脑瘫儿童髋关节脱位的治疗：163 例患儿近端股骨截骨术与股骨骨盆联合截骨术 5 年比较

Treatment of Hip Displacement in Children With Cerebral Palsy: A 5-year Comparison of Proximal Femoral Osteotomy and Combined Femoral-Pelvic Osteotomy in 163 Children.

机构信息

Department of Women's and Children's Health, Karolinska Institutet.

Department of Highly Specialized Pediatric Orthopedics and Medicine, Astrid Lindgren's Children Hospital, Karolinska University Hospital, Stockholm.

出版信息

J Pediatr Orthop. 2024 Jul 1;44(6):e536-e541. doi: 10.1097/BPO.0000000000002674. Epub 2024 Mar 13.

DOI:10.1097/BPO.0000000000002674

PMID:38477355

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11152590/

Abstract

BACKGROUND

This study compared the 5-year outcomes of isolated proximal femoral varus osteotomy (FO) and combined proximal femoral varus and pelvic osteotomy (FPO) for the treatment of hip displacement in children with cerebral palsy (CP) in Sweden, focusing on the number of reoperations and residual hip displacement.

METHODS

The study included 163 children with a 5-year follow-up after FO or FPO in the national Swedish CP surveillance program, CPUP. Descriptive statistics and univariate and multivariate Cox regression analyses were used to identify whether the age at surgery, sex, Gross Motor Function Classification System level, CP dominant symptom, hip migration percentage (MP), type of surgery (unilateral/bilateral), and history of soft tissue hip surgery were related to the 5-year outcomes after surgery. Failure after hip surgery was defined as a skeletal reoperation involving the hip and/or MP >50%.

RESULTS

During the period 2001 to 2017, 163 children (65 girls) underwent 246 femoral and/or pelvic osteotomies (154 FO, 47 bilaterally; 92 FPO, 16 bilaterally) and had a 5-year follow-up; 95 and 74 children had ≥1 FO or FPO as the primary skeletal surgery, respectively. The mean preoperative MP (51%±18% for FO and 59%±17% for FPO, P =0.001) and age at surgery (6.2±2.5 years for FO and 7.3±2.8 years for FPO, P =0.014) differed between procedures. At the 5-year follow-up, 5 hips (5%) had reoperations and 5 hips (5%) had radiological failure among the 92 FPOs, and 33 (21%) had reoperations and 14 (9%) radiological failure among the 154 FOs. The difference in outcome failure rate was significant ( P <0.001). Multivariate Cox regression analysis showed a lower risk for failure with FPO [hazard ratio (HR)=0.32, 95% CI: 0.15-0.68] compared with FO. A higher preoperative MP increased the risk for outcome failure (HR=1.21, 95% CI: 1.15-1.36 for each 5% increment).

CONCLUSIONS

FPO had a higher mean preoperative MP but a lower 5-year outcome failure rate compared with FO. A higher preoperative MP was associated with an increased risk of failure.

LEVEL OF EVIDENCE

Level II-prospective comparative study.

摘要

背景

本研究比较了单纯股骨近端内翻截骨术（FO）和股骨近端内翻合并骨盆截骨术（FPO）治疗脑瘫（CP）患儿髋关节移位的 5 年疗效，重点关注再次手术数量和残余髋关节移位。

方法

该研究纳入了全国瑞典 CP 监测项目 CPUP 中 163 例接受 FO 或 FPO 治疗并随访 5 年的患儿。采用描述性统计、单变量和多变量 Cox 回归分析，确定手术时的年龄、性别、粗大运动功能分级系统（GMFCS）水平、CP 主要症状、髋关节移位百分比（MP）、手术类型（单侧/双侧）和髋关节软组织手术史是否与术后 5 年的结果相关。髋关节手术后失败定义为涉及髋关节和/或 MP＞50%的骨骼再手术。

结果

2001 年至 2017 年期间，163 例患儿（65 例女性）接受了 246 次股骨和/或骨盆截骨术（154 例行 FO，其中 47 例双侧；92 例行 FPO，其中 16 例双侧），并进行了 5 年随访；95 例和 74 例患儿分别至少有 1 次 FO 或 FPO 作为主要骨骼手术。FO 和 FPO 的术前 MP（分别为 51%±18%和 59%±17%，P=0.001）和手术时的年龄（分别为 6.2±2.5 岁和 7.3±2.8 岁，P=0.014）存在差异。在 5 年随访时，92 例 FPO 中有 5 髋（5%）行再次手术，5 髋（5%）出现影像学失败；154 例 FO 中有 33 髋（21%）行再次手术，14 髋（9%）出现影像学失败。结果失败率的差异具有统计学意义（P＜0.001）。多变量 Cox 回归分析显示，与 FO 相比，FPO 的失败风险更低[风险比（HR）=0.32，95%可信区间：0.15-0.68]。术前 MP 越高，结果失败的风险越高（每增加 5%，HR=1.21，95%可信区间：1.15-1.36）。