Abstract：
OBJECTIVE: To evaluate the actual change in clinical hip pain and hip migration after operation for non-ambulatory flaccid neuromuscular (NM) scoliosis and investigate whether there is an association between hip migration and coronal/sagittal pelvic tilt (CO-PT/SA-PT).
METHODS: This retrospective, single-center, observational study evaluated a total of 134 patients with non-ambulatory flaccid neuromuscular scoliosis who underwent surgery performed by a single surgeon between 2003 and 2020, with at least 2 years of follow-up period. Operation procedures were conducted in two stages, beginning with L5-S1 anterior release followed by posterior fixation. Radiologic parameters were measured at preoperative, immediate postoperative, and last follow-up periods with clinical hip pain and clinical hip dislocation events.
RESULTS: The significant improvements occurred in various parameters after correction surgery for NM scoliosis, containing Cobb\'s angle of major curve and CO-PT. However, Reimer\'s hip migration percentage (RMP) was increased on both side of hip (High side, 0.23 ± 0.16 to 0.28 ± 0.21; Low side, 0.20 ± 0.14 to 0.23 ± 0.18). Hip pain and dislocation events were also increased (Visual analog scale score, 2.5 ± 2.3 to 3.6 ± 2.6, P value < 0.05; dislocation, 6-12). Logistic regression analysis of the interactions between ΔRMP(High) and the change of sagittal pelvic tilt (ΔSA-PT) after correction reveals a significant negative association. (95% CI 1.003-1.045, P value = 0.0226).
CONCLUSIONS: In cases of non-ambulatory flaccid NM scoliosis, clinical hip pain, and subluxation continued to deteriorate even after correction of CO-PT. There was a relationship between the decrease in SA-PT, and an increase in hip migration percentage on high side, indicating the aggravation of hip subluxation.
METHODS: This retrospective, single-center, observational study evaluated a total of 134 patients with non-ambulatory flaccid neuromuscular scoliosis who underwent surgery performed by a single surgeon between 2003 and 2020, with at least 2 years of follow-up period. Operation procedures were conducted in two stages, beginning with L5-S1 anterior release followed by posterior fixation. Radiologic parameters were measured at preoperative, immediate postoperative, and last follow-up periods with clinical hip pain and clinical hip dislocation events.
RESULTS: The significant improvements occurred in various parameters after correction surgery for NM scoliosis, containing Cobb\'s angle of major curve and CO-PT. However, Reimer\'s hip migration percentage (RMP) was increased on both side of hip (High side, 0.23 ± 0.16 to 0.28 ± 0.21; Low side, 0.20 ± 0.14 to 0.23 ± 0.18). Hip pain and dislocation events were also increased (Visual analog scale score, 2.5 ± 2.3 to 3.6 ± 2.6, P value < 0.05; dislocation, 6-12). Logistic regression analysis of the interactions between ΔRMP(High) and the change of sagittal pelvic tilt (ΔSA-PT) after correction reveals a significant negative association. (95% CI 1.003-1.045, P value = 0.0226).
CONCLUSIONS: In cases of non-ambulatory flaccid NM scoliosis, clinical hip pain, and subluxation continued to deteriorate even after correction of CO-PT. There was a relationship between the decrease in SA-PT, and an increase in hip migration percentage on high side, indicating the aggravation of hip subluxation.
摘要：
目的：评估非卧床弛缓性神经肌肉（NM）脊柱侧凸术后临床髋部疼痛和髋部移位的实际变化，并研究髋部移位与冠状位/矢状位骨盆倾斜（CO-PT/SA-PT）之间是否存在关联。
方法：本回顾性研究，单中心,观察性研究评估了在2003年至2020年期间由一名外科医生进行手术的134例非卧床弛缓性神经肌肉脊柱侧凸患者,随访期至少2年.操作程序分两个阶段进行，从L5-S1前路释放开始，然后后路固定。术前测量放射学参数，术后即刻,以及末次随访期间的临床髋关节疼痛和临床髋关节脱位事件。
结果：NM脊柱侧凸矫正手术后各种参数的显着改善，包含Cobb的主曲线角度和CO-PT。然而,Reimer的髋部迁移百分比(RMP)在髋部两侧增加(高侧,0.23±0.16至0.28±0.21；低侧，0.20±0.14至0.23±0.18）。髋关节疼痛和脱位事件也增加(视觉模拟量表评分，2.5±2.3～3.6±2.6，P值<0.05；脱位，6-12).校正后ΔRMP（高）与矢状骨盆倾斜（ΔSA-PT）变化之间的相互作用的Logistic回归分析显示出显着的负相关。（95%CI1.003-1.045，P值=0.0226）。
结论：在非动态弛缓性NM脊柱侧凸的情况下，临床髋部疼痛，即使在校正CO-PT后，半脱位仍继续恶化。SA-PT下降之间存在关系，高侧的髋关节迁移百分比增加，提示髋关节半脱位的加重.
方法：本回顾性研究，单中心,观察性研究评估了在2003年至2020年期间由一名外科医生进行手术的134例非卧床弛缓性神经肌肉脊柱侧凸患者,随访期至少2年.操作程序分两个阶段进行，从L5-S1前路释放开始，然后后路固定。术前测量放射学参数，术后即刻,以及末次随访期间的临床髋关节疼痛和临床髋关节脱位事件。
结果：NM脊柱侧凸矫正手术后各种参数的显着改善，包含Cobb的主曲线角度和CO-PT。然而,Reimer的髋部迁移百分比(RMP)在髋部两侧增加(高侧,0.23±0.16至0.28±0.21；低侧，0.20±0.14至0.23±0.18）。髋关节疼痛和脱位事件也增加(视觉模拟量表评分，2.5±2.3～3.6±2.6，P值<0.05；脱位，6-12).校正后ΔRMP（高）与矢状骨盆倾斜（ΔSA-PT）变化之间的相互作用的Logistic回归分析显示出显着的负相关。（95%CI1.003-1.045，P值=0.0226）。
结论：在非动态弛缓性NM脊柱侧凸的情况下，临床髋部疼痛，即使在校正CO-PT后，半脱位仍继续恶化。SA-PT下降之间存在关系，高侧的髋关节迁移百分比增加，提示髋关节半脱位的加重.
