Journal of Pediatric Orthopaedics-Part B最新文献

Pediatric femoral neck fractures result primarily from high-energy trauma. Common treatment methods include screw fixation and the placement of a proximal femoral locking plate. However, there is limited biomechanical evidence favoring one method over another for the treatment of unstable fractures. This study aimed to evaluate the biomechanical properties of screws and proximal femoral locking plates for the treatment of unstable pediatric femoral neck fractures using a synthetic bone model. Fourteen synthetic composite femurs were divided into two groups that included screw fixation (S) and locking plates (P). All specimens were prepared using a vertically oriented osteotomy to simulate unstable Delbet type II femoral neck fractures. Fixation in Group S employed three 6.5 mm cannulated screws, while Group P utilized a proximal femoral locking plate with 5.0 mm screws. The axial stiffness, cyclic elongation, and ultimate failure load were assessed using a universal material testing machine under standardized loading conditions. Statistical analyses were performed to compare biomechanical properties between the groups. Group P exhibited significantly greater axial stiffness (763 ± 212 N/mm) compared to that of Group S (547 ± 93 N/mm, P  = 0.026). Following cyclic loading, elongation was significantly smaller in Group P (0.42 ± 0.2 mm) vs. Group S (0.88 ± 0.4 mm, P  = 0.002). The ultimate failure load was also higher in Group P (2511 ± 321 N) than it was in Group S (2036 ± 256 N, P  = 0.007). The failure modes differed, with Group S exhibiting screw bending and femoral neck collapse and Group P exhibiting subtrochanteric fractures. Proximal femoral locking plates offer superior biomechanical performance compared to that of screw fixation in unstable pediatric femoral neck fractures. These findings suggest that locking plates are a viable alternative to enhance stability and potentially reduce postoperative complications.

Level of evidence: Level IV.

This study investigated the impact of preoperative vertebral rotation (VR) on the surgical outcomes in spinal muscular atrophy (SMA) scoliosis. A retrospective analysis of 27 SMA patients (mean age 13.4 ± 4.3 years) who underwent scoliosis surgery between 2015 and 2019 was conducted. Preoperative VR was measured using Aaro-Dahlborn's and Ho's methods on computed tomography images. Surgical outcome prediction was evaluated using the Pearson correlation coefficient, linear stepwise regression, receiver operating characteristic (ROC) curve, and logistic regression analyses. Ho's method yielded significantly higher VR measurements than Aaro-Dahlborn's ( P  < 0.001). Postoperative Cobb angles correlated positively with preoperative Cobb angles ( r ² = 0.425, P  = 0.0002), Ho's method VR ( r ² = 0.449, P  = 0.0001), and Aaro-Dahlborn's method VR ( r ² = 0.4352, P  = 0.0002). Stepwise regression identified preoperative Ho's method VR and Cobb angles as independent predictors of postoperative Cobb angles. Postoperative Cobb angles >30 ° indicated increased risk of deformity progression in SMA. ROC curve analysis showed preoperative Ho's method VR significantly predicted postoperative Cobb angles >30 ° (area under the curve: 0.813, P  = 0.006), with an optimal cutoff of 35 °. Logistic regression analysis revealed patients with preoperative Ho's method VR > 35 ° had a higher risk of postoperative Cobb angles >30 ° (odds ratio: 10.36, 95% confidence interval: 1.050-102.261, P  = 0.045). This study demonstrated that Ho's method better predicted surgical outcomes, with preoperative Ho's method VR > 35 ° at the apex associated with higher initial residual scoliosis curves after surgery. These findings could enhance surgical planning and improve outcome predictions in SMA scoliosis correction.

