Kasprzyk Maciej, Koch Aleksander, Jóźwiak Marek
Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland.
J Child Orthop. 2025 Jan 10;19(1):83-91. doi: 10.1177/18632521241300880. eCollection 2025 Feb.
Our study aimed to present health-related quality of life (HRQL) after combined bone reconstruction in nonambulatory patients with cerebral palsy (CP) after at least a 2-year follow-up and to assess its impact on HRQL using the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire (CPCHILD) as the primary outcome measure.
In this prospective study, we analyzed 31 nonambulatory patients with spastic or mixed CP (GMFCS levels IV-V) who underwent hip reconstructive surgery between 2015 and 2021. The surgical procedures included one-sided varus derotation osteotomy of the femur with Dega transiliac osteotomy and, on the opposite side, varus derotation osteotomy (VDRO) of the femur with shortening and, as needed, Dega pelvic osteotomy.
The study demonstrated significant improvement in the hip joint motion range, as assessed by the Thomas test, in hip abduction and rotational movements of the hip, as well as reduction of spasticity. The procedures also resulted in significant radiographic improvement of the femoral head coverage. The assessment of symptoms and problems associated with the hip revealed a positive influence of the surgery on pain, contractures, toileting/perineal hygiene, dressing, seating, transferring, and position changes. The mean improvement at a follow-up visit was significant in all domains of the CPCHILD, except for communication and social interaction.
Hip reconstruction with VDRO and Dega pelvic osteotomy can enhance the HRQL of children with CP. These surgical interventions can help to achieve the correct hip position and to reduce pain, which positively affects the patient QL, although proactive treatment results in less invasive procedures.
IV case series.
我们的研究旨在呈现非行走型脑瘫（CP）患者在进行联合骨重建后至少2年随访的健康相关生活质量（HRQL），并使用照顾者优先事项和儿童残疾生活健康指数问卷（CPCHILD）作为主要结局指标评估其对HRQL的影响。
在这项前瞻性研究中，我们分析了2015年至2021年间接受髋关节重建手术的31例痉挛型或混合型CP（粗大运动功能分级系统IV - V级）非行走型患者。手术程序包括一侧股骨内翻旋转截骨术联合Dega髂骨截骨术，另一侧股骨内翻旋转截骨术（VDRO）并缩短，必要时行Dega骨盆截骨术。
通过托马斯试验评估，研究表明髋关节活动范围、髋关节外展和旋转运动有显著改善，痉挛程度减轻。这些手术还使股骨头覆盖情况在影像学上有显著改善。对与髋关节相关的症状和问题的评估显示，手术对疼痛、挛缩、如厕/会阴卫生、穿衣、就座、转移和体位改变有积极影响。除沟通和社交互动外，CPCHILD所有领域在随访时的平均改善均显著。
VDRO和Dega骨盆截骨术进行髋关节重建可提高CP儿童的HRQL。这些手术干预有助于实现正确的髋关节位置并减轻疼痛，对患者生活质量有积极影响，尽管积极治疗会使手术创伤更小。
IV级病例系列。
