Howard Jason J, Graham H Kerr, Johari Ashok, Narayanan Unni, Bennett Lisa, Presedo Ana, Shore Benjamin J, Guerschman Tatiana, Aroojis Alaric
Department of Orthopedic Surgery, Nemours Children's Hospital, 1600 Rockland Road, Wilmington, Delaware 19803, USA.
Department of Orthopaedic Surgery, Royal Children's Hospital, 50, Flemington Road, Parkville, Victoria 3052, Australia.
SICOT J. 2024;10:30. doi: 10.1051/sicotj/2024023. Epub 2024 Aug 22.
This review brings together a multidisciplinary, multinational team of experts to discuss the current state of knowledge in the detection and treatment of hip displacement in cerebral palsy (CP), a global public health problem with a high disease burden. Though common themes are pervasive, different views are also represented, reflecting the confluence of traditional thinking regarding the aetiology and treatment of hip displacement in CP with emerging research that challenges these tried-and-true principles. The development of hip displacement is most closely related to gross motor function, with radiographic surveillance programs based on the Gross Motor Function Classification System (GMFCS), the goal being early detection and timely treatment. These treatments may include non-operative methods such as abduction bracing and Botulinum Neurotoxin A (BoNT-A), but outcomes research in this area has been variable in quality. This has contributed to conflicting opinions and limited consensus. Soft tissue lengthening of the hip adductors and flexors has traditionally been employed for younger patients, but population-based studies have shown decreased survivorship for this treatment when performed in isolation. Concerns with the identification of hip displacement in very young children are raised, noting that early reconstructive surgery has a high recurrence rate. This has prompted consideration of viable minimally invasive alternatives that may have better success rates in very young children with CP, or may at least delay the need for osteotomies. Recent reports have implicated the role of abnormal proximal femoral growth and secondary acetabular dysplasia as a primary cause of hip displacement, related to ambulatory status and abductor function. As such, guided growth of the proximal femur has emerged as a possible treatment that addresses this purported aetiology, with promising early results.
本综述汇聚了一个多学科、多国专家团队，以探讨脑瘫（CP）患儿髋关节脱位检测与治疗的当前知识状况，这是一个具有高疾病负担的全球公共卫生问题。尽管普遍存在一些共同主题，但也呈现了不同观点，反映出关于CP患儿髋关节脱位病因和治疗的传统思维与挑战这些久经考验原则的新兴研究的融合。髋关节脱位的发展与粗大运动功能最为密切相关，基于粗大运动功能分类系统（GMFCS）开展影像学监测项目，目标是早期发现并及时治疗。这些治疗方法可能包括外展支具和肉毒杆菌神经毒素A（BoNT - A）等非手术方法，但该领域的疗效研究质量参差不齐。这导致了意见分歧且共识有限。传统上，对于较年幼的患者采用髋内收肌和屈肌的软组织延长术，但基于人群的研究表明，单独进行这种治疗时生存率会降低。文中还提出了对极年幼患儿髋关节脱位识别的担忧，指出早期重建手术的复发率很高。这促使人们考虑可行的微创替代方法，这些方法在极年幼的CP患儿中可能有更高的成功率，或者至少可以推迟截骨手术的需求。最近的报告表明，股骨近端异常生长和继发性髋臼发育不良是髋关节脱位的主要原因，与行走状态和外展肌功能有关。因此，股骨近端引导生长已成为一种可能解决这一所谓病因的治疗方法，早期结果很有前景。
