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Femoral derotational osteotomy: Surgical indications and outcomes in children with cerebral palsy

机译：股骨回旋截骨术：脑瘫患儿的手术指征和预后

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Excessive femoral anteversion is common among children with cerebral palsy, and is, frequently treated by a femoral derotational osteotomy (FDO). It is important to understand surgical, indications for FDO, and the impact of these indications on the treatment outcomes. The Random Forest algorithm was used to objectively identify historical surgical indications in a large retrospective, cohort of 1088 limbs that had previously undergone single-event multi-level surgery. Treatment, outcome was based on transverse plane kinematics obtained from three-dimensional gait analysis. The, classifier effectively identified the historic indications (accuracy=.85, sensitivity=.93, specificity=.69, positive predictive value=.86, negative predictive value=.82), and naturally divided limbs into four, clusters: two homogeneous +FDO clusters (with/without significant internal hip rotation during gait), one homogeneous -FDO cluster, and a mixed cluster. Concomitant surgeries were similar among the, clusters. Limbs with excessive anteversion and internal hip rotation during gait had excellent outcomes, in the transverse plane. Limbs with excessive anteversion but only mild internal hip rotation had good, outcomes at the hip level; but a significant number of these limbs ended up with an excessive external, foot progression angle. The Random Forest algorithm was highly effective for identifying and, organizing historic surgical indications. The derived criteria can be used to give surgical decision making, guidance in a majority of limbs. The results suggest that limbs with anteversion and significant, internal hip rotation during gait benefit from an FDO, but limbs with excessive anteversion and only, mild internal hip rotation are at risk of developing an excessive external foot progression angle.
机译：过度股骨前倾在脑瘫患儿中很常见，并且经常通过股骨旋转截骨术（FDO）进行治疗。了解手术，FDO适应症以及这些适应症对治疗结果的影响非常重要。在一个大型回顾性队列中，先前曾接受过单事件多级手术的1088例肢体使用了随机森林算法来客观地识别历史手术指征。治疗的结果基于从三维步态分析获得的横断面运动学。分类器有效地识别了历史指示（准确度= .85，敏感性= .93，特异性= .69，阳性预测值= .86，阴性预测值= .82），并且自然地将肢体分为四个集群：两个同质+ FDO群集（步态期间有/没有明显的内部髋关节旋转），一个均匀的-FDO群集和一个混合群集。群集之间的伴随手术相似。在步态中，前肢过度前倾和内部髋关节旋转的肢体在横断面上具有极好的结果。过度前倾但仅轻微的内部髋关节旋转的四肢在髋关节水平具有良好的预后。但是这些肢体中有相当多的人最终以过度的外部脚步前进角度结束。随机森林算法对于识别和组织历史性手术指征非常有效。推导的标准可用于在大多数肢体中提供手术决策和指导。结果表明，在步态中具有前倾角和明显的内部髋关节旋转的四肢可受益于FDO，但是具有过度前倾角且仅具有轻微的内部髋关节旋转的四肢有形成过度的外足前进角的风险。

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