Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, Lodz, Poland.
Dev Med Child Neurol. 2011 Nov;53(11):1019-23. doi: 10.1111/j.1469-8749.2011.04077.x. Epub 2011 Aug 16.
Children with severe forms of cerebral palsy (CP) are at high risk of hip joint displacement. Various studies have found that the pain from affected joints occurs in 40 to 84% of studied individuals. The purpose of this study was to establish a correlation between the density of nociceptors localized in selected areas of the spastic dislocated hip joint and clinical evidence of hip joint pain in children with CP.
Nineteen samples of articular capsule and 19 samples of teres ligaments, collected during open hip joint reduction from 19 non-ambulatory children with spastic CP (Gross Motor Function Classification System level V; mean age 9y 6mo; 10 males, nine females), were studied. Pain was assessed using the numeric rating scale completed by caregivers. The density of nociceptive fibres was compared between the children with painful and children with painless hip joints, using S-100 and substance P monoclonal antibodies.
The presence of S-100 protein and substance P were significantly increased (p=0.024 and p=0.02 respectively) in the children with painful hip joints. There were significantly positive correlations between the intensity of pain and the density of nerve fibres with S-100 protein (teres ligament, p=0.001; joint capsule, p=0.032) as well as substance P (teres ligament, p=0.001).
Direct and indirect inflammatory factors, present in dislocated hip joints with cartilage damage in children with spastic CP, lead to hip joint sensitization.
患有严重脑瘫（CP）的儿童髋关节易发生位移，有多项研究发现，受影响关节的疼痛发生在 40%至 84%的研究对象中。本研究旨在确定定位在痉挛性髋关节脱位的特定区域的伤害感受器密度与 CP 儿童髋关节疼痛的临床证据之间的相关性。
从 19 名非运动性痉挛性 CP 儿童（Gross Motor Function Classification System 水平 V；平均年龄 9 岁 6 个月；男性 10 名，女性 9 名）的开放性髋关节复位中收集 19 个关节囊样本和 19 个臀中肌韧带样本。使用数字评分量表由照顾者评估疼痛。使用 S-100 和 P 物质单克隆抗体比较有疼痛和无痛髋关节儿童之间伤害感受器纤维的密度。
有疼痛髋关节儿童的 S-100 蛋白和 P 物质的存在显著增加（p=0.024 和 p=0.02 分别）。疼痛强度与 S-100 蛋白（臀中肌韧带，p=0.001；关节囊，p=0.032）和 P 物质（臀中肌韧带，p=0.001）神经纤维密度之间存在显著正相关。
存在于 CP 痉挛性髋关节脱位伴软骨损伤的直接和间接炎症因子导致髋关节敏化。
