Paediatric Orthopaedics and Trumatology Department, K. Marcinkowski Medical University, Poznań, Poland.
Disabil Rehabil. 2011;33(15-16):1367-72. doi: 10.3109/09638288.2010.532281. Epub 2010 Nov 20.
Pain is a serious complication associated with hip dislocation in cerebral palsy (CP), limiting patient independence and quality of life. This study aimed to determine the frequency of pain in severe CP patients with hip dislocation and to reveal factors associated with the hip pain.
Seventy-three consecutive new-intervention CP patients admitted to authors' institution with spastic quadriplegia, mean age 10.8 years (range 4.0-18.0 years) were enrolled: 31 females and 42 males, totally 99 dislocated hips. All patients were assessed level IV or V according to the Gross Motor Function Classification Scale (GMFCS) and had poor communication skills. Pain severity was evaluated according to the Numeric Rating Scale (NRS-11). Data concerning previously applied physiotherapy was collected to divide the patients into subgroups: A - no abduction therapy (n = 24), B - abduction therapy (n = 35) and C - abduction therapy and horse-back riding (n = 13). On the pelvic antero-posterior radiographs head migration percentage was measured to reveal hip dislocation. Femoral head cartilage degenerative lesions were evaluated for size and location in 45 hips undergoing surgical treatment.
Overall pain prevalence was 56%. The appearance of pain was associated with the patient age (p = 0.048), previous abduction physiotherapy (p < 0.00001), previous horse-back riding therapy (p < 0.00001) and anterior location of degenerative changes of the femoral head (p = 0.03). Pain intensity was related to the size of the degenerative cartilage lesions (p = 0.004) and to the degree of femoral anteversion (p < 0.0001).
Extensive abduction exercises, hippotherapy and presence of degenerative cartilage lesions on the anterior part of femoral head may be considered risk factors for hip pain appearance in the dislocated hip of a child with severe spastic CP. Other associated factors are abduction exercise intensity, age, excessive femoral anteversion and size of degenerative cartilage lesions.
疼痛是脑瘫（CP）患者髋关节脱位的严重并发症，限制了患者的独立性和生活质量。本研究旨在确定患有髋关节脱位的严重 CP 患者疼痛的频率，并揭示与髋部疼痛相关的因素。
73 例新接受作者机构治疗的痉挛性四肢瘫痪 CP 患者连续入组，平均年龄 10.8 岁（范围 4.0-18.0 岁）：31 名女性和 42 名男性，共 99 个脱位髋关节。所有患者根据粗大运动功能分类量表（GMFCS）评估为 IV 级或 V 级，沟通能力较差。疼痛严重程度根据数字评分量表（NRS-11）进行评估。收集有关先前应用物理疗法的数据，将患者分为亚组：A-无外展治疗（n=24），B-外展治疗（n=35）和 C-外展治疗和骑马（n=13）。在骨盆前后位 X 光片上测量股骨头迁移百分比以显示髋关节脱位。对 45 例接受手术治疗的髋关节进行股骨头软骨退行性病变大小和位置评估。
总体疼痛患病率为 56%。疼痛的出现与患者年龄（p=0.048）、先前的外展物理疗法（p<0.00001）、先前的骑马治疗（p<0.00001）和股骨头退行性变化的前侧位置有关（p=0.03）。疼痛强度与退行性软骨病变的大小（p=0.004）和股骨前倾角的程度（p<0.0001）有关。
广泛的外展运动、骑马和股骨头前侧部分的退行性软骨病变可能被认为是严重痉挛性 CP 患者髋关节脱位后髋部疼痛出现的危险因素。其他相关因素包括外展运动强度、年龄、股骨前倾角过大和退行性软骨病变的大小。
