Delbrück Heide, Gehlen Yannik, Hildebrand Frank, Brunner Reinald
Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Emeritus, University Children's Hospital Basel, Switzerland.
EFORT Open Rev. 2024 Aug 1;9(8):773-784. doi: 10.1530/EOR-23-0043.
Up to 90% of nonambulatory patients with cerebral palsy (CP) experience hip displacement during their lifetime. Reconstructive surgery is recommended. Redisplacement rate is an outcome parameter.
In a systematic literature review (MEDLINE, Embase and CENTRAL databases) until January 2023 we searched for reports with redisplacement rates after bony hip reconstructive surgery in nonambulatory patients. Quantitative data synthesis, subgroup analysis and meta-regression with moderators were carried out.
The pooled mean redisplacement rate was 16% (95% CI: 12-21%) with a prediction interval of 3-51% (Q: 149; df: 32; P < 0.001; I2: 78%; τ2: 0.67 and τ: 0.82) in 28 studies (1540 hips). Varus derotation osteotomy (VDRO) alone showed a higher redisplacement rate than VDRO + pelvic osteotomy (30% vs 12%, P < .0001). Mean age in the VDRO-alone subgroup was 7.1 years and in the combined group 9.5 years (P = .004). In meta-regression, lower redisplacement rates were observed with higher preoperative migration index (MI) (correlation coefficient: -0.0279; P = .0137), where comprehensive surgery was performed. Variance in true effects are explained by type of bone surgery (57%), preoperative MI (11%), age (5%) and MI for definition of failure (20%). No significant reduction in the redisplacement rate could be observed over the mid-years of studies (1977-2015).
Our pooled data support the more extensive surgical approach in patients with high preoperative MI and emphasize the superiority of combined surgery. Studies should report a coordinated set of parameters and outcome classifications according to internationally accepted gradings to reduce redisplacement in future.
高达90%的非行走型脑瘫（CP）患者在其一生中会出现髋关节脱位。建议进行重建手术。再脱位率是一个结果参数。
在截至2023年1月的系统文献综述（MEDLINE、Embase和CENTRAL数据库）中，我们搜索了关于非行走型患者进行髋部骨重建手术后再脱位率的报告。进行了定量数据综合、亚组分析和带有调节因素的元回归分析。
在28项研究（1540例髋关节）中，汇总的平均再脱位率为16%（95%CI：12 - 21%），预测区间为3 - 51%（Q：149；自由度：32；P < 0.001；I²：78%；τ²：0.67；τ：0.82）。单纯内翻旋转截骨术（VDRO）的再脱位率高于VDRO + 骨盆截骨术（30%对12%，P <.0001）。单纯VDRO亚组的平均年龄为7.1岁，联合组为9.5岁（P =.004）。在元回归分析中，术前移位指数（MI）越高，再脱位率越低（相关系数：-0.0279；P =.0137），即进行了综合手术的情况。真实效应的差异由骨手术类型（57%）、术前MI（11%）年龄（5%）和失败定义的MI（20%）来解释。在研究的中期（1977 - 2015年），未观察到再脱位率有显著降低。
我们汇总的数据支持对术前MI高的患者采用更广泛的手术方法，并强调联合手术的优越性。未来的研究应根据国际认可的分级报告一套协调的参数和结果分类，以减少再脱位。
