Journal of Pediatric Orthopaedics-Part B最新文献

Hip dislocation is a common and severe complication in children with cerebral palsy (CP), significantly affecting their quality of life. In cases of unilateral hip dislocation, there is ongoing debate regarding the choice between unilateral versus bilateral reconstructive surgeries. This study explores an alternative approach that combines unilateral hip reconstruction surgery with contralateral Proximal Femoral Guided Growth (PFGG) as a potential solution. A retrospective observational study was conducted at a pediatric neuro-orthopedic referral center from 2019 to 2022, including children who underwent hip reconstruction surgery and contralateral PFGG. The minimum follow-up period was 2 years. Collected data included demographic, clinical, and surgical details, radiological parameters, as well as complications. Eleven patients (six females and five males) with varying levels of functional impairment (2 Gross Motor Function Classification System level III, 4 level IV, and 5 level V) were included. The median age at surgery was 7.7 years (range: 4.9-11 years), with a median follow-up period of 29.6 months (range: 24.1-55.6 months). Significant improvements were observed in all parameters for the reconstructed hip and in several parameters for the PFGG-treated hip, particularly migration percentage, head-shaft angle, and Hilgenreiner epiphyseal angle (P < 0.05). Reconstructed hips had significantly more complications than those treated with PFGG(13 versus 2, P < 0.001). Combining hip reconstruction surgery with contralateral PFGG offers a promising alternative to traditional bilateral reconstructive procedures when managing unilateral hip dislocation in CP patients. This approach not only addresses the immediate hip dislocation but also prevents future contralateral hip displacement within the same surgical session, while minimizing complication rates. Further studies are needed to validate these findings and establish comprehensive guidelines for this surgical strategy. Level of evidence: Level IV, case series.

Opioids are the mainstay of pain management in scoliosis surgery. We hypothesized that in adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) surgery, perioperative intravenous (IV) lidocaine would reduce postoperative opioid requirement and pain scores. In this retrospective observational before-and-after study, we identified AIS patients who underwent single-stage PSF at a tertiary university hospital from 2020 to 2022. All patients received total intravenous anesthesia. The Lidocaine group received a bolus of 1.5 mg/kg IV lidocaine prior to induction, followed by infusion at 2 mg/kg/h. At wound closure, the rate was reduced to 1 mg/kg/h and continued for 30 min in recovery. All patients received patient-controlled analgesia (PCA) morphine postoperatively. The primary outcome was total morphine consumption in the first 24 h. The secondary outcome was mean pain scores over 48 h using a numerical rating scale. We included 115 patients: 59 in the Usual Care group and 56 in the Lidocaine group. Postoperative morphine use in the first 24 h showed no significant difference (Lidocaine: 13.5 ± 8.9 mg vs Usual Care: 13.9 ± 10.6 mg; P  = 0.821). The cumulative morphine milligram equivalents per kilogram bodyweight at 48 h was 0.43 mg/kg. Mean pain scores were higher in the Lidocaine group in the first 48 h (4.25 ± 0.37 vs 3.67 ± 1.46; P  = 0.03). Perioperative IV lidocaine administered as an analgesic adjunct for AIS surgery did not reduce postoperative morphine requirement. Although pain scores were statistically higher in patients receiving intravenous lidocaine, the difference was minimal and lacked clinical significance.

The amount of three-dimensional (3D) correction with apical sublaminar band (hybrid-SLB) technique has not been compared to all-pedicle screw instrumentation for adolescent idiopathic scoliosis (AIS) using detailed axial correction metrics or comparable rod types. Our purpose is to compare 3D improvement in AIS deformities following posterior spinal instrumentation and fusion (PSIF) with hybrid-SLB and segmental correction to all-pedicle screw correction. Patients ages 10-18 years with AIS who underwent PSIF between 2015 and 2022 and had preoperative and postoperative EOS imaging were included. Electronic medical records were reviewed for demographic, Lenke classification, operative technique, and 3D EOS data. Average changes in major and minor Cobb angle, axial rotation, thoracic kyphosis, and lumbar lordosis were compared. Ninety-five patients met inclusion criteria with 55 in the hybrid-SLB group (mean age 14.9 ± 1.9 years) and 40 in all-pedicle screw (mean age 14.7 ± 2.1 years). While all-pedicle screw demonstrated greater correction of major (45.7 ± 13.4 vs 37.9 ± 14.3 degrees; P  = 0.008) and minor (28.7 ± 13.1 vs 17.8 ± 12.5 degrees; P  = 0.001) Cobb angles, hybrid-SLB showed greater increase in T4-T12 kyphosis (13.3 ± 15.3 vs 5.6 ± 13.5 degrees; P  = 0.01). Correction of T1-T12 kyphosis, axial rotation, and lumbar lordosis was similar between groups. 3D EOS analysis of AIS patients before and after PSIF revealed that all-pedicle screw constructs had greater overall coronal plane correction and hybrid-SLB had greater thoracic sagittal plane correction. Axial corrective abilities were similar. Hybrid-SLB may have advantages for correction of thoracic lordosis or hypokyphosis. Level of evidence: Level III, retrospective cohort study.

Treatment for neuromuscular hip dysplasia (NMHD) typically involves osteotomies of the proximal femur and/or pelvis, and the potential for significant volume blood loss is high. Tranexamic acid (TXA) functions as an antifibinolytic and has been shown to reduce bleeding in many operative settings. Retrospective evidence for the use of TXA in children undergoing NMHD reconstruction is inconclusive, and to our knowledge, prospective evaluation has never been performed. The purpose of this study was to examine the effectiveness of TXA use on intra- and postoperative outcomes during bony reconstruction for NMHD. In this matched comparative study, a prospective cohort of patients undergoing bony reconstruction for NMHD who were given TXA was enrolled and then matched to a retrospective cohort who previously underwent the same surgery without administration of TXA. The primary outcome variable was a change in perioperative hemoglobin values from preoperative to 1 day postoperatively. Secondary objectives were percent loss of estimated blood volume, postoperative transfusion requirements, and length of hospital stay. Forty-eight patients, 24 in each cohort, were included in the analyses. Mean age at surgery was 7.09 years (±2.5). Fifty percent of each cohort underwent bilateral varus derotational osteotomy with pelvic acetabuloplasty. No statistical differences were found in postoperative hemoglobin differences ( P  = 0.18), length of hospital stay ( P  = 0.45), or blood transfusion requirements ( P  = 0.56) between cohorts. Intraoperative administration of TXA to patients undergoing bony reconstruction for NMHD was not found to reduce postoperative blood loss or requirement for blood transfusion. Future studies should employ a larger, prospective randomized controlled trial to verify these findings.

Tranexamic acid (TXA), approved initially for medical bleeding, has expanded its utility to various surgical contexts, including pediatric orthopedic and trauma surgery, though limited research has been conducted in this population. This study aimed to evaluate TXA's efficacy and safety in pediatric orthopedic and trauma surgeries, focusing on its impact on blood loss reduction and transfusion requirements. Through a comprehensive literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, eight retrospective studies were analyzed, all involving pediatric patients with cerebral palsy undergoing orthopedic surgery. TXA dosing regimens varied across studies, with loading doses ranging from 10 to 50 mg/kg and maintenance doses from 1 to 10 mg/kg/h. Consistently, TXA administration was associated with a significant decrease in intraoperative blood loss and transfusion needs compared with nonadministered groups, with no reported thromboembolic events, indicating its safety in pediatric orthopedic and trauma surgeries.

