Kliniğimizde serebral palsi tanılı hastalarda yapılan rekonstrüktif kalça cerrahisinin proksimal femoral geometri ve asetabuluma etkilerinin radyolojik ve fonksiyonel sonuçlarının değerlendirilmesi
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Serebral palsili (SP) bireylerde nöromüsküler kalça deplasmanı, ayak bileği ekin deformitesinden sonra
ikinci en yaygın anomalidir. Kalça deplasmanı olan hastaların; yaşam kalitesini ve işlevini iyileştirmek amacıyla
koruyucu, rekonstrüktif veya kurtarıcı cerrahi işlemler uygulanmaktadır. Çalışmamızdaki amaç SP’li hastalarda
kalça rekonstrüktif cerrahilerin, proksimal femoral geometri ve asetabuluma etkilerinin kısa ve orta vadedeki
etkilerinin fonksiyonel ve radyolojik olarak değerlendirilmesini amaçladık.
Yöntem: Kliniğimizde Ocak 2013- Ocak 2024 tarihleri arasında serebral palsi tanılı hastaların ameliyatlarının
retrospektif değerlendirilerek kalça rekonstrüktif cerrahisi olan vakaların belirlenmesi planlandı. Dahil edilme
kriterlerimize uygun hastaların verileri sistemden elde edildi. Tüm hastaların ameliyat öncesi ve son
kontrollerinde standardize olarak çekilmiş pelvis ön arka grafileri çalışma kapsamında değerlendirildi. Grafilerde
Reimer migrasyon indeksi (RMI), asetabular indeks (AI), Sharp açısı, merkez kenar açısı (MKA), femur boyunşaft
açısı, femur baş-şaft açısı, medializasyon indeksi (MeI) durumu değerlendirildi. Tüm hastalara fonksiyonel
değerlendirme için fonksiyonel mobilite skalası (FMS) ve ağrı değerlendirilmesi için 10 puanlı VAS uygulandı.
Gruplar arası ve zamana göre karşılaştırmalarda bağımlı örneklem t testi ile genel lineer model tekrarlı ölçümler
testi kullanılmış, p değerinin 0,05’ten küçük olması (p<0,05) istatistiksel olarak anlamlı kabul edilmiştir.
Bulgular: Çalışmaya dahil edilen 37 hastanın 20’si kadın (%54), 17’si erkekti (%46). Kapsama alınan 37 hastanın
47 kalçası değerlendirildi. Opere edilen 47 kalçanın %51’i sağ, %49’u sol kalçaydı. 37 hastanın son kontrollerinde
en küçüğü 6 yaşında en büyüğü 21 yaşında idi. Ameliyat edilen 24 kalçaya femoral osteotomiye ek olarak pelvik
osteotomi uygulandı. İzole femoral osteotomi yapılan hastalar grup 1, ek olarak pelvik osteotomi uygulanan
hastalar grup 2 olarak belirlendi. Grup 1 yaş ortalaması 14,9 ± 4,3, takip süresi 4,6 ± 2 iken; grup 2 yaş ortalaması
10,7 ± 3,2, takip süresi 3,5 ± 1,2 yıldı. Ameliyat öncesi değerlendirmede Grup 2'nin Grup 1'e kıyasla anlamlı
derecede daha yüksek Reimer Migrasyon İndeksine sahip olduğunu göstermiştir. (p <0,001). Bu, Grup 2'deki
hastaların ameliyat öncesinde daha ileri derecede patolojiye sahip olduğunu düşündürmektedir. Ameliyat sonrası
yapılan değerlendirmede ise, her iki grup arasındaki bu fark azalmış olmakla birlikte, Grup 1'in sonuçları Grup
2'ye göre anlamlı olarak daha iyi düzelme göstermiştir. (p = 0,01). Grup 2, ameliyat öncesi asetabular İndeksi
değerlerinde Grup 1'e göre istatistiksel olarak anlamlı bir yükseklik sergilemiştir (p = 0,004). Ancak, cerrahi
müdahale sonrasında iki grup arasındaki bu farkın önemi kaybolmuş, göstergeler arasındaki fark istatistiksel
olarak anlamsız hale gelmiştir (p = 0,14). İki grup arasında ameliyat öncesi yapılan ölçümlerde, Grup 2 anlamlı
derecede daha yüksek Merkez Kenar açısı değerlerine sahiptir. (p <0,001), bu da daha şiddetli displaziye işaret
eder. Ameliyat sonrası, Grup 1 bu açıda Grup 2'ye kıyasla anlamlı bir iyileşme sergilemiştir. (p = 0,003).
