Jackie and Gene Autry Orthopedic Center.
Keck School of Medicine, University of Southern California, Los Angeles, CA.
J Pediatr Orthop. 2024 Oct 1;44(9):e803-e808. doi: 10.1097/BPO.0000000000002762. Epub 2024 Jun 27.
Posterior spinal fusion (PSF) and hip reconstruction are commonly indicated surgeries in children with cerebral palsy (CP), particularly those functioning at GMFCS levels IV and V. These are large and often painful procedures, and previous literature suggests that hip surgery is more painful than spine surgery in this patient population. The purpose of this study is to investigate pain scores and opioid use following hip and spine surgery in a large cohort of children with CP, including many patients who have undergone both types of surgery.
A retrospective chart review was performed to identify children with CP who underwent hip reconstruction and/or PSF at a tertiary children's hospital between 2004 and 2022. Charts were reviewed for demographic data, pain scores, pain medication usage, duration of hospital stay, and complications.
Data were collected for 200 patients (101 male, 99 female) who met inclusion criteria. Eighty-seven patients underwent hip reconstruction, 62 spinal fusion, and 51 both hip and spine surgery asynchronously. Median (interquartile range) age at the time of surgery was significantly older for spinal fusion compared with hip surgery [13.1 (4.9) vs. 8.1 (5.7) y, P <0.0001]. Length of stay was significantly longer after PSF, with a median of 6 (4) days compared with 2 (1) days after hip surgery ( P <0.0001). Both maximum and average daily pain scores were similar following hip and spine surgery, with the exception that average pain scores for hip surgery were slightly higher on postoperative day 1, hip=1.73 vs. spine=1.0 ( P <0.0001). The amount of opioids used, expressed as morphine milligram equivalents (MME)/kg were similar in the hip and spine surgery groups; however, it was significantly lower in the hip surgery group on postoperative day 0, hip=0.06 versus spine=0.17 ( P <0.0001). For the 51 patients who underwent both hip and spine surgery, the amount of opioids used mirrored that for the entire group (similar MME/kg, though only statistically significantly less on POD 0 and 3), and pain scores were not significantly different between the 2 groups except in 2 circumstances. The 2 exceptions in these 51 patients both demonstrated lower pain scores in patients after hip surgery, including lower maximum pain scores on POD 1 ( P =0.041), and lower average pain scores on POD3 ( P =0.043).
This is the largest series to date comparing postoperative pain in children with CP after hip and spine surgery, including 51 of 200 patients who underwent both types of surgery. The results of this study demonstrate that hip surgery is not more painful than spine surgery in children with CP, and conflict with the traditional belief that hip surgery is more painful. This is important information for health care providers when counseling patients and families regarding these surgeries in children with CP.
Level 3.
后路脊柱融合术（PSF）和髋关节重建术是脑瘫（CP）患儿常见的手术治疗方法，尤其是 GMFCS 水平 IV 和 V 的患儿。这些手术通常较大且疼痛明显，既往文献表明，与脊柱手术相比，髋关节手术在该患者人群中更为疼痛。本研究的目的是在大量 CP 患儿中调查髋关节和脊柱手术后的疼痛评分和阿片类药物使用情况，包括许多同时接受这两种手术的患者。
对 2004 年至 2022 年期间在一家三级儿童医院接受髋关节重建术和/或 PSF 的 CP 患儿进行了回顾性图表审查。对图表进行了审查，以获取人口统计学数据、疼痛评分、疼痛药物使用情况、住院时间和并发症。
共收集了 200 名符合纳入标准的患者（男性 101 名，女性 99 名）的数据。87 例接受髋关节重建术，62 例接受脊柱融合术，51 例同时进行髋关节和脊柱手术。与髋关节手术相比，脊柱融合术的手术时年龄中位数（四分位距）明显更大[13.1（4.9）比 8.1（5.7）岁，P＜0.0001]。PSF 后住院时间明显延长，中位数为 6（4）天，而髋关节手术为 2（1）天（P＜0.0001）。髋关节和脊柱手术后的最大和平均每日疼痛评分相似，除了髋关节手术后第 1 天平均疼痛评分稍高，髋关节=1.73 比脊柱=1.0（P＜0.0001）。髋关节和脊柱手术组中使用的阿片类药物量（以吗啡毫克当量（MME）/kg 表示）相似；然而，髋关节手术组在术后第 0 天的使用量明显较低，髋关节=0.06 比脊柱=0.17（P＜0.0001）。对于 51 例同时进行髋关节和脊柱手术的患者，使用的阿片类药物量与整个组相似（相同的 MME/kg，尽管仅在术后第 0 天和第 3 天统计学上有显著差异），并且除了两种情况外，两组之间的疼痛评分没有显著差异。在这 51 例患者中的 2 个例外均显示出髋关节手术后患者的疼痛评分较低，包括术后第 1 天的最大疼痛评分较低（P=0.041）和术后第 3 天的平均疼痛评分较低（P=0.043）。
这是迄今为止比较 CP 患儿髋关节和脊柱手术后术后疼痛的最大系列研究，包括 200 例患者中有 51 例同时接受了这两种手术。本研究的结果表明，髋关节手术在 CP 患儿中并不比脊柱手术更疼痛，与髋关节手术更疼痛的传统观念相矛盾。这对于在 CP 患儿中为这些手术提供咨询时的医护人员具有重要意义。
3 级。
