Kentish M, Wynter M, Snape N, Boyd R
Queensland Cerebral Palsy Health Service, Royal Childrens Hospital, Brisbane, QLD, Australia.
J Pediatr Rehabil Med. 2011;4(3):205-17. doi: 10.3233/PRM-2011-0176.
This study reports the five-year outcomes of a prospective population-based study of clinical hip surveillