Identification of risk factors for reconstructive hip surgery after intrathecal baclofen therapy in children with cerebral palsy.

IF 1.1 4区医学 Q3 ORTHOPEDICS Acta orthopaedica et traumatologica turcica Pub Date : 2023-05-01 DOI:10.5152/j.aott.2023.22017

Ali Asma, Jason J Howard, Armağan Can Ulusaloglu, Kenneth J Rogers, Freeman Miller, M Wade Shrader

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Abstract

Objective: This study aimed to determine the risk factors for reconstructive hip surgery after intrathecal baclofen pump application in children with cerebral palsy.

Methods: Inclusion criteria were children with hypertonic (spastic or mixed spastic/dystonic motor type) cerebral palsy, intrathecal baclofen implantation <8 years of age, no reconstructive osteotomies prior to or concomitant with intrathecal baclofen implantation and at least a 5-year follow-up. Exclusion criteria included reconstructive osteotomies prior to or concurrent with intrathecal baclofen implantation, lack of at least 1 hip surveillance radiograph before intrathecal baclofen, lack of a 5-year follow-up, or having selective dorsal rhizotomy. In addition, patients with bony surgery plus last follow-up migration percentage ≥50% were labeled as required reconstruction hips.

Results: We identified 34 patients (68 hips). The mean follow-up was 9.2 ± 2.8 years. The mean age for intrathecal baclofen application was 6.4 ± 1.2 years. Seven patients were Gross Motor Function Classification System IV, and 27 were V. Eighteen patients (52.9%) with 31 hips (45.6%) were requiring reconstruction at the final follow-up. In multivariate analysis, male sex (odds ratio 12.8, P=.012), pre-intrathecal baclofen migration percentage (odds ratio 1.1, P=0.003), age at intrathecal baclofen implantation (odds ratio 0.24, P=.002), and delta migration percentage (odds ratio 1.1, P=.002) were significant risk factors for requiring reconstruction. Patients with intrathecal baclofen <6.2 years of age had a significantly higher rate of requiring reconstruction. A pre-intrathecal baclofen migration percentage >31% had a greater risk of progression to requiring reconstruction (P=.001). Delta migration percentage higher than 15% was significantly associated with progression to requiring reconstruction (P=.043).

Conclusion: The risk of requiring reconstruction osteotomies after intrathecal baclofen was significantly increased in males, those younger (±migration percentage >31%) at the time of intrathecal baclofen implantation and those with an increased rate of migration percentage progression after intrathecal baclofen implantation.

Level of evidence: Level IV, Prognostic Study.

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脑瘫患儿鞘内注射巴氯芬治疗后髋关节重建手术的危险因素识别。

目的：本研究旨在确定鞘内应用巴氯芬泵治疗脑瘫儿童髋关节重建手术的危险因素。方法：纳入标准为高渗性（痉挛型或混合痉挛/肌张力运动型）脑瘫患儿，鞘内植入巴氯芬。结果：我们确定了34名患者（68髋）。平均随访9.2±2.8年。鞘内应用巴氯芬的平均年龄为6.4±1.2岁。7名患者采用毛运动功能分类系统IV，27名患者采用V。18名患者（52.9%），31个髋关节（45.6%）在最终随访时需要重建。在多变量分析中，男性（比值比12.8，P=0.012）、鞘内注射前巴氯芬迁移率（比值比1.1，P=0.003）、鞘内巴氯芬植入时的年龄（比值比0.24，P=0.002）和德尔塔迁移率（优势比1.1，P=.002）是需要重建的重要危险因素。鞘内注射巴氯芬31%的患者进展到需要重建的风险更大（P=0.001）。德尔塔迁移率高于15%与进展到需要修复显著相关（P=0.043）。结论：男性鞘内注射巴氯芬后需要重建截骨的风险显著增加，鞘内植入巴氯芬时较年轻（±迁移百分比>31%）的患者，以及鞘内植入巴氯芬后迁移百分比进展率增加的患者。证据级别：IV级，预后研究。

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来源期刊

Acta orthopaedica et traumatologica turcica ORTHOPEDICS-

CiteScore

2.00

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0.00%

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审稿时长

>12 weeks

期刊介绍： Acta Orthopaedica et Traumatologica Turcica (AOTT) is an international, scientific, open access periodical published in accordance with independent, unbiased, and double-blinded peer-review principles. The journal is the official publication of the Turkish Association of Orthopaedics and Traumatology, and Turkish Society of Orthopaedics and Traumatology. It is published bimonthly in January, March, May, July, September, and November. The publication language of the journal is English. The aim of the journal is to publish original studies of the highest scientific and clinical value in orthopedics, traumatology, and related disciplines. The scope of the journal includes but not limited to diagnostic, treatment, and prevention methods related to orthopedics and traumatology. Acta Orthopaedica et Traumatologica Turcica publishes clinical and basic research articles, case reports, personal clinical and technical notes, systematic reviews and meta-analyses and letters to the Editor. Proceedings of scientific meetings are also considered for publication. The target audience of the journal includes healthcare professionals, physicians, and researchers who are interested or working in orthopedics and traumatology field, and related disciplines.