Congenital femoral deficiency (CFD) or proximal femoral focal deficiency (PFFD) has been a controversial topic to present, describe, classify, and treat. Since 1939, many classifications have been proposed to describe the disease and plan possible treatment - however, no single widely accepted classification. The currently available classification could not fill the gap between description and surgical planning. Some provided a graphical description of the disease with possible treatment plans, yet there is minimal evidence of its reliability and reproducibility. We propose to develop a new classification with specific criteria. The suggested classification has four types of PFFD/CFD: Type 1 morphological abnormality of the whole femur; Type 2 congenital absence of the femur is subdivided into A - total absence and B - partial absence; Type 3 abnormal proximal femur is subdivided into A - apparent neck pseudoarthrosis and B - coxa vara; and Type 4 short femur (congenital short femur).

Pediatric orthopedic care in Vietnam has experienced transformative growth over the past three decades, overcoming challenges unique to low-resource settings through innovation, collaboration, and dedication. This review explores Vietnam's progress in managing congenital deformities, trauma care, and rehabilitation, with a focus on decentralized care delivery, cost-effective surgical techniques, and capacity-building initiatives. Highlighting the critical roles played by the Vietnam Pediatric Orthopaedic Association and international collaborations, this analysis underscores the impact of tailored interventions and multidisciplinary approaches. By integrating technology, fostering education, and addressing systemic disparities, Vietnam exemplifies the potential for sustainable advancements in pediatric orthopedic care globally, even amidst resource constraints.

Perinatal hip sonography (PHS) is not mandatory in Italy, but during the last years, it has been performed increasingly more even in babies with negative Ortolani maneuver. We aimed to investigate whether the increased use of PHS decreased the number of Graf's type IV hips needing closed/open reduction (COR) at the Bambino Gesù Hospital of Rome, Palidoro (BGHRP). We consulted the BGHRP database from 2012 to 2022 to determine the number of patients with Graf's type IV hips who had COR; the COR patients who had PHS done inside and outside the hospital; the patients who had brace treatment after PHS with a diagnosis of DDH. The hospital's sonographers were ascertained to be experts in Graf's method because they had attended several instructional courses, while the sonographers operating in other centers had not received this training. Sixty-three patients with Graf's type IV hips had COR from 2012 to 2016 while 31, from 2017 to 2022. The difference was significant ( P  = 0.009). The 67 patients with COR who came to BGHRP for follow-up were divided into two groups. Group 1 included 61 patients who had PHS done outside the hospital. In those patients, several DDH had a wrong diagnosis and none had brace treatment. Group 2 included six patients out of the 277 with DDH who had PHS done at BGHRP and who received brace treatment. The difference between the two groups was significant ( P  < 0.001). To decrease the number of dislocated hips needing COR, an increased use of PHS is not sufficient but it is also necessary that sonographers must be experts in Graf's method and aware of DDH treatment.

Dandy-Walker malformations (DWM) is a rare condition with an estimated prevalence of 1 in 30 000 cases. Although DWM often complicates scoliosis, its prevalence and the time of onset are unknown because only a few reports have described the association between scoliosis and DWM. This case series describes spinal deformity associated with DWM. The clinical records and spinal radiographs of 23 consecutive patients with DWM at a single centre were reviewed. DWM was clinically diagnosed if patients met the following three conditions: (1) posterior fossa enlargement, (2) cerebellar hypoplasia and (3) cystic dilation of the fourth ventricle on MRI. Radiological assessment records for the presence, prevalence and time of onset of DWM were studied. Twelve of 23 patients (52%) demonstrated a scoliotic deformity, with 3 (13%) having severe deformities exceeding 60°. The average age at diagnosis was 3.6 ± 2.9 years (range: 0.7-9.7) and at radiographic examination during the final follow-up was 8.7 years (range 1.0-22.0). Only two patients were skeletally mature. The coronal angular deformity at the final follow-up was 34.2 ± 32.3° (range: 10.1-125.1°). One patient with moderate deformity >25° died before bracing. In addition, of three patients with severe deformities, only one had undergone posterior spinal fusion. The prevalence of scoliosis in DWM was 52%, and all patients who developed scoliosis reported early-onset scoliosis under 10 years of age. Early diagnosis and screening of spine deformity are required for patients with DWM to prevent disease progression. Evidence level: 4.

Level of evidence: Level IV - case series.