Essiet Edidiong, Egu Chinedu, Akintunde Samuel, Rauf Mohammed Qasim
Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, GBR.
Spinal Surgery, Queens Medical Centre, Nottingham University Hospitals, Nottingham, GBR.
Cureus. 2024 Dec 8;16(12):e75348. doi: 10.7759/cureus.75348. eCollection 2024 Dec.
Avascular necrosis (AVN) of the femoral head confers a risk of morbidity amongst cerebral palsy (CP) patients. Meanwhile, the proportion who develop AVN post hip reduction surgery is unclear, and the risk factors are not established. To estimate the incidence and risk factors for AVN post hip reduction surgery in CP patients, we reviewed and analysed literature from Medline, Embase, and Web of Science repositories between January 1, 1990, and August 31, 2024. The included publications were reviewed for the incidence and risk factors in this cohort of patients. Findings were appraised using the methodological index for non-randomised studies, and scores and results were descriptively analysed. Given the marked heterogeneity of retrieved data, results were reported as standardised values, including the mean weighted incidence rate. A total of 1619 hip reduction surgeries were performed on 1045 CP patients across 12 retrospective studies with 424 cases of AVN. The mean age at surgery ranged from 7.3 to 16.2 across studies. The mean incidence was 0.482% ± 0.06945 per person-year. Most patients were in gross motor function classification system V, with a preoperative mean Reimers index of 54.11-80%. The average methodological items for non-randomised studies score was 10.08/16 ± 0.28 for all studies (n=12). AVN has a definite relationship with hip reduction surgery. The low methodological quality of reviewed studies informs the need for well-designed prospective randomised controlled studies to understand the mechanics of this relationship in terms of age of surgery and Reimers hip migration index, guide surgical timing, and patient selection.
股骨头缺血性坏死（AVN）会使脑瘫（CP）患者面临发病风险。与此同时，髋关节复位手术后发生AVN的患者比例尚不清楚，且风险因素尚未明确。为了评估CP患者髋关节复位手术后AVN的发病率及风险因素，我们检索并分析了1990年1月1日至2024年8月31日期间Medline、Embase和科学网数据库中的文献。对纳入的出版物进行审查，以确定该队列患者的发病率和风险因素。使用非随机研究的方法学指数对研究结果进行评估，并对评分和结果进行描述性分析。鉴于检索数据存在显著异质性，结果以标准化值报告，包括平均加权发病率。在12项回顾性研究中，共对1045例CP患者进行了1619例髋关节复位手术，其中424例发生AVN。各研究中手术时的平均年龄在7.3岁至16.2岁之间。平均发病率为每人年0.482%±0.06945。大多数患者处于粗大运动功能分级系统V级，术前平均Reimers指数为54.11 - 80%。所有研究（n = 12）的非随机研究方法学项目平均得分为10.08/16 ± 0.28。AVN与髋关节复位手术有明确关系。所审查研究的方法学质量较低，这表明需要设计良好的前瞻性随机对照研究，以从手术年龄和Reimers髋关节移位指数方面了解这种关系的机制，指导手术时机和患者选择。
