Imerci Ahmet, Miller Freeman, Howard Jason J, Shrader M Wade
Department of Orthopaedic Surgery, Nemours Children's Health, Delaware Valley, Wilmington, DE USA.
Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
Indian J Orthop. 2024 Apr 25;58(6):669-679. doi: 10.1007/s43465-024-01144-0. eCollection 2024 Jun.
Proximal femoral osteotomy (PFO) is a reconstructive surgical option used to improve hip containment or correct internal hip rotation gait in children with cerebral palsy (CP). A few reports describe the risk of surgical complications after PFO. The purpose of this study was to determine the risk factors associated with adverse postoperative surgical outcomes in pediatric patients with CP following PFO and to report the treatment of complications.
Following institutional review board approval, 1085 (1003 primary and 82 secondary) PFO procedures were retrospectively reviewed in 563 children with CP with at least 1 year of follow-up after final surgery over an 18-year follow-up period. Demographic characteristics, motor type, gross motor function classification system (GMFCS) level, medical comorbidities, feeding tube status, seizure history, intervention type, and prevalence of PFO-related surgical complications and associated treatments were evaluated. Multivariate regression analysis was performed to determine risk factors for all surgical complications.
During a 5.8-year (± 3.8 years) follow-up, at least 1 surgical complication was identified in 143 (13.1%) hips in 121 (21.5%) patients after PFO in children with CP. Of these complications, the most common was heterotopic ossification (65 [6%] of hips); most of which were asymptomatic and required no treatment. Other complications included 25 (2%) nonunions, 21 (2%) deep or superficial infections, 13 (1%) delayed unions, 12 (1%) peri-implant fractures, and 7 early implant failures (0.64). The rate of revision surgery due to these complications was 13.1% (6.8% of hips), of which 41% (30 revision surgeries) were for the treatment of nonunion. Regarding the development of delayed union or nonunion, dystonia, GMFCS level IV/V, and seizure history were identified as risk factors by multivariate analysis.
The prevalence of surgical complications after PFO was 13.1% with 6.8% of hips requiring revision surgery. Dystonia, seizure history, and nonambulatory status were the strongest predictors for the need for revision surgery after PFO. These data can be used to help counsel patients and families regarding the risks associated with PFO for children with CP. IV; retrospective study.
股骨近端截骨术（PFO）是一种用于改善脑瘫（CP）患儿髋关节包容或纠正髋关节内旋步态的重建性手术选择。少数报告描述了PFO术后手术并发症的风险。本研究的目的是确定CP患儿PFO术后不良手术结局的相关危险因素，并报告并发症的治疗情况。
经机构审查委员会批准，对563例CP患儿的1085例（1003例初次手术和82例二次手术）PFO手术进行回顾性分析，这些患儿在最后一次手术后至少随访1年，随访期为18年。评估人口统计学特征、运动类型、粗大运动功能分类系统（GMFCS）水平、合并症、喂养管状态、癫痫病史、干预类型以及PFO相关手术并发症的发生率和相关治疗情况。进行多变量回归分析以确定所有手术并发症的危险因素。
在5.8年（±3.8年）的随访期间，CP患儿PFO术后121例（21.5%）患者的143髋（13.1%）至少出现1种手术并发症。在这些并发症中，最常见的是异位骨化（65髋[6%]）；其中大多数无症状，无需治疗。其他并发症包括25例（2%）骨不连、21例（2%）深部或浅表感染、13例（1%）延迟愈合、12例（1%）植入物周围骨折和7例早期植入物失败（0.64）。因这些并发症进行翻修手术的比例为13.1%（6.8%的髋），其中41%（30例翻修手术）是用于治疗骨不连。关于延迟愈合或骨不连的发生，多变量分析确定肌张力障碍、GMFCS IV/V级和癫痫病史为危险因素。
PFO术后手术并发症的发生率为13.1%，6.8%的髋需要翻修手术。肌张力障碍、癫痫病史和非行走状态是PFO术后需要翻修手术的最强预测因素。这些数据可用于帮助向患者和家属提供有关CP患儿PFO相关风险的咨询。IV；回顾性研究。
