Combined closed reduction by soft tissue release, Varus Derotation Shortening Femoral Osteotomy and/or Modified Dega acetabuloplasty in Spastic dysplastic hip in Cerebral palsy children
European Journal of Molecular & Clinical Medicine,
2021, Volume 8, Issue 4, Pages 2170-2179
AbstractBackground: Evaluation of radiographic and clinical results of combined soft tissue release, varus derotation shortening (VDS) femoral osteotomy and modified Dega acetabuloplasty without an open reduction of the hip in treating paralytic dysplastic hip (PDH) in spastic cerebral palsy (CP). This approach aimed to treating (PDH) in CP patients is still open to a debate that revolves around the question “Whether the surgical treatment should be the same as in cases not suffering from Spastic CP?”. Patients and methods Thirty five children with (50 hips) in spastic cerebral palsy were included. The mean follow-up was 4 years. Clinical results were analyzed using the Gross Motor Functional Classification System (GMFCS) in spastic CP patients. Radiographic assessment and measurements of migration percentage (MP) was done before and after surgery. Results: The rate of hip displacement was reduced in the treatment group by (0.5%) per year (95% confidence interval,−0.5% to 6%; p=0.16) when weighted for the uncertainty in rates as the differing numbers of (MP) measurements per subject. Postoperative radiographic results according to Severin placed 35 hips (70%) in grade 1 and 2 and 15 hips (30%) in grade 3 and 4. The average center-edge angle was 35°, the average acetabular index was 10°, and the average migration index was 15% for the hips in the >5 years children, and the values at the final evaluation were 40°, 10°, and 15% for the hips in < 5 years children. Conclusions: Significant correlation between improvement in GMFCS level results according to age before 5 years at the time of the procedure that the younger the age of the patient at time of the treatment, the significant clinical improvement. The clinical results were excellent in each group, and the radiographic parameters of the acetabular configuration were comparable at the final evaluation.
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