Hägglund Gunnar, Lauge-Pedersen Henrik, Wagner Philippe
Department of Orthopaedics, Lund University Hospital, S-221 85 Lund, Sweden.
BMC Musculoskelet Disord. 2007 Oct 26;8:101. doi: 10.1186/1471-2474-8-101.
Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme.
In a total population of children with CP a standardised clinical and radiological follow-up of the hips was carried out as a part of a hip prevention programme. The present study is based on 212 children followed until 9-16 years of age.
Of the 212 children, 38 (18%) developed displacement with Migration Percentage (MP) >40% and further 19 (9%) MP between 33 and 39%. Mean age at first registration of hip displacement was 4 years, but some hips showed MP > 40% already at two years of age. The passive range of hip motion at the time of first registration of hip displacement did not differ significantly from the findings in hips without displacement. The risk of hip displacement varied according to CP-subtype, from 0% in children with pure ataxia to 79% in children with spastic tetraplegia. The risk of displacement (MP > 40%) was directly related to the level of gross motor function, classified according to the gross motor function classification system, GMFCS, from 0% in children in GMFCS level I to 64% in GMFCS level V.
Hip displacement in CP often occurs already at 2-3 years of age. Range of motion is a poor indicator of hips at risk. Thus early identification and early radiographic examination of children at risk is of great importance. The risk of hip displacement varies according to both CP-subtype and GMFCS. It is sometimes not possible to determine subtype before 4 years of age, and at present several definitions and classification systems are used. GMFCS is valid and reliable from 2 years of age, and it is internationally accepted. We recommend a hip surveillance programme for children with CP with radiographic examinations based on the child's age and GMFCS level.
脑瘫（CP）患儿的髋关节脱位是一个常见且严重的问题。通过对有髋关节脱位风险的儿童进行筛查和预防性治疗，可以避免脱位。本研究的目的是分析发生髋关节移位的脑瘫患儿的特征，以优化髋关节监测方案。
在脑瘫患儿的总体人群中，作为髋关节预防计划的一部分，对髋关节进行了标准化的临床和放射学随访。本研究基于212名随访至9至16岁的儿童。
在这212名儿童中，38名（18%）出现移位，移位百分比（MP）>40%，另有19名（9%）的MP在33%至39%之间。首次记录髋关节移位时的平均年龄为4岁，但有些髋关节在2岁时MP就已>40%。首次记录髋关节移位时髋关节的被动活动范围与未移位髋关节的检查结果相比，差异无统计学意义。髋关节移位的风险因脑瘫亚型而异，从单纯共济失调型儿童的0%到痉挛性四肢瘫儿童的79%。移位风险（MP>40%）与根据粗大运动功能分类系统（GMFCS）分类的粗大运动功能水平直接相关，从GMFCS I级儿童的0%到GMFCS V级儿童的64%。
脑瘫患儿的髋关节移位常在2至3岁时就已发生。活动范围并不是髋关节有风险的良好指标。因此，对有风险的儿童进行早期识别和早期影像学检查非常重要。髋关节移位的风险因脑瘫亚型和GMFCS而异。有时在4岁之前无法确定亚型，目前使用多种定义和分类系统。GMFCS从2岁起有效且可靠，并且已被国际认可。我们建议为脑瘫患儿制定髋关节监测方案，根据患儿年龄和GMFCS水平进行影像学检查。
