ACETABULOPLASTIE DE DEGA chez l’enfant avec paralysie cérébrale Voie percutanée versus voie classique

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Introduction The impact of neuromuscular damage on the hip joint in cerebral palsy, is frequent, exceeding 70% and can be a source of severe complications ranging from a simple vicious attitude making perineal hygiene care difficult, to subluxation or dislocation source of pain in more than 30% and osteoarthritis. Hip surgery is necessary, even for bedridden spastic children, the goal is to obtain a reduced, painless and stable hip. We compared the results of the minimally invasive Dega acetabuloplasty versus the classic approach to demonstrate the value or not of this new percutaneous approach described by Canavese in the treatment of subluxations and dislocations of the hip with acetabular dysplasia. Material and Methods We have made an open-label clinical trial including 21 children with spastic tetraparesis cerebral palsy, presenting acetabular dysplasia with subluxation or dislocation of the hip treated by classical and percutaneous Dega pelvic osteotomy, associated with varization-shortening-derotation femoral osteotomy. The primary endpoint was measurement of the Reimers index and the secondary endpoints studied were acetabular angle, pain intensity, intraoperative data including level of intraoperative irradiation, blood loss, operating time as well as the length of hospitalization. Results A total of 25 hips were operated on (21 patients), 12 hips by percutaneous Dega osteotomy and 13 hips by conventional pelvic osteotomy. The mean age of the patients was 7 years-old, 16 patients were GMF-CS IV level and 5 GMF-CS V patients. The mean operating time was 28 minutes during percutaneous pelvic surgery and 58 minutes lord of the classic first. The percentage of Reimers migration went from 70 ± 28% preoperatively to 13 ± 28% after OPP and from 93 ± 12% to 10.27% after OPC and the acetabular angle went from 37 ± 7 ° to 15 ° after OPP and 45 ± 6 ° at 21 ° after OPC at the last follow-up. Conclusion The two percutaneous and conventional approaches give similar results with regard to the correction of acetabular dysplasia, on the other hand the minimally invasive pelvic approach has clear advantages: Shortened operating time, less blood loss, duration of shorter hospital stay. The disadvantage of this first method is the higher irradiation for the surgeon.