Abstract：
BACKGROUND: Hip reconstruction is an established procedure in pediatric patients with neurogenic hip dislocation. An open triradiate cartilage provides the advantage of a high plasticity of the bone which prevents an intraarticular fracture and postoperative adaptation of shape. Some patients with dislocated hips, however, arrive late. A hip reconstruction is still feasible as shown earlier but the long-term risk for osteoarthritis, and recurrence of dislocation, and functional outcome is unknown. It is the aim of our investigation to evaluate long-term clinical and radiological outcomes of hip reconstruction by Dega type pelvic osteotomy performed after fusion of the triradiate epiphyseal cartilage in patients suffering from cerebral palsy.
METHODS: We retrospectively analyzed 43 hips in 37 patients with a hip reconstruction for correction of hip dislocation or subluxation. In all patients, the triradiate cartilage was fused before surgery. Age at surgery was 15 years and 2 months on average and follow-up time was mean 13 years 5 months.
RESULTS: Mean Kellgren Lawrence score at final follow-up was significantly higher than at preoperative investigation (P < 0.00001). At long-term follow-up 3 of 43 hips had developed pain, and 1 of them required arthroplasty. Reimers´ migration index was stable over the years and was not higher at last follow-up compared to the index observed shortly after surgery (P = 0.857), so was the Sharp angle (P = 0.962). We found no significant reduction in the range of motion of the hip in the sagittal plane.
CONCLUSIONS: We noted mild radiological signs of osteoarthritis which possibly occur due to an intraarticular acetabulum fracture during bending down the acetabulum. Nevertheless, hip reconstruction in patients with cerebral palsy and closed triradiate cartilage remains a valuable option as it results in a stable, painless hip for more than a decade.
METHODS: We retrospectively analyzed 43 hips in 37 patients with a hip reconstruction for correction of hip dislocation or subluxation. In all patients, the triradiate cartilage was fused before surgery. Age at surgery was 15 years and 2 months on average and follow-up time was mean 13 years 5 months.
RESULTS: Mean Kellgren Lawrence score at final follow-up was significantly higher than at preoperative investigation (P < 0.00001). At long-term follow-up 3 of 43 hips had developed pain, and 1 of them required arthroplasty. Reimers´ migration index was stable over the years and was not higher at last follow-up compared to the index observed shortly after surgery (P = 0.857), so was the Sharp angle (P = 0.962). We found no significant reduction in the range of motion of the hip in the sagittal plane.
CONCLUSIONS: We noted mild radiological signs of osteoarthritis which possibly occur due to an intraarticular acetabulum fracture during bending down the acetabulum. Nevertheless, hip reconstruction in patients with cerebral palsy and closed triradiate cartilage remains a valuable option as it results in a stable, painless hip for more than a decade.
摘要：
背景：髋关节重建是神经源性髋关节脱位的儿科患者的既定手术。开放的三辐射软骨提供了骨的高可塑性的优点,其防止关节内骨折和术后形状适应。有些髋关节脱臼的病人,然而,迟到。如前所述，髋关节重建仍然可行，但骨关节炎的长期风险，再一次的脱位,功能结果未知。我们的研究目的是评估脑瘫患者三放射骨软骨融合后通过Dega型骨盆截骨术进行髋关节重建的长期临床和放射学结果。
方法：我们回顾性分析了37例进行髋关节重建以矫正髋关节脱位或半脱位的患者的43髋。在所有患者中，手术前三辐射软骨融合。手术年龄平均15岁零2个月，随访时间平均13年5个月。
结果：最终随访时的平均KellgrenLawrence评分明显高于术前调查（P<0.00001）。在长期随访中，43个臀部中有3个出现疼痛，其中1人需要关节成形术.Reimers的迁移指数多年来是稳定的，与手术后不久观察到的指数相比，在最后一次随访中并不高（P=0.857），锐角也是如此(P=0.962)。我们发现矢状平面中髋关节的运动范围没有显着减少。
结论：我们注意到轻度骨性关节炎的放射学征象，这种征象可能是由于髋臼下弯曲时发生的关节内骨折所致。然而，髋关节重建的患者脑瘫和闭合三辐射软骨仍然是一个有价值的选择，因为它导致稳定，十多年无痛髋关节。
方法：我们回顾性分析了37例进行髋关节重建以矫正髋关节脱位或半脱位的患者的43髋。在所有患者中，手术前三辐射软骨融合。手术年龄平均15岁零2个月，随访时间平均13年5个月。
结果：最终随访时的平均KellgrenLawrence评分明显高于术前调查（P<0.00001）。在长期随访中，43个臀部中有3个出现疼痛，其中1人需要关节成形术.Reimers的迁移指数多年来是稳定的，与手术后不久观察到的指数相比，在最后一次随访中并不高（P=0.857），锐角也是如此(P=0.962)。我们发现矢状平面中髋关节的运动范围没有显着减少。
结论：我们注意到轻度骨性关节炎的放射学征象，这种征象可能是由于髋臼下弯曲时发生的关节内骨折所致。然而，髋关节重建的患者脑瘫和闭合三辐射软骨仍然是一个有价值的选择，因为它导致稳定，十多年无痛髋关节。
