Article

This study aimed to evaluate the effect of complementary and alternative
medicine (CAM) approaches on long-term surgical requirements, and clinical and
radiographic outcomes for children with cerebral palsy and hip displacement.
METHOD: Twenty-three children with cerebral palsy and early hip displacement who
were offered preventive hip surgery and whose parents declined in favour of CAM
approaches were followed (13 males, 10 females; mean age 13 y 9 mo [SD 3 y 1 mo];
mean length of follow-up 10 y 2 mo [SD 2 y 11 mo]; 17 with spastic quadriplegia,
two with spastic triplegia, and four with spastic diplegia; three with gross
motor function classified at Gross Motor Function Classification System [GMFCS]
level II, four at level III, six at level IV, and 10 at level V). Principal
outcome measures were progression of hip displacement (measured by migration
percentage: the percentage of the femoral head sitting outside of the
acetabulum), eventual need for reconstructive or salvage surgery, and long-term
hip morphology (classified by the Melbourne Cerebral Palsy Hip Classification
Scale). The results were compared with a previously reported cohort of 46
children who had surgery when recommended (31 males, 15 females; mean age 13 y 11
mo [SD 1 y 6 mo]; mean length of follow-up 10 y 10 mo; 10 with diplegia and 36
with quadriplegia; three at GMFCS level II, 11 at level III, 20 at level IV, and
12 at level V). RESULTS: Outcomes for 23 children who had pursued CAM were
analysed (mean length of follow-up 10 y 2 mo). Hip displacement progressed in one
or both hips in all non-ambulant children (GMFCS level IV or V). Of the 20
children with documented progressive hip displacement, eight developed pain and
deformity requiring salvage surgery. An additional 11 children with progressive
hip displacement had late reconstructive surgery when symptoms first started.
There was strong evidence of a relationship between GMFCS and both progressive
hip displacement (chi(2) =17.78; p=0.001) and final Melbourne Cerebral Palsy Hip
Classification Scale grade
(odds ratio 12.5; p=0.012; 95% confidence interval
1.7-90.4). There was also evidence of those children who pursued CAM requiring
more complex surgery than the group who had surgery when recommended (odds ratio
2.5; p=0.002; 95% confidence interval 1.4-4.5). INTERPRETATION:
CAM therapy did
not appear to influence the progression of hip displacement in children with
cerebral palsy. Most children required major reconstructive surgery or salvage
surgery despite pursuing CAM.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2013 Mac Keith
Press.

Langue : ANGLAIS