Fonksiyonel skorlama için yapılan fonksiyonel mobilite skalasında (FMS) Grup 1'in Grup 2'ye göre istatistiksel
olarak anlamlı derecede daha iyi performans sergilediğini göstermektedir. Özellikle FMS 500m skalasında elde
edilen p değeri (p = 0,002), Grup 1'in Grup 2'ye göre istatistiksel olarak anlamlı derecede daha iyi performans
sergilediğini göstermektedir. Vas Skoru grup 1’de ameliyat öncesi ort. 6,7 ± 0,9, ameliyat sonrası 1,1 ± 0,9; grup
2’de ameliyat öncesi ort. 8,1 ± 0,9, ameliyat sonrası 2,3 ± 1,2 bulundu.
Sonuç: Çalışmamızın bulguları, kalça rekonstrüktif cerrahilerin, serebral palsili hastalarda kalça deplasmanı ve
çıkıklarının tedavisinde kısa-orta vadede etkinliği ve güvenilirliği konusundaki literatürü desteklemektedir. Kalça
rekonstrüktif cerrahilerinde yaş sınırı literatürde tartışmalı olsa da biz çalışmamızda 8 yaşından önce yapılan
cerrahilerin kısa orta dönemde benzer sonuçlar elde ettiğini gördük. İzole VDRO yapılan grupta her ne kadar
asetabular örtünme sağlansa da ileri asetabular displazisi olan hastalarda pelvik osteotomi de eklenmesini
öneriyoruz.
Objective: Neuromuscular hip displacement is the second most common anomaly after ankle joint deformity in individuals with cerebral palsy (CP). Conservative, reconstructive or salvage surgical procedures are performed to improve the quality of life and function of patients with hip displacement. The aim of our study was to evaluate the short and medium term effects of hip reconstructive surgeries on proximal femoral geometry and acetabulum in patients with CP, both functionally and radiologically. Method: We planned to retrospectively evaluate the surgeries of patients diagnosed with cerebral palsy between January 2013 and January 2024 in our clinic to determine the cases with hip reconstructive surgery. The data of patients who met our inclusion criteria were obtained from the system. Standardized anteroposterior pelvic radiographs of all patients taken preoperatively and at the last follow-up were evaluated within the scope of the study. Reimer migration index (RMI), acetabular index (AI), Sharp angle, central margin angle, femoral neckshaft angle, femoral head-shaft angle, and medialization index (MeI) were evaluated. Functional mobility scale (FMS) for functional assessment and 10-point VAS for pain assessment were applied to all patients. Dependent sample t test and general linear model repeated measures test were used for intergroup and time comparisons, and a p value less than 0.05 (p<0.05) was considered statistically significant. Results: Of the 37 patients included in the study, 20 were female (54%) and 17 were male (46%). Forty-seven hips of the 37 patients were evaluated. Of the 47 operated hips, 51% were right hips and 49% were left hips. The youngest of the 37 patients was 6 years old and the oldest was 21 years old at the last follow-up. Pelvic osteotomy was performed in addition to femoral osteotomy in 24 operated hips. Patients who underwent isolated femoral osteotomy were defined as group 1 and patients who underwent pelvic osteotomy were defined as group 2. The mean age of group 1 was 14.9 ± 4.3 years with a follow-up period of 4.6 ± 2 years, while the mean age of group 2 was 10.7 ± 3.2 years with a follow-up period of 3.5 ± 1.2 years. Preoperative evaluation showed that Group 2 had a significantly higher Reimer Migration Index compared to Group 1 (p < 0.001). This suggests that patients in Group 2 had more advanced pathology preoperatively. In the postoperative evaluation, the results of Group 1 showed significantly better improvement than Group 2, although this difference between both groups was reduced (p = 0.01). Group 2 showed a statistically significant higher preoperative acetabular Index value than Group 1 (p = 0.004). However, after the surgical intervention, the significance of this difference between the two groups disappeared and the difference between the indicators became statistically insignificant (p = 0.14). In the preoperative measurements between the two groups, Group 2 had significantly higher Center Edge angle values (p < 0.001), indicating more severe dysplasia. Postoperatively, Group 1 showed a significant improvement in this angle compared to Group 2 (p = 0.003). The functional mobility scale (FMS) for functional scoring shows that Group 1 performed statistically significantly better than Group 2. In particular, the p value obtained in the FMS 500m scale (p = 0.002) shows that Group 1 performed statistically significantly better than Group 2. The preoperative mean Vas Score in group 1 was. 6.7 ± 0.9 preoperatively and 1.1 ± 0.9 postoperatively in group 1; preoperative mean in group 2. 8.1 ± 0.9 preoperatively and 2.3 ± 1.2 postoperatively. Conclusion: The findings of our study support the literature on the short-medium term efficacy and safety of hip reconstructive surgeries in the treatment of hip displacement and dislocation in patients with cerebral palsy. Although the age limit for hip reconstructive surgeries is controversial in the literature, we found that surgeries performed before the age of 8 years achieved similar results in the short-medium term in our study. Although acetabular coverage was achieved in the isolated VDRO group, we recommend adding pelvic osteotomy in patients with advanced acetabular dysplasia.
