Bevan Alistair, Buchan Stephanie, Aarvold Alexander, Bennet Simon, Rad Darius, Le Prevost Nick, Edwards Caroline
Faculty of Medicine, University of Southampton, Southampton, UK.
University Hospitals of Derby and Burton NHS Foundation Trust, Derbyshire, UK.
Indian J Orthop. 2024 Sep 16;58(12):1844-1851. doi: 10.1007/s43465-024-01257-6. eCollection 2024 Dec.
Hip surgery is often necessary for children with severe neuromuscular disabilities to avoid chronic pain resulting from hip migration. This study correlated the Surgical Vulnerability Score (SVS), a novel measure of physiological reserve, with reconstructive hip surgery outcomes to improve shared surgical decision-making.
Sixty-eight cases performed by a single surgeon were retrospectively evaluated. Cases were graded according to physiological vulnerability using the SVS, which was then correlated with two outcomes: length of hospital stay (LOS) and severity of postoperative complications. The Gross Motor Function Classification System (GMFCS) level was used as a baseline comparison. Sub-analysis compared results for patients who underwent only a femoral varus derotation osteotomy (VDRO) ( = 48) with those who underwent a combined VDRO and Dega Pelvic Osteotomy (Dega PO) ( = 20).
Results showed that a higher SVS was associated with increased LOS (= 0.001) and severity of postoperative complications ( = 0.0008). A greater GMFCS level was not associated with either LOS ( = 0.246) or the severity of postoperative complications ( = 0.282). For patients who underwent only a VDRO, an increase in SVS had no association with LOS ( = 0.483) or severity of complications ( = 0.981). However, for patients who underwent both a VDRO and Dega PO, a higher SVS was associated with increased LOS ( = 0.0002) and severity of complications ( = 0.0001).
The SVS can aid surgical decision-making and prepare the child's family for surgery. Early intervention and fixation using only a VDRO may lead to better outcomes, underscoring the importance of hip surveillance programs in the early identification of migrating hips.
对于患有严重神经肌肉残疾的儿童，髋关节手术通常是必要的，以避免因髋关节移位导致的慢性疼痛。本研究将手术脆弱性评分（SVS）（一种生理储备的新测量方法）与髋关节重建手术结果相关联，以改善共同的手术决策。
回顾性评估由一名外科医生实施的68例病例。根据生理脆弱性使用SVS对病例进行分级，然后将其与两个结果相关联：住院时间（LOS）和术后并发症的严重程度。采用粗大运动功能分类系统（GMFCS）水平作为基线对照。亚分析比较了仅接受股骨内翻旋转截骨术（VDRO）（n = 48）的患者与接受VDRO联合德加骨盆截骨术（德加PO）（n = 20）的患者的结果。
结果显示，较高的SVS与住院时间增加（P = 0.001）和术后并发症严重程度增加（P = 0.0008）相关。较高的GMFCS水平与住院时间（P = 0.246）或术后并发症严重程度（P = 0.282）均无关。对于仅接受VDRO的患者，SVS的增加与住院时间（P = 0.483）或并发症严重程度（P = 0.981）无关。然而，对于接受VDRO和德加PO的患者，较高的SVS与住院时间增加（P = 0.0002）和并发症严重程度增加（P = 0.0001）相关。
SVS有助于手术决策，并让患儿家属为手术做好准备。仅使用VDRO进行早期干预和固定可能会带来更好的结果，强调了髋关节监测计划在早期识别移位髋关节方面的重要性。