Reconstructive hip surgery is essential for managing hip displacement in nonambulatory children with cerebral palsy (CP); however, its impact on health-related quality of life (HRQoL) and caregiver burden remains unclear. This study evaluates postoperative changes in HRQoL and caregiver burden. This prospective observational study included 19 nonambulatory children with spastic CP classified as Gross Motor Function Classification System (GMFCS) levels III-V undergoing reconstructive hip surgery. HRQoL and caregiver burden were assessed using the Pediatric Quality of Life Inventory (PedsQL 4.0) and the Zarit Burden Interview (ZBI), respectively, at baseline and during a 12-month follow-up. Subgroup analyses were performed based on Reimers' migration index, GMFCS levels, and age. PedsQL scores showed a continuous improvement over 12 months, with a significant increase from baseline to 1 year ( P  < 0.001). Caregiver burden (ZBI) slightly increased at 3 months but progressively declined thereafter, with significant reductions at 9 months ( P  = 0.010) and 12 months ( P  = 0.002). Subgroup analyses by Reimers' migration index, GMFCS level, and age revealed no significant between-group differences in outcome scores ( P  > 0.05). Reconstructive hip surgery enhances HRQoL and reduces caregiver burden over time in nonambulatory children with CP. These findings highlight the long-term benefits of surgical intervention.

This article aims to introduce a novel growth-guidance technique for early onset scoliosis (EOS) surgery, utilizing closed multiaxial screws (CMAS) as an alternative to Shilla trolley screws. We report clinical and radiographic outcomes from five EOS patients treated between 2021 and 2024, who underwent active apex correction using CMAS. This method provided an effective alternative for anchoring in the cephalad and caudad regions. Our analysis shows a significant reduction in the major coronal Cobb angle from an average of 71.2 to 19.6° postoperatively, with a 22.8% increase in truncal height maintained at the final follow-up. Importantly, no neurological changes were observed, and patients were braced for the initial 3 months after surgery. In conclusion, CMAS offers a user-friendly and effective alternative for growth guidance in EOS treatment, demonstrating reliable outcomes.

We evaluated the imaging and clinical outcomes of posterior thoracic-pelvic corrective fixation (TP-PCF) for nonambulant neuromuscular scoliosis (NA-NMS), including the Caregiver Priorities and Child Health Index of Life with the Japanese version of the Disabilities Questionnaire (J-CPCHILD), and analyzed the J-CPCHILD and preoperative and postoperative radiographic parameters to determine whether sagittal and coronal alignment correlate with preoperative and postoperative quality of life (QoL) in NMS, respectively. Twenty-five patients (nine males and 16 females) with a mean age of 14.3 ± 2.0 years, who had TP-PCF and were followed up for >2 years postoperatively, were included. Sitting radiographs and the J-CPCHILD were evaluated preoperatively, at 1 year postoperatively, and at the final visit. Preoperative major curve and pelvic obliquity (PO) were 102.4 ± 22.2 ° and 21.5 ± 9.9 °, which significantly improved to 51.4 ± 18.8 ° and 10.9 ± 7.6 °, respectively, at the final visit. At the final visit, lumbar lordosis and sacral slope showed a significant increase of 46.6 ± 18.5 ° and 30.2 ± 17.5 ° compared with preoperative values of 25.8 ± 33.2 ° and 24.4 ± 31.0 °, respectively. Sagittal vertical axis showed a significant decrease of 2.2 ± 35.3 mm at the final visit compared with 37.1 ± 36.5 mm preoperatively. However, iliac screw (IS)-related implant failure was observed in four (16%) patients. Significant improvement from 37.1 ± 20.8 to 51.2 ± 25.2 points and from 49.6 ± 12.6 to 59.1 ± 14.9 points was observed in the positioning domain ( P  = 0.047) and total score ( P  = 0.032) of the J-CPCHILD, respectively, at 1 year postoperatively compared with preoperatively. However, no correlations were identified between the respective domains of the J-CPCHILD and the magnitude of the major curves, PO, or sagittal plane vertical axis, either preoperatively or postoperatively. According to caregivers, improvement in comprehensive trunk stability with better global balance, similar to that of the ambulant patient, contributed to overall QoL after TP-PCF for NA-NMS. However, IS-related implant failure occurred in approximately 16% of the patients.

