Combined soft tissue release and proximal femur guided growth for spastic hip displacement in children with cerebral palsy-5-year follow-up

Hsiang-Heng Cheng ； Wei-Chun Lee ； Wen-E Yang ； Hsuan-Kai Kao ； Chia-Hsieh Chang

《Formosan Journal of Musculoskeletal Disorders》 10卷1期 (2019/02) Pp. 17-23

https://doi.org/10.6492/FJMD.201902_10(1).0003

摘要

Background: Soft tissue release combined with guided growth has been used to correct coxa valga and hip displacement in children with cerebral palsy (CP). Purpose: The purpose of this study was to report the 5-year radiological outcomes. Methods: This case series study included consecutive patients who received soft-tissue release and guided growth in the proximal femur from January 2004 to May 2012 with a minimum 5-years of follow-up. Surgical indications were children with spastic CP aged 4 to 10 years, gross motor function classification system level IV or V, and hip displacement with migration percentage (MP) ＞ 30%. Parameters including Reimer's MP, head-shaft angle (HSA), acetabulum index (AI), and articular trochanter distance (ATD) were compared between preoperative and postoperative 5-year images. Results: Nine children received guided growth surgery and soft tissue release during the study period. Mean age at the time of operation was 6.0 years with a mean follow-up duration of 69.6 months. One girl received pelvic osteotomy 3 years after guided growth due to persistent hip displacement. The other eight children with 12 displaced hips showed the MP improved from 51.3% to 30.4% (p = 0.001) and the HSA decreased from 174.4° to 159.3° (p ＜ 0.001) in 5 years. The AI and ATD did not change significantly. Conclusion: Significant improvement in the MP by 20.9% and the HSA by 15.1° in 5 years supported guided growth in treating hip displacement with MP more than 50% in nonambulatory children with CP. Repeated guided growth or pelvis osteotomy is recommended for persistent hip dysplasia.

關鍵字

cerebral palsy ； guided growth ； hip displacement