Bin Majid Ozair, Alzayed Zayed S, Saba Iram, Aournaser Alia A, Valoria Ruby Anne A, Koaban Saeed, Zaabi Shahad A, Nogud Alaeldein A, Sharif Abdulrahman M
Orthopaedic Surgery, Sultan Bin Abdulaziz Humanitarian City, Riyadh, SAU.
Research, Sultan Bin Abdulaziz Rehabilitation Center, Riyadh, SAU.
Cureus. 2024 Feb 11;16(2):e53996. doi: 10.7759/cureus.53996. eCollection 2024 Feb.
Introduction For spastic hip dislocations, a variety of operations are available with open hip reduction and varus derotational osteotomy of the proximal femur combined with pelvic osteotomy ± adductor release being a good option with favourable outcomes. This study aims to assess the outcome and complications of combined open hip reduction with pelvic osteotomy and varus derotational osteotomy. Methods In this study, 70 hips in 52 patients with spastic hip dislocation due to cerebral palsy were included. All included patients were treated surgically in our institute between January 2016 and December 2021. There were 31 males and 21 females. For each patient, information was collected about the age at the time of surgery and different radiological parameters at three different time intervals: pre-operatively, immediately post-operatively, and at the final follow-up. We also collected information about any complications arising from the surgery performed. Results The mean duration of follow-up was 19.58 months. The acetabular index decreased from an average of 35.01° to 17.18° with a mean difference of 17.83° (p<0.001). The central edge angle, which averaged -49.13° in the pre-operative period, increased to 26.34° and then marginally decreased to 25.47° at the final follow-up. The average migration index of 80.51% in the pre-operative period improved to 1.4% post-operatively with a mean difference of -79.11% (p<0.01). The migration index increased to 8.54% at the final follow-up. Similarly, the neck-shaft angle, which averaged 160.89° in the pre-operative period, decreased to 125.23° at the time of final follow-up with a percentage change of -22.16%. Conclusion Single-stage combined surgery in the form of combined open hip reduction and pelvic osteotomy with varus derotational osteotomy successfully treats the condition and shows good outcomes in patients with spastic hip dislocations. This treatment is associated with very few complications.
引言 对于痉挛性髋关节脱位，有多种手术方式可供选择，开放髋关节复位加股骨近端内翻旋转截骨术联合骨盆截骨术±内收肌松解术是一种不错的选择，疗效良好。本研究旨在评估开放髋关节复位联合骨盆截骨术和内翻旋转截骨术的疗效及并发症。方法 本研究纳入了52例因脑瘫导致痉挛性髋关节脱位患者的70个髋关节。所有纳入患者于2016年1月至2021年12月在我院接受手术治疗。其中男性31例，女性21例。对于每位患者，收集了手术时的年龄以及三个不同时间点（术前、术后即刻和最终随访时）的不同放射学参数。我们还收集了手术相关的任何并发症信息。结果 平均随访时间为19.58个月。髋臼指数从平均35.01°降至17.18°，平均差值为17.83°（p<0.001）。术前平均为-49.13°的中心边缘角在最终随访时增至26.34°，随后略有降至25.47°。术前平均80.51%的移位指数术后改善至1.4%，平均差值为-79.11%（p<0.01）。最终随访时移位指数增至8.54%。同样，术前平均为160.89°的颈干角在最终随访时降至125.23°，百分比变化为-22.16%。结论 开放髋关节复位联合骨盆截骨术和内翻旋转截骨术的单阶段联合手术成功治疗了痉挛性髋关节脱位患者的病情，并显示出良好的疗效。该治疗方法并发症极少。
