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IF 1.4 3区医学 Q3 ORTHOPEDICS

Journal of Pediatric Orthopaedics Pub Date : 2025-04-03 DOI:10.1097/BPO.0000000000002964

Kevin Chun-Kai Chiu, Chia-Che Lee, Kuan-Wen Wu, Kuang-Yu Cheng, Ken N Kuo, Ting-Ming Wang

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引用次数: 0

摘要

背景：股骨近端引导生长是一种治疗髋臼的微创手术，对脑瘫（CP）患者的短期治疗效果很好。然而，由于它会改变躯干的生长，现有研究缺乏直到骨骼成熟的全面长期分析：这项回顾性研究纳入了2012年至2017年期间接受股骨近端引导生长手术的痉挛性CP患儿，并随访至趾骨闭合。影像学测量包括头轴角（HSA）、Hilgenreiner-骺端角（HEA）、髋臼指数（AI）、Reimer迁移百分比（MP）和α角。比较了卧床/非卧床（GMFCS I-III/IV、V）和进行/不进行软组织松解的结果。分析了与骨骺提前闭合和股骨头畸形相关的因素：在骨骼成熟期接受引导生长研究的29名患者（53个髋关节）中，有4名患者（6个髋关节，11.3%）因严重畸形而导致手术失败，需要进行股骨头屈曲截骨术。GMFCS IV-V 级患者（27.3%，3/11）比 GMFCS I-III 级患者（5.6%，1/18）更常见。在其余的 25 名患者（47 个髋关节）中，有 7 个髋关节（14.9%）同时接受了骨盆截骨术，并对 AI 和 MP 分别进行了评估。所有放射学参数均有明显改善（结论：引导生长成功地改善了两种方法的治疗效果：引导生长术成功改善了行动不便组和非行动不便组的预后，但对严重发育不良的效果较差。这种微创手术存在一些问题，包括骨骺从螺钉上长出、需要重新插入、骨骺闭合较早以及股骨头畸形：证据级别：IV级，治疗性研究。

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Outcome and Femoral Head Deformity Following Hip Guided Growth in Children With Cerebral Palsy at Skeletal Maturity.

Background: Guided growth of the proximal femur, a minimally invasive procedure for coxa valga, shows promising short-term outcomes in cerebral palsy (CP). However, as it alters physis growth, existing studies lack comprehensive long-term analysis until skeletal maturity.

Methods: This retrospective study included children with spastic CP who underwent proximal femur-guided growth surgery between 2012 and 2017, followed until physeal closure. Radiographic measurements included head-shaft angle (HSA), Hilgenreiner-epiphyseal angle (HEA), acetabular index (AI), Reimer's migration percentage (MP), and α angle. Outcomes were compared between ambulatory/nonambulatory (GMFCS I-III/IV, V) and with/without soft tissue release. Factors associated with earlier physeal closure and femoral head deformity were analyzed.

Results: Among 29 patients (53 hips) with guided growth studied at skeletal maturity, 4 patients (6 hips, 11.3%) experienced procedure failure and required varus osteotomy due to severe deformities. It was more common in GMFCS IV-V patients (27.3%, 3/11) than in GMFCS I-III (5.6%, 1/18). In the remaining 25 patients (47 hips), 7 hips (14.9%) received concomitant pelvic osteotomy with AI and MP evaluated separately. All radiographic parameters improved significantly (P<0.001). Epiphysis grew off the screw in 25 hips (53.2%), requiring reinsertion in 19 (40.4%), with a higher rate in nonambulatory children (73.3% vs. 25%, P=0.002). Changes of the parameters showed no difference between ambulatory/nonambulatory (GMFCS I-III/IV, V) and with/without soft tissue release. The cumulative duration of screw crossing the physis was a key factor for earlier closure (P<0.001) and correlated with increased α angle (P=0.039).

Conclusion: Guided growth successfully improved outcomes in both ambulatory and nonambulatory groups, although less effective in severe dysplasia. This minimally invasive procedure has some concerns, including the epiphysis growing off the screw, reinsertion need, earlier physeal closure, and femoral head deformity.

Level of evidence: Level IV, therapeutic study.

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来源期刊

Journal of Pediatric Orthopaedics 医学-小儿科

CiteScore

3.30

自引率

17.60%

发文量

512

审稿时长

6 months

期刊介绍： Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.