Departments of Orthpaedic Surgery.
Pediatric and Adolescent Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
J Pediatr Orthop. 2022 Jan 1;42(1):e78-e82. doi: 10.1097/BPO.0000000000001989.
The rates and risk factors contributing to failure after hip reconstruction among patients with cerebral palsy (CP) are not well established. In analyzing a large cohort of children with CP who underwent hip reconstruction, the objectives of this study are to establish (1) the failure rates and (2) associated risk factors.
This retrospective study included chart and radiographic review of patients between the ages of 1 to 18, with a diagnosis of CP, who underwent a hip reconstructive procedure at a single children's hospital over a 9-year period (2010 to 2018). Patients without at least 2 years of follow-up were excluded. Age at time of surgery, sex, Gross Motor Function Classification System (GMFCS), procedure(s) performed, preoperative migration percentage (MP), neck-shaft angle, and acetabular index (AI) were recorded. Failure was defined as need for revision surgery or a MP >50% on follow-up radiographs. Logistic regression and multiple-variable regression-type models were used to test for significance of risk factors.
Of the 291 hips in 179 patients (102 males, 77 females) that met inclusion criteria, 38 hips (13%) failed. Significant differences in the failure group were seen in age at time of surgery (6.2±3.2 vs. 8.1±3.2; P<0.001), preoperative MP (62.3±28.7 vs. 39.9±24.1%; P<0.001) and preoperative neck-shaft angle (164.9±8.2 vs. 157.3±15.6 degrees; P<0.001). Age below 6 at time of surgery significantly increased failure rate (26% vs. 6.3%, P<0.001) as did preoperative MP >70% (28.9% vs. 9.9%, P<0.001). Receiving an acetabular osteotomy was protective against failure (9.1% vs. 16.9%, P=0.048), particularly in patients with a preoperative AI >25° (odds ratio=0.236; confidence interval: 0.090-0.549).
In this case series, failure after hip reconstruction for children with CP was determined to be 13.1%. There was a higher risk associated with age under 6 at time of surgery or a preoperative MP >70%. Correction of acetabular dysplasia when AI is more than 25 degrees with acetabular osteotomy at time of hip reconstruction, exerted a protective effect against subsequent failure.
Level III-retrospective case series.
脑瘫（CP）患者髋关节重建后失败的发生率和相关风险因素尚未明确。本研究对在单家儿童医院接受髋关节重建的大量 CP 患儿进行分析，旨在确定（1）失败率，以及（2）相关风险因素。
本回顾性研究纳入了 2010 年至 2018 年期间在一家儿童医院接受髋关节重建手术的年龄在 1 至 18 岁之间、CP 诊断明确的患儿的图表和影像学检查资料。排除了随访时间不足 2 年的患儿。记录患儿的年龄、性别、粗大运动功能分类系统（GMFCS）分级、手术方式、术前骨盆迁徙率（MP）、颈干角和髋臼指数（AI）。将需要翻修手术或随访 X 线片上 MP＞50%定义为失败。采用逻辑回归和多变量回归模型检验风险因素的显著性。
符合纳入标准的 179 例患儿的 291 髋中，38 髋（13%）失败。失败组与成功组在手术时的年龄（6.2±3.2 岁比 8.1±3.2 岁；P＜0.001）、术前 MP（62.3±28.7%比 39.9±24.1%；P＜0.001）和术前颈干角（164.9±8.2 度比 157.3±15.6 度；P＜0.001）方面存在显著差异。手术时年龄＜6 岁显著增加失败率（26%比 6.3%，P＜0.001），术前 MP＞70%也显著增加失败率（28.9%比 9.9%，P＜0.001）。接受髋臼截骨术可降低失败风险（9.1%比 16.9%，P=0.048），尤其是术前 AI＞25°的患儿（比值比=0.236；95%置信区间：0.090-0.549）。
本病例系列研究中 CP 患儿髋关节重建后失败率为 13.1%。手术时年龄＜6 岁或术前 MP＞70%与较高的失败风险相关。在髋关节重建时，对于 AI ＞25°的患儿，采用髋臼截骨术纠正髋臼发育不良，可降低随后的失败风险。
III 级-回顾性病例系列研究。
