Lebe Moritz, van Stralen Renée Anne, Buddhdev Pranai
Broomfield & Addenbrookes Hospitals, Chelmsford CM1 7ET, UK.
Erasmus MC Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands.
Children (Basel). 2022 Apr 25;9(5):609. doi: 10.3390/children9050609.
Guided growth is frequently used to modify lower-limb alignment in children, and recently temporary medial hemiepiphysiodesis of the proximal femur (TMH-PF) has been used for the management of hips at risk of subluxation in cerebral palsy (CP) patients. The aim of our study was to evaluate the efficacy of TMH-PF in the management of neuromuscular hip dysplasia in children with cerebral palsy.
A systematic search of the literature was performed by using PubMed, EMBASE, CINAHL, MEDLINE, Scopus and Cochrane databases. Pre- and postoperative radiographic changes of the migration percentage (MP), head-shaft angle (HSA) and acetabular index (AI) were included in a meta-analysis. Secondary outcomes were treatment complication rates, technical considerations and the limitations of this novel technique.
Four studies (93 patients; 178 hips) met the eligibility criteria for inclusion in the meta-analysis. All three radiographic measurements showed significant changes at a minimum of 2 years of follow-up. Mean changes for MP were 8.48% (95% CI 3.81-13.14), HSA 12.28° (95% CI 11.17-13.39) and AI 3.41° (95% CI 0.72-6.10), with I of 75.74%, 0% and 87.68%, respectively. The serious complication rate was overall low; however, physeal 'growing off' of the screw was reported in up to 43% of hips treated.
TMH-PF is an effective and predictable method to treat CP patients with 'hips at risk', and the overall complication rate is low; however, further work is required to identify the best candidates and surgical timing, as well as choice of technique and implant.
引导生长常用于儿童下肢对线的矫正，最近股骨近端临时内侧半骨骺阻滞术（TMH-PF）已被用于治疗脑瘫（CP）患者有半脱位风险的髋关节。我们研究的目的是评估TMH-PF在治疗脑瘫儿童神经肌肉性髋关节发育不良中的疗效。
通过使用PubMed、EMBASE、CINAHL、MEDLINE、Scopus和Cochrane数据库对文献进行系统检索。将术前和术后的影像学变化，即迁移百分比（MP）、头干角（HSA）和髋臼指数（AI）纳入荟萃分析。次要结果包括治疗并发症发生率、技术考量以及这项新技术的局限性。
四项研究（93例患者；178个髋关节）符合纳入荟萃分析的资格标准。所有三项影像学测量在至少2年的随访中均显示出显著变化。MP的平均变化为8.48%（95%CI 3.81 - 13.14），HSA为12.28°（95%CI 11.17 - 13.39），AI为3.41°（95%CI 0.72 - 6.10），I分别为75.74%、0%和87.68%。严重并发症发生率总体较低；然而，报道称在接受治疗的髋关节中，高达43%出现螺钉“骨骺脱离”。
TMH-PF是治疗有“髋关节风险”的CP患者的一种有效且可预测的方法，总体并发症发生率较低；然而，需要进一步研究以确定最佳候选者、手术时机，以及技术和植入物的选择。
