Effect Of Lumbar SPR On Hip Development In Children With Spastic Cerebral Pals

Cerebral palsy(CP)is a syndrome mainly manifested by movement disorders and abnormal posture due to premature labor,dystocia,asphyxia,jaundice,etc.The most common type of cerebral palsy is spastic cerebral palsy.Hip dysplasia is a common malformation of the musculoskeletal system in children with cerebral palsy.Without timely intervention in the early stage,it will gradually evolve into subluxation and total dislocation of the hip joint,which further affects the mobility of children.The efficacy of selective posterior rhizotomy(SPR)in reducing muscle tension and relieving spasm has been recognized by most domestic scholars,and it is an important scientific progress in the surgical treatment of cerebral palsy.The effect of SPR on reducing muscle tone and relieving spasticity is certain,but its effect on hip joint development in children with spastic cerebral palsy is not clear.It has been reported that SPR may affect the development of the hip joint in children with cerebral palsy,and progressive hip subluxation and dislocation may occur after surgery.There are many studies on hip deformity in children with cerebral palsy at home and abroad,but there are few studies on the impact of SPR on the development of hip joint in children with cerebral palsy.Objective:To explore the effect of selective posterior rhizotomy on the hip development in children with spastic cerebral palsy.Methods:A retrospective study was performed on 50 children(100 hips)who underwent SPR for spastic cerebral palsy in our department from February 2017 to February 2020.The patients were divided into preschool group and school age group according to the age at operation.The clinical and imaging results of the two groups were compared.Results:All children in both groups had operation performed successfully without serious complications.The preschool group consumed significantly less operative time with significantly less intraoperative blood loss than the school age group(P<0.05).The children were followed up from 2 to 3 years,with an average of(2.52±0.43)years.Ashworth muscle tone scales and MRC scale for hip muscle strength as well as The score of Gross Motor Function Measure(GMFM)88-E,hip flexor-extension and adduction-abduction ROMs significantly improved at the latest follow-up compared with those preoperatively in both groups(P<0.05).However,there were no statistically significant differences in the abovementioned clinical items between the two groups at any corresponding time points(P>0.05).Radiographically,There was no new hip dislocation and subluxation deformity in the two groups after operation.Compared with those preoperatively the acetabular index(AI)and neck shaft angle(NSA)had not significantly changed in both groups at the latest follow-up(P<0.05);the center-edge(CE)Angle in the preschool group increased significantly(P<0.05),whereas which remained unchanged in school-age group(P<0.05);the migration percentage(MP)of femoral head significantly decreased in both groups at the latest follow up(P<0.05).Comparison between the two groups before operation,the AI,MP and NS A of preschool group were significantly higher than those of school-age group(P<0.05),and the CE angle of preschool group was significantly lower than that of school-age group(P<0.05).Despite of the facts that the preschool group still had significantly greater AI and NSA,whereas significantly less CE angle than the school-age group(P<0.05),there was no significant difference in MP between the two groups at the latest follow up(P>0.05).Conclusion:Lumbosacral SPR can improve the development of hip joint in children with spastic cerebral palsy.