Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy
Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy
复制标题
DOI：
10.2106/jbjs.c.01099
复制
发表时间：
2005-04-01
影响因子：
5.3
通讯作者：
Miller, F
中科院分区：
文献类型：
--
作者：
Presedo, A;Oh, CW;Miller, F
背景：痉挛性髋关节半脱位和脱位是脑瘫儿童的常见问题。软组织松解已被证明对预防痉挛性髋关节脱位是有益的。1988年建立了基于患者年龄、髋关节外展和髋关节移位百分比的治疗方案。本研究的目的是评估65名按照该方案治疗并随访至少8年的儿童的结果。方法：对符合纳入标准的74例患儿中65例患儿的病历和x线片进行回顾性分析。47名儿童患有痉挛性四肢瘫痪，无法行走；18名患有痉挛性双瘫的儿童能够独立行走或使用辅助设备。手术时的平均年龄为4.4岁。对129例髋关节进行了开放内收肌肌腱切开术和腰肌收缩或髂腰肌肌腱切开术，平均随访10.8年。随访时的平均年龄为15岁。根据术前、术后1年和最后随访时髋关节移位百分比进行分组。患者的最终结局是根据髋关节的恶化来确定的。进行分析以确定影响结果的潜在因素。结果：良好32例（49%），一般11例（17%），不良3例（4%），失败19例（30%）。术前髋部平均移位率为34%，最后随访时为18%。19例患者需要后续骨重建手术，11例患者需要重复软组织释放。术后1年的迁移率最能预测最终结果（p = 0.001）。术前能够行走的患者远期预后较好（p = 0.01）。术前髋关节移位百分比和手术年龄对结果均无显著影响。结论：65例痉挛性髋关节半脱位患儿中，有67%（43例）的软组织松解对长期预防髋关节脱位是有效的。术前与预后相关的两个因素是痉挛性双瘫的累及模式和行走能力。术后一年髋关节移位率是预测最终结果的良好指标。
Background: Spastic hip subluxation and dislocation are common problems in children with cerebral palsy. Soft-tissue releases have proved to be beneficial in the prevention of spastic hip dislocation. A protocol for treatment based on patient age, hip abduction, and hip migration percentage was established in 1988. The purpose of this study was to assess the outcome in sixty-five children treated according to this protocol and followed for a minimum of eight years.Methods: The medical records and radiographs of sixty-five children, from an original series of seventy-four patients, who met the inclusion criteria were available for review. Forty-seven children had spastic quadriplegia and were unable to walk; eighteen children had spastic diplegia and were able to walk independently or with assistive devices. The mean age at the time of the surgery was 4.4 years. Open adductor tenotomy and psoas muscle recession or iliopsoas tenotomy were performed on 129 hips, which were followed for a mean of 10.8 years. The mean age at the time of follow-up was fifteen years. Hips were grouped according to the hip migration percentage preoperatively, at one year postoperatively, and at the time of final follow-up. The final outcome for the patient was defined according to the worse hip. An analysis was performed to identify potential factors influencing outcome.Results: Thirty-two patients (49%) had a good result, eleven (17%) had a fair result, three (4%) had a poor result, and nineteen (30%) had a failure. The mean hip migration percentage was 34% preoperatively and 18% at the time of final follow-up. Nineteen patients required subsequent osseous reconstructive procedures, and eleven required repeat soft-tissue releases. The migration percentage at one year postoperatively was the most predictive of the final outcome (p = 0.001). Patients who had been able to walk preoperatively had a better long-term outcome (p = 0.01). Neither the preoperative hip migration percentage nor the age at surgery significantly affected the outcome.Conclusions: Soft-tissue release was effective for long-term prevention of hip dislocation in 67% (forty-three) of sixty-five children with spastic hip subluxation. Two preoperative factors that were related to a favorable outcome were a spastic diplegic pattern of involvement and the ability to walk. The hip migration percentage at one year postoperatively was a good predictor of final outcome.