{"title":"痉挛性神经肌肉性脊柱侧凸患者脊柱融合术后髋关节移位的发生率和危险因素。","authors":"Yuki Taniguchi, Daiki Urayama, Keita Okada, Sayumi Yabuki, Ayato Nohara, Takashi Ono, Yoshitaka Matsubayashi, Hiroyuki Nakarai, Koji Nakajima, Hideki Nakamoto, So Kato, Sakae Tanaka, Yasushi Oshima","doi":"10.1097/BSD.0000000000001782","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective multicenter cohort study.</p><p><strong>Objective: </strong>To investigate the incidence and risk factors of postoperative hip displacement following spinal fusion in nonambulant patients with spastic neuromuscular scoliosis.</p><p><strong>Summary of background data: </strong>In patients with spastic neuromuscular disorders, spinal deformity, and hip displacement mutually influence each other; however, little is known about the clinical impact of spinal fusion on the incidence of hip displacement.</p><p><strong>Methods: </strong>We retrospectively analyzed nonambulant patients with spastic neuromuscular disorders undergoing primary fusion with a minimum follow-up of 1 year. The primary outcome was new postoperative hip displacement. To identify potential risk factors for postoperative hip displacement, an association analysis was conducted.</p><p><strong>Results: </strong>We identified 67 eligible patients (29 males and 38 females) with a mean age of 14.1 years and a mean follow-up period of 49.4 months. Overall, 11 cases of postoperative hip displacement (10 up hip, and 1 down hip) were identified in 11 patients (16.4%). Patients with hip displacement were significantly more skeletally immature at surgery, had a significantly larger preoperative curve magnitude (115.6 vs. 97.5 degrees), larger correction of the Cobb angle (71.0 vs. 56.8 degrees), larger preoperative pelvic obliquity (36.2 vs. 24.3 degrees), and included a significantly higher proportion of cases with pelvic fixation ( P =0.03). Compared with patients with nondislocated stable up hip joints, 10 patients with new up hip displacement had a significantly higher preoperative migration percentage (MP) in the up hip (40.6 vs. 31.4, P =0.047). Receiver operating characteristic curve analysis revealed that the optimal cutoff value of the preoperative MP of the up hip for predicting postoperative displacement was 28.8 (sensitivity, 90.0%; specificity, 47.8%).</p><p><strong>Conclusions: </strong>When performing spinal fusion in patients with spastic neuromuscular disorders, especially in those with identified potential risk factors, patients and their caregivers should be informed preoperatively about the possibility of subsequent hip displacement.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E463-E469"},"PeriodicalIF":1.7000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Incidence and Risk Factors for Postoperative Hip Displacement Following Spinal Fusion in Nonambulant Patients With Spastic Neuromuscular Scoliosis.\",\"authors\":\"Yuki Taniguchi, Daiki Urayama, Keita Okada, Sayumi Yabuki, Ayato Nohara, Takashi Ono, Yoshitaka Matsubayashi, Hiroyuki Nakarai, Koji Nakajima, Hideki Nakamoto, So Kato, Sakae Tanaka, Yasushi Oshima\",\"doi\":\"10.1097/BSD.0000000000001782\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective multicenter cohort study.</p><p><strong>Objective: </strong>To investigate the incidence and risk factors of postoperative hip displacement following spinal fusion in nonambulant patients with spastic neuromuscular scoliosis.</p><p><strong>Summary of background data: </strong>In patients with spastic neuromuscular disorders, spinal deformity, and hip displacement mutually influence each other; however, little is known about the clinical impact of spinal fusion on the incidence of hip displacement.</p><p><strong>Methods: </strong>We retrospectively analyzed nonambulant patients with spastic neuromuscular disorders undergoing primary fusion with a minimum follow-up of 1 year. The primary outcome was new postoperative hip displacement. To identify potential risk factors for postoperative hip displacement, an association analysis was conducted.