AIM: To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy.METHODS: Twenty-one non-ambulatory children and adolescents(22 hips) were consecutive...AIM: To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy.METHODS: Twenty-one non-ambulatory children and adolescents(22 hips) were consecutively treated with percutaneous pelvic osteotomy, which was used in conjunction with varus, derotational, shortening femoral osteotomy and soft tissue release, to correct progressive hip subluxation and acetabular dysplasia. The age, gender, Gross Motor Function Classification System level, side(s) of operated hip, total time of follow-up, immediate post-operative immobilization, complications, and the need for revision surgery were recorded for all patients. RESULTS: Seventeen patients(81%) were classified as GMFCS level Ⅳ, and 4(19%) patients were classified as GMFCS level Ⅴ. At the time of surgery, the mean age was10.3 years(range: 4-15 years). The mean Reimers' migration percentage improved from 63%(range: 3%-100%) pre-operatively to 6.5%(range: 0%-70%) at the final follow-up(p < 0.05). The mean acetabular angle(AA) improved from 34.1°(range: 19°-50°) pre-operatively to 14.1°(range: 5°-27°)(P < 0.05). Surgical correction of MP and AA was comparable in hips with open(n = 14) or closed(n = 8) triradiate cartilage(P < 0.05). All operated hips were pain-free at the time of the final follow-up visit, although one patient had pain for 6 mo after surgery. We did not observe any cases of bone graft dislodgement or avascular necrosis of the femoral head.CONCLUSION: Pelvic osteotomy through a less invasive surgical approach appears to be a valid alternative with similar outcomes to those of standard techniques. This method allows for less muscle stripping and blood loss and a shorter operating time.展开更多
In most European countries,Pediatric Orthopedic (PO) surgeons graduated from an approved Orthopedic and Trauma surgery training program which lasts 5 or 6 years,depending on the country.Upon completion of the Orthoped...In most European countries,Pediatric Orthopedic (PO) surgeons graduated from an approved Orthopedic and Trauma surgery training program which lasts 5 or 6 years,depending on the country.Upon completion of the Orthopedic and Trauma surgery program,the future PO surgeon must complete an additional subspecialty training (one to two years,depending on the country) in PO surgery.The possibility to become a certified PO surgeon through the specialization in Pediatric Surgery (option Orthopedics) or through a dedicated PO surgery training program only exists in France and in Romania,respectively.Credit as active and fully responsible PO surgeon can only be claimed when the trainee has actively participated in all phases of treatment,from diagnosis to treatment,without forgetting the management of complications and the setting up of an adequate follow-up of children and adolescents with musculoskeletal disorders.展开更多
文摘AIM: To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy.METHODS: Twenty-one non-ambulatory children and adolescents(22 hips) were consecutively treated with percutaneous pelvic osteotomy, which was used in conjunction with varus, derotational, shortening femoral osteotomy and soft tissue release, to correct progressive hip subluxation and acetabular dysplasia. The age, gender, Gross Motor Function Classification System level, side(s) of operated hip, total time of follow-up, immediate post-operative immobilization, complications, and the need for revision surgery were recorded for all patients. RESULTS: Seventeen patients(81%) were classified as GMFCS level Ⅳ, and 4(19%) patients were classified as GMFCS level Ⅴ. At the time of surgery, the mean age was10.3 years(range: 4-15 years). The mean Reimers' migration percentage improved from 63%(range: 3%-100%) pre-operatively to 6.5%(range: 0%-70%) at the final follow-up(p < 0.05). The mean acetabular angle(AA) improved from 34.1°(range: 19°-50°) pre-operatively to 14.1°(range: 5°-27°)(P < 0.05). Surgical correction of MP and AA was comparable in hips with open(n = 14) or closed(n = 8) triradiate cartilage(P < 0.05). All operated hips were pain-free at the time of the final follow-up visit, although one patient had pain for 6 mo after surgery. We did not observe any cases of bone graft dislodgement or avascular necrosis of the femoral head.CONCLUSION: Pelvic osteotomy through a less invasive surgical approach appears to be a valid alternative with similar outcomes to those of standard techniques. This method allows for less muscle stripping and blood loss and a shorter operating time.
文摘In most European countries,Pediatric Orthopedic (PO) surgeons graduated from an approved Orthopedic and Trauma surgery training program which lasts 5 or 6 years,depending on the country.Upon completion of the Orthopedic and Trauma surgery program,the future PO surgeon must complete an additional subspecialty training (one to two years,depending on the country) in PO surgery.The possibility to become a certified PO surgeon through the specialization in Pediatric Surgery (option Orthopedics) or through a dedicated PO surgery training program only exists in France and in Romania,respectively.Credit as active and fully responsible PO surgeon can only be claimed when the trainee has actively participated in all phases of treatment,from diagnosis to treatment,without forgetting the management of complications and the setting up of an adequate follow-up of children and adolescents with musculoskeletal disorders.