[非行走型脑瘫患者的骨盆倾斜和脊柱侧弯：对234名15岁以上患者的描述性研究]

[Pelvic obliquity and scoliosis in non-ambulatory patients with cerebral palsy: a descriptive study of 234 patients over 15 years of age].

作者信息

Hodgkinson I, Bérard C, Chotel F, Bérard J

机构信息

Service de Rééducation Fonctionnelle Pédiatrique, L'Escale, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite Cedex.

出版信息

Rev Chir Orthop Reparatrice Appar Mot. 2002 Jun;88(4):337-41.

DOI:

PMID:12124532

Abstract

PURPOSE OF THE STUDY

Children with cerebral palsy who cannot walk have an oblique pelvis and scoliosis. There is a certain degree of controversy in the literature on the best way to manage this difficult situation. We present a descriptive analysis of a population of non-ambulatory adults with cerebral palsy in order to formulate hypotheses concerning the factors determining scoliosis.

MATERIAL AND METHODS

This descriptive cross-sectional study was conducted in 234 patients aged over 15 years who had cerebral palsy and could not walk. Physical examination and an x-ray of the pelvis and spine in the reclining position were obtained for all patients. The following variables were recorded: luxation and subluxation of the hip, spontaneous deviation attitude, ability or not to turn over in bed, pelvic obliquity, history of bone surgery, defective hip abduction. The statistical analysis accounted for laterality and pelvis obliquity to the scoliosis convexity and the laterality of the hip excentration.

RESULTS

Scoliosis was observed in 66.2% of the patients; it was more than 60 degrees in 34.5%. Two basic groups were distinguished: thoracolumbar scoliosis (41.6%) and lumbar scoliosis (41.6%). The prevalence of oblique pelvi was 59.9% with important difference by side: 31.6% right oblique and 68.4% left oblique pelvi. We were unable to find any relationship between the side of the pelvic obliquity and the side of the scoliosis convexity, the side of the hip excentration, or the deviation attitude, but the deviation attitude appeared to be a risk factor for pelvic obliquity, which itself was a risk factor for excentration, which was a risk factor for scoliosis.

DISCUSSION

Scoliosis is an important problem in this population. Hip luxation is a direct risk factor for scoliosis, but the deviation attitude and pelvic obliquity are intermediary stages. The prevalence of oblique pelvi was greater on the left than the right. This finding should be confirmed in other series before hypotheses can be formulated concerning this difference.

摘要

研究目的

无法行走的脑瘫患儿存在骨盆倾斜和脊柱侧弯。关于如何最佳处理这一棘手情况，文献中存在一定程度的争议。我们对一群非行走型脑瘫成人进行描述性分析，以便就决定脊柱侧弯的因素提出假设。

材料与方法

这项描述性横断面研究针对234名年龄超过15岁、患有脑瘫且无法行走的患者开展。对所有患者进行了体格检查以及卧位时骨盆和脊柱的X线检查。记录了以下变量：髋关节脱位和半脱位、自发偏斜姿势、床上翻身能力、骨盆倾斜度、骨外科手术史、髋关节外展缺陷。统计分析考虑了脊柱侧弯凸侧的左右侧性和骨盆倾斜度以及髋关节外展的左右侧性。

结果

66.2%的患者观察到脊柱侧弯；34.5%的患者侧弯超过60度。区分出两个基本组：胸腰段脊柱侧弯（41.6%）和腰段脊柱侧弯（41.6%）。骨盆倾斜的患病率为59.9%，左右侧存在显著差异：右侧倾斜骨盆占31.6%，左侧倾斜骨盆占68.4%。我们未能发现骨盆倾斜侧与脊柱侧弯凸侧、髋关节外展侧或偏斜姿势之间存在任何关联，但偏斜姿势似乎是骨盆倾斜的一个危险因素，而骨盆倾斜本身是外展的一个危险因素，外展又是脊柱侧弯的一个危险因素。