</p><p><strong>Results: </strong>We identified 67 eligible patients (29 males and 38 females) with a mean age of 14.1 years and a mean follow-up period of 49.4 months. Overall, 11 cases of postoperative hip displacement (10 up hip, and 1 down hip) were identified in 11 patients (16.4%). Patients with hip displacement were significantly more skeletally immature at surgery, had a significantly larger preoperative curve magnitude (115.6 vs. 97.5 degrees), larger correction of the Cobb angle (71.0 vs. 56.8 degrees), larger preoperative pelvic obliquity (36.2 vs. 24.3 degrees), and included a significantly higher proportion of cases with pelvic fixation ( P =0.03). Compared with patients with nondislocated stable up hip joints, 10 patients with new up hip displacement had a significantly higher preoperative migration percentage (MP) in the up hip (40.6 vs. 31.4, P =0.047). Receiver operating characteristic curve analysis revealed that the optimal cutoff value of the preoperative MP of the up hip for predicting postoperative displacement was 28.8 (sensitivity, 90.0%; specificity, 47.8%).</p><p><strong>Conclusions: </strong>When performing spinal fusion in patients with spastic neuromuscular disorders, especially in those with identified potential risk factors, patients and their caregivers should be informed preoperatively about the possibility of subsequent hip displacement.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":10457,\"journal\":{\"name\":\"Clinical Spine Surgery\",\"volume\":\" \",\"pages\":\"E463-E469\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Spine Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BSD.0000000000001782\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Spine Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BSD.0000000000001782","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/6 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
研究设计：回顾性多中心队列研究。目的：探讨痉挛性神经肌肉性脊柱侧凸患者脊柱融合术后髋关节移位的发生率及危险因素。背景资料总结：在痉挛性神经肌肉疾病患者中，脊柱畸形和髋关节移位相互影响；然而，关于脊柱融合对髋关节移位发生率的临床影响知之甚少。方法：我们回顾性分析了接受初级融合治疗的痉挛性神经肌肉疾病患者，随访时间至少为1年。主要结果为术后髋关节移位。为了确定术后髋关节移位的潜在危险因素，我们进行了关联分析。结果：我们确定了67例符合条件的患者（男性29例，女性38例），平均年龄14.1岁，平均随访时间49.4个月。总体而言，11例患者（16.4%）中发现了11例术后髋关节移位（10例上髋关节，1例下髋关节）。髋关节移位患者在手术时骨骼发育明显更不成熟，术前曲线幅度明显更大（115.6比97.5度），Cobb角矫正幅度明显更大（71.0比56.8度），术前骨盆倾角较大（36.2比24.3度），骨盆固定比例明显更高（P=0.03）。与未脱位的稳定上髋关节患者相比，10例新上髋关节移位患者的上髋关节术前移位百分比（MP）明显更高（40.6 vs. 31.4， P=0.047）。受试者工作特征曲线分析显示，术前上髋关节MP预测术后移位的最佳临界值为28.8(敏感性为90.0%；特异性,47.8%)。结论：当对痉挛性神经肌肉疾病患者进行脊柱融合术时，特别是那些有潜在危险因素的患者，术前应告知患者及其护理人员后续髋关节移位的可能性。证据等级：三级。
Incidence and Risk Factors for Postoperative Hip Displacement Following Spinal Fusion in Nonambulant Patients With Spastic Neuromuscular Scoliosis.
Study design: Retrospective multicenter cohort study.
Objective: To investigate the incidence and risk factors of postoperative hip displacement following spinal fusion in nonambulant patients with spastic neuromuscular scoliosis.
Summary of background data: In patients with spastic neuromuscular disorders, spinal deformity, and hip displacement mutually influence each other; however, little is known about the clinical impact of spinal fusion on the incidence of hip displacement.
Methods: We retrospectively analyzed nonambulant patients with spastic neuromuscular disorders undergoing primary fusion with a minimum follow-up of 1 year. The primary outcome was new postoperative hip displacement. To identify potential risk factors for postoperative hip displacement, an association analysis was conducted.
Results: We identified 67 eligible patients (29 males and 38 females) with a mean age of 14.1 years and a mean follow-up period of 49.4 months. Overall, 11 cases of postoperative hip displacement (10 up hip, and 1 down hip) were identified in 11 patients (16.4%). Patients with hip displacement were significantly more skeletally immature at surgery, had a significantly larger preoperative curve magnitude (115.6 vs. 97.5 degrees), larger correction of the Cobb angle (71.0 vs. 56.8 degrees), larger preoperative pelvic obliquity (36.2 vs. 24.3 degrees), and included a significantly higher proportion of cases with pelvic fixation ( P =0.03). Compared with patients with nondislocated stable up hip joints, 10 patients with new up hip displacement had a significantly higher preoperative migration percentage (MP) in the up hip (40.6 vs. 31.4, P =0.047). Receiver operating characteristic curve analysis revealed that the optimal cutoff value of the preoperative MP of the up hip for predicting postoperative displacement was 28.8 (sensitivity, 90.0%; specificity, 47.8%).
Conclusions: When performing spinal fusion in patients with spastic neuromuscular disorders, especially in those with identified potential risk factors, patients and their caregivers should be informed preoperatively about the possibility of subsequent hip displacement.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