Objective: Neuromuscular hip displacement is the second most common anomaly after ankle joint deformity in individuals with cerebral palsy (CP). Conservative, reconstructive or salvage surgical procedures are performed to improve the quality of life and function of patients with hip displacement. The aim of our study was to evaluate the short and medium term effects of hip reconstructive surgeries on proximal femoral geometry and acetabulum in patients with CP, both functionally and radiologically. Method: We planned to retrospectively evaluate the surgeries of patients diagnosed with cerebral palsy between January 2013 and January 2024 in our clinic to determine the cases with hip reconstructive surgery. The data of patients who met our inclusion criteria were obtained from the system. Standardized anteroposterior pelvic radiographs of all patients taken preoperatively and at the last follow-up were evaluated within the scope of the study. Reimer migration index (RMI), acetabular index (AI), Sharp angle, central margin angle, femoral neckshaft angle, femoral head-shaft angle, and medialization index (MeI) were evaluated. Functional mobility scale (FMS) for functional assessment and 10-point VAS for pain assessment were applied to all patients. Dependent sample t test and general linear model repeated measures test were used for intergroup and time comparisons, and a p value less than 0.05 (p<0.05) was considered statistically significant. Results: Of the 37 patients included in the study, 20 were female (54%) and 17 were male (46%). Forty-seven hips of the 37 patients were evaluated. Of the 47 operated hips, 51% were right hips and 49% were left hips. The youngest of the 37 patients was 6 years old and the oldest was 21 years old at the last follow-up. Pelvic osteotomy was performed in addition to femoral osteotomy in 24 operated hips. Patients who underwent isolated femoral osteotomy were defined as group 1 and patients who underwent pelvic osteotomy were defined as group 2. The mean age of group 1 was 14.9 ± 4.3 years with a follow-up period of 4.6 ± 2 years, while the mean age of group 2 was 10.7 ± 3.2 years with a follow-up period of 3.5 ± 1.2 years. Preoperative evaluation showed that Group 2 had a significantly higher Reimer Migration Index compared to Group 1 (p < 0.001). This suggests that patients in Group 2 had more advanced pathology preoperatively. In the postoperative evaluation, the results of Group 1 showed significantly better improvement than Group 2, although this difference between both groups was reduced (p = 0.01). Group 2 showed a statistically significant higher preoperative acetabular Index value than Group 1 (p = 0.004). However, after the surgical intervention, the significance of this difference between the two groups disappeared and the difference between the indicators became statistically insignificant (p = 0.14). In the preoperative measurements between the two groups, Group 2 had significantly higher Center Edge angle values (p < 0.001), indicating more severe dysplasia. Postoperatively, Group 1 showed a significant improvement in this angle compared to Group 2 (p = 0.003). The functional mobility scale (FMS) for functional scoring shows that Group 1 performed statistically significantly better than Group 2. In particular, the p value obtained in the FMS 500m scale (p = 0.002) shows that Group 1 performed statistically significantly better than Group 2. The preoperative mean Vas Score in group 1 was. 6.7 ± 0.9 preoperatively and 1.1 ± 0.9 postoperatively in group 1; preoperative mean in group 2. 8.1 ± 0.9 preoperatively and 2.3 ± 1.2 postoperatively. Conclusion: The findings of our study support the literature on the short-medium term efficacy and safety of hip reconstructive surgeries in the treatment of hip displacement and dislocation in patients with cerebral palsy. Although the age limit for hip reconstructive surgeries is controversial in the literature, we found that surgeries performed before the age of 8 years achieved similar results in the short-medium term in our study. Although acetabular coverage was achieved in the isolated VDRO group, we recommend adding pelvic osteotomy in patients with advanced acetabular dysplasia.
Açıklama
Anahtar Kelimeler
Fonksiyonel mobilite skalası, Functional mobility scale, Kalça rekonstrüktif cerrahi, Hip reconstructive surgery, Proksimal femoral geometri, Proximal femoral geometry, Reimer migrasyon indeksi, Reimer migration index, Serebral palsi, Cerebral palsy
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Akkaya, M. K. (2024). Kliniğimizde serebral palsi tanılı hastalarda yapılan rekonstrüktif kalça cerrahisinin proksimal femoral geometri ve asetabuluma etkilerinin radyolojik ve fonksiyonel sonuçlarının değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Ortopedi ve Travmatoloji Anabilim Dalı, Konya.
