Westberry David E, Carson Lisa, Shull Emily R, Hyer Lauren C
Shriners Hospitals for Children® - Greenville, Greenville, South Carolina, USA.
J Pediatr Orthop B. 2023 Sep 1;32(5):461-469. doi: 10.1097/BPB.0000000000001091. Epub 2023 May 1.
Children with cerebral palsy (CP) and neuromuscular hip dysplasia (NMHD) frequently require hip reconstruction including femoral and pelvic osteotomies. Outcomes and complications in CP patients with NMHD who underwent varying degrees of hip reconstruction surgeries were examined. Ninety-nine patients with a diagnosis of CP who underwent surgical management of NMHD over a 15-year period (2005-2020) were reviewed. Three patient cohorts with varying degrees of surgery were analyzed including: (1) unilateral femoral osteotomy with pelvic osteotomy; (2) bilateral femoral osteotomy with unilateral pelvic osteotomy; and (3) simultaneous bilateral femoral osteotomy and bilateral pelvic osteotomy. Data points included operative (OR) time, length of stay (LOS), estimated blood loss (EBL), and transfusion requirement. Complications during the perioperative and postoperative periods were identified and graded by severity. Increased EBL, need for transfusion, OR time, and LOS were observed more frequently in patients undergoing bilateral reconstruction. Complication rates were high for all three cohorts, with 87% of cases in the bilateral pelvic osteotomy cohort experiencing ≥1 complication. However, 90% of these were considered grade I or II and required no or minimal intervention. The average postoperative migration index at final follow-up for treated hips was significantly less in bilateral pelvic osteotomy cases. Patients with CP and bilateral NMHD can be safely managed with bilateral simultaneous comprehensive reconstruction. The data presented in this study can help both surgeons and families anticipate a more accurate postoperative course. Level of evidence: III.
患有脑瘫（CP）和神经肌肉性髋关节发育不良（NMHD）的儿童经常需要进行髋关节重建，包括股骨和骨盆截骨术。我们研究了接受不同程度髋关节重建手术的CP合并NMHD患者的手术结果和并发症情况。回顾了99例在15年期间（2005 - 2020年）被诊断为CP并接受NMHD手术治疗的患者。分析了三个不同手术程度的患者队列，包括：（1）单侧股骨截骨术加骨盆截骨术；（2）双侧股骨截骨术加单侧骨盆截骨术；（3）同时进行双侧股骨截骨术和双侧骨盆截骨术。数据点包括手术时间（OR）、住院时间（LOS）、估计失血量（EBL）和输血需求。确定围手术期和术后并发症并按严重程度分级。在接受双侧重建的患者中，EBL增加、输血需求、手术时间和住院时间更为常见。所有三个队列的并发症发生率都很高，双侧骨盆截骨术队列中87%的病例发生≥1种并发症。然而，其中90%被认为是I级或II级，无需或只需极少干预。在双侧骨盆截骨术病例中，治疗后髋关节在最终随访时的平均术后移位指数显著更低。CP合并双侧NMHD的患者可以通过双侧同时进行全面重建得到安全治疗。本研究提供的数据可以帮助外科医生和患者家庭更准确地预测术后病程。证据级别：III级。
