Аңдатпа
Background. Hip instability develops in 3-60% of patients with spastic cerebral palsy (CP) and is a leading cause of pain, postural impairment, and reduced quality of life. Reconstructive surgery includes femoral varus derotation osteotomy combined with acetabuloplasty. However, the need for routine capsulotomy remains controversial. The aim of the study — to evaluate the effectiveness of an intraoperative fluoroscopic reducibility test in the surgical treatment of hip dislocation in children with spastic cerebral palsy based on an analysis of clinical, radiographic, and functional outcomes Methods. This retrospective comparative cohort study conducted between 2019 and 2025 included 82 patients with 118 affected hips. Spastic diplegia was present in 79% of patients and spastic quadriplegia in 21%. The mean patient age was 8.4 years. Patients were allocated to the study groups intraoperatively according to the results of the fluoroscopic reducibility test. When the lateral center-edge angle (LCEA) was ≥20°, closed reduction without capsulotomy was performed (Group I, n = 76 hips; 64%). When the LCEA was 20°, capsulotomy with the removal of intra-articular obstacles to reduction was performed (Group II, n = 42 hips; 36%). Statistical analysis was performed using generalized estimating equations (GEE) with patient-level clustering. A 1:1 propensity score-matched sensitivity analysis included 84 hips. The primary outcome was hip stability, defined as a Reimers migration percentage (MP) of 30%, at a minimum follow-up of 2 years. The prespecified equivalence margin was 15%. Results. The mean follow-up was 3.5 years (95% CI 3.3-3.9). Hip stability was achieved in 93% of hips in Group I and 88% of hips in Group II. The between-group difference was 5.2% (95% CI -4.1 to +14.5), confirming equivalence between the treatment strategies. Operative time was 45 minutes shorter in Group I (p 0.001). The rates of avascular necrosis (8%) and recurrent hip displacement (5%) did not differ between the groups. A preoperative MP of ≥ 75% (OR 1.9) and spastic quadriplegia (OR 2.1) were independent predictors of the need for capsulotomy. The area under the receiver operating characteristic curve was 0.80 (95% CI 0.69-0.91). Pain reduction and caregiver satisfaction scores of ≥ 4 out of 5, achieved in 79% of cases, did not differ between the groups. Conclusion. The intraoperative fluoroscopic reducibility test allowed capsulotomy to be avoided in 64% of cases, with comparable radiographic outcomes and a significantly shorter operative time. These findings support a selective rather than routine approach to capsulotomy during reconstruction of neuromuscular hip dislocation in children with cerebral palsy.