Hooks John B, Dayya David
Medicine, College of Osteopathic Medicine, University of New England, Biddeford, USA.
Family Medicine, New England Healthcare, New Canaan, USA.
Cureus. 2023 Oct 4;15(10):e46495. doi: 10.7759/cureus.46495. eCollection 2023 Oct.
Patients with cerebral palsy (CP) frequently require surgical hip interventions in early adulthood due to spasticity-related gait abnormalities. In most instances, these cases are characterized by severe restrictions on mobility. This is the case of a male patient with CP who underwent right proximal femoral open reduction internal fixation (ORIF) and reverse osteotomy for right hip subluxation in young adulthood. Patients with CP who undergo total hip arthroplasty (THA) or ORIF with reverse osteotomy often require future revision. The patient was initially given an estimated 10-year longevity for his plate and screw construct (hardware). Forty-four years later, the patient presented with debilitating chronic bilateral hip pain, requiring the assistance of a cane for ambulation. There is a limited body of knowledge on ORIF and reverse osteotomy follow-up in patients with CP within a 30- to 50-year period. At the 44th-year follow-up, CT and X-ray imaging found postoperative changes in the right femur, including intact hardware, bilateral acetabular dysplasia, right femoral stress fracture, progression of hip arthritis, and right iliopsoas bursitis. Surgery for hardware revision was not indicated. Gradual restoration of function was achieved over a 14-month period with conservative management. This case suggests that physical therapy (PT), exercise, and sporadic non-steroidal anti-inflammatory drug (NSAID) use are effective for improving chronic degenerative changes, associated bursitis, and loss of function in patients who developed CP-induced gait complications in young adulthood. These improvements can be made several decades after undergoing ORIF and osteotomies. This course of treatment was effective in improving the patient's quality of life without additional surgical interventions.
由于痉挛相关的步态异常，脑瘫（CP）患者在成年早期经常需要进行髋关节手术干预。在大多数情况下，这些病例的特点是行动严重受限。本文介绍的是一名患有CP的男性患者，他在年轻时接受了右股骨近端切开复位内固定术（ORIF）和右髋关节半脱位的反向截骨术。接受全髋关节置换术（THA）或ORIF及反向截骨术的CP患者通常需要进行未来翻修。该患者最初其钢板和螺钉结构（硬件）的使用寿命估计为10年。44年后，患者出现了使人衰弱的双侧慢性髋部疼痛，行走需要拐杖辅助。关于CP患者在30至50年内进行ORIF和反向截骨术的随访知识有限。在第44年的随访中，CT和X线成像发现右股骨术后有变化，包括硬件完好、双侧髋臼发育不良、右股骨应力性骨折、髋关节炎进展和右髂腰肌滑囊炎。未建议进行硬件翻修手术。通过保守治疗，在14个月的时间里逐渐恢复了功能。该病例表明，物理治疗（PT）、运动和偶尔使用非甾体抗炎药（NSAID）对于改善成年早期出现CP诱发步态并发症的患者的慢性退行性改变、相关滑囊炎和功能丧失是有效的。这些改善可以在接受ORIF和截骨术几十年后实现。这种治疗过程在无需额外手术干预的情况下有效改善了患者的生活质量。
