Hara Reiko, Rethlefsen Susan A, Wren Tishya A L, Kay Robert M
Motion and Sports Analysis Laboratory, Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Bioengineering (Basel). 2023 Oct 18;10(10):1214. doi: 10.3390/bioengineering10101214.
Asymmetry of pelvic rotation affects function. However, predicting the post-operative changes in pelvic rotation is difficult as the root causes are complex and likely multifactorial. This retrospective study explored potential predictors of the changes in pelvic rotation after surgery with or without femoral derotational osteotomy (FDRO) in ambulatory children with cerebral palsy (CP). The change in the mean pelvic rotation angle during the gait cycle, pre- to post-operatively, was examined based on the type of surgery (with or without FDRO) and CP distribution (unilateral or bilateral involvement). In unilaterally involved patients, pelvic rotation changed towards normal with FDRO ( = 0.04), whereas patients who did not undergo FDRO showed a significant worsening of pelvic asymmetry ( = 0.02). In bilaterally involved patients, the changes in pelvic rotation did not differ based on FDRO ( = 0.84). Pelvic rotation corrected more with a greater pre-operative asymmetry (β = -0.21, SE = 0.10, = 0.03). Sex, age at surgery, GMFCS level, and follow-up time did not impact the change in pelvic rotation. For children with hemiplegia, internal hip rotation might cause compensatory deviation in pelvic rotation, which could be improved with surgical correction of the hip. The predicted changes in pelvic rotation should be considered when planning surgery for children with CP.
骨盆旋转不对称会影响功能。然而，由于根本原因复杂且可能是多因素的，预测术后骨盆旋转的变化很困难。这项回顾性研究探讨了在患有脑性瘫痪（CP）的能行走儿童中，进行或未进行股骨去旋转截骨术（FDRO）手术后骨盆旋转变化的潜在预测因素。根据手术类型（有或无FDRO）和CP分布（单侧或双侧受累），检查了步态周期中术前至术后平均骨盆旋转角度的变化。在单侧受累患者中，进行FDRO时骨盆旋转向正常方向改变（P = 0.04），而未进行FDRO的患者骨盆不对称明显恶化（P = 0.02）。在双侧受累患者中，基于FDRO的骨盆旋转变化无差异（P = 0.84）。术前不对称程度越大，骨盆旋转矫正得越多（β = -0.21，标准误 = 0.10，P = 0.03）。性别、手术年龄、GMFCS水平和随访时间均不影响骨盆旋转的变化。对于偏瘫儿童，髋关节内旋可能导致骨盆旋转的代偿性偏差，通过髋关节手术矫正可改善这种情况。在为CP儿童计划手术时，应考虑骨盆旋转的预测变化。
