Gose Shinichi, Sakai Takashi, Shibata Toru, Murase Tsuyoshi, Yoshikawa Hideki, Sugamoto Kazuomi
Department of Orthopaedic Surgery, Morinomiya Hospital, Osaka, Japan.
J Pediatr Orthop. 2009 Dec;29(8):896-902. doi: 10.1097/BPO.0b013e3181c0e957.
Three-dimensional computed tomography (3D-CT) eliminates the positioning errors and allows the clinician to more accurately assess the radiographic parameters present. To elucidate the 3D geometry of the acetabulum and the extent of hip subluxation/dislocation in patients with cerebral palsy (CP), quantitative morphometric analysis was performed using 3D-CT data.
We evaluated 150 hips in 75 patients with bilateral spastic CP. The mean age of the patients was 5.4 years (range: 2.7 to 6.9 y). The fitting plane of the ilium was projected onto the coronal plane and then onto the sagittal plane, and then the angle formed with a horizontal line was defined as CTalpha (the lateral opening angle) and CTbeta (the sagittal inclination angle), respectively. The center of the acetabulum and the femoral head were defined, and the distance between these centers was divided by the femoral head diameter, defined as CT migration percentage (CTMP, %).
In 123 (82%) of the 150 hips, the femoral head center was located posteriorly, superiorly, and laterally relative to the acetabular center. Large CTalpha cases tended to show large CTMP. CTalpha and CTMP were significantly larger in the cases with Gross Motor Functional Classification System (GMFCS) level IV/V and spastic quadriplegia, than in the cases with GMFCS level II/III and spastic diplegia. CTbeta showed significant correlation with the acetabular defect on the lateral 3D reconstructed images.
Three-dimensional acetabular geometry and migration percentage in CP patients can be analyzed quantitatively using 3D-CT regardless of the abnormal spastic posture. The extent of acetabular dysplasia and subluxation is more severe in patients with GMFCS level IV/V and spastic quadriplesia.
Level 4.
三维计算机断层扫描（3D-CT）消除了定位误差，使临床医生能够更准确地评估现有的影像学参数。为了阐明脑瘫（CP）患者髋臼的三维几何结构以及髋关节半脱位/脱位的程度，使用3D-CT数据进行了定量形态学分析。
我们评估了75例双侧痉挛性CP患者的150个髋关节。患者的平均年龄为5.4岁（范围：2.7至6.9岁）。将髂骨的拟合平面投影到冠状面，然后再投影到矢状面，然后将与水平线形成的角度分别定义为CTα（外侧开口角）和CTβ（矢状倾斜角）。定义髋臼中心和股骨头中心，并将这些中心之间的距离除以股骨头直径，定义为CT移位百分比（CTMP，%）。
在150个髋关节中的123个（82%）中，股骨头中心相对于髋臼中心位于后方、上方和外侧。CTα大的病例往往显示CTMP大。与GMFCS II/III级和痉挛性双瘫病例相比，GMFCS IV/V级和痉挛性四肢瘫病例的CTα和CTMP明显更大。CTβ与外侧3D重建图像上的髋臼缺损显著相关。
无论痉挛姿势异常如何，均可使用3D-CT对CP患者的三维髋臼几何结构和移位百分比进行定量分析。GMFCS IV/V级和痉挛性四肢瘫患者的髋臼发育不良和半脱位程度更严重。
4级。