This research aims to investigate femoral neck anteversion (FNA) on the less involved side in unilateral cerebral palsy (CP) and examine its impact on hip rotation during gait. Sixty-nine patients with unilateral CP, with a mean of 21 years, were included study. Static and dynamic hip rotation ranges were quantified via physical examination and three-dimensional motion analysis. Patients were stratified into five levels of involvement according to modified Winters' classification. FNA differences between modified Winters' classification types and correlation with static and dynamic hip rotation were analyzed. Hip morphology was classified based on the Melbourne Cerebral Palsy Hip Classification Scale E&R. Regarding FNA, our analysis suggested a moderate correlation ( r  = 0.61, P  < 0.05) between both sides. Hip dysplasia was found in 20.5 and 23.1% of the less involved and more involved sides, respectively, in 39 patients. Increased FNA was associated with increased static hip internal and decreased external rotation for both sides ( P  < 0.05). A positive correlation was observed between FNA and dynamic hip rotation on the more involved side ( P  < 0.05). Conversely, on the less involved side, FNA showed no significant correlation with pelvic, hip, or knee rotation. This study demonstrates that in unilateral CP, the less involved side is also significantly affected, a moderate correlation exists between the two sides, and both hips may exhibit dysplasia. These findings underscore the necessity for a comprehensive bilateral clinical assessment. Long-term surveillance of both hips and consideration of the less involved side for surgical planning may be warranted.

The objective of this study is to evaluate the role of the Shelf-AID technique as a method of containment in cases with Perthes disease. This clinical study included 21 hips in 20 patients with Perthes disease. They were followed up clinically and radiologically, with a mean follow-up was 18.7 ± 3.27 months. Hip arthrography was done for all cases to ensure that no hinge abduction was present. We combine shelf acetabuloplasty with soft tissue release (hip adductor and iliopsoas release) associated with percutaneous drilling. There was a statistically significant improvement in the Sharp acetabular index from 41.81 ± 1.72 to 35.67 ± 2.24 at final follow-up. There was also a statistically significant improvement in center edge angle from 27.76 ± 4.04 preoperatively to 51.48 ± 5.47 postoperatively. Acetabular coverage also improved from 76.33 ± 4.71% to 117.05 ± 7.98% at final follow-up. Functional improvement was assessed by the Harris hip score, which improved from 77.05 ± 3.31 preoperatively to 86.95 ± 3.46 at final follow-up ( t  = 16.367, P  < 0.001). We recommend the use of the Shelf-AID technique as we described for containment in patients with Perthes disease with reducible subluxation.

The popliteal artery runs along the posterior surface of the distal femur. An exostosis on the posteromedial aspect of the distal femur can potentially affect the course of this artery, depending on its position and shape. This study aimed to clarify the relationship between distal femur exostoses and the course of the popliteal artery in patients with multiple cartilaginous exostoses. This study included 10 patients who underwent exostosis resection in the posteromedial aspect of the distal femur between April 2002 and March 2022. Sex, age, operated side, course of the popliteal artery relative to the exostosis, exostosis shape, recurrence rate, and perioperative complications were analyzed. Exostosis shape was classified as pedunculated or sessile based on the lateral radiographic view. The patients were divided into three groups based on the course of the popliteal artery relative to the exostosis: lateral, over, and medial. The study included eight male patients and two female patients. The mean age at operation was 12.8 years. Three patients had pedunculated lesions, and seven had sessile lesions. The popliteal artery ran laterally in six cases, over in three, and medially in one. The median follow-up period was 1.1 years. There were no cases of recurrence or major complications. The course of the popliteal artery may vary depending on the location and shape of the exostosis. Understanding this relationship preoperatively and paying attention to the artery intraoperatively are essential to prevent vascular damage.