组织松解的基础上联合骺板引导生长，该方法在改善髋关节位置方面优于单纯软组织松解。对于不能行走的患者或 MP 为 50%-70%的严重髋关节移位患者，可通过控制 MP 小于 40%，避免行股骨截骨，使此类侵袭性较小的手术获益。
