Can a Surgical Vulnerability Score Predict Outcomes of Hip Reconstruction in Children with Severe Neuromuscular Disability?

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-09-16 DOI:10.1007/s43465-024-01257-6

Alistair Bevan, Stephanie Buchan, Alexander Aarvold, Simon Bennet, Darius Rad, Nick Le Prevost, Caroline Edwards

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Abstract

Background

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.

Materials and methods

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) (n = 48) with those who underwent a combined VDRO and Dega Pelvic Osteotomy (Dega PO) (n = 20).

Results

Results showed that a higher SVS was associated with increased LOS (p = 0.001) and severity of postoperative complications (p = 0.0008). A greater GMFCS level was not associated with either LOS (p = 0.246) or the severity of postoperative complications (p = 0.282). For patients who underwent only a VDRO, an increase in SVS had no association with LOS (p = 0.483) or severity of complications (p = 0.981). However, for patients who underwent both a VDRO and Dega PO, a higher SVS was associated with increased LOS (p = 0.0002) and severity of complications (p = 0.0001).

Conclusions

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.

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手术易损性评分能否预测严重神经肌肉残疾儿童髋关节重建的结果？

背景严重神经肌肉残疾儿童通常需要进行髋关节手术，以避免髋关节移位导致的慢性疼痛。本研究将外科脆弱性评分（SVS）--一种新的生理储备测量方法--与髋关节重建手术结果相关联，以改善共同的手术决策。使用 SVS 根据生理脆弱性对病例进行分级，然后将 SVS 与两种结果相关联：住院时间（LOS）和术后并发症的严重程度。粗大运动功能分级系统（GMFCS）水平被用作基线比较。子分析比较了仅接受股骨外翻截骨术（VDRO）的患者（n = 48）与接受VDRO和Dega骨盆联合截骨术（Dega PO）的患者（n = 20）的结果。结果结果显示，SVS越高，住院时间（LOS）（p = 0.001）和术后并发症（p = 0.0008）的严重程度就越高。而 GMFCS 水平越高，则与住院时间（p = 0.246）或术后并发症严重程度（p = 0.282）无关。对于只接受 VDRO 的患者，SVS 的增加与 LOS（p = 0.483）或并发症的严重程度（p = 0.981）没有关系。然而，对于同时接受 VDRO 和 Dega PO 的患者，较高的 SVS 与较长的生命周期（p = 0.0002）和并发症严重程度（p = 0.0001）相关。仅使用 VDRO 进行早期干预和固定可能会带来更好的预后，这凸显了髋关节监测计划在早期识别髋关节移位方面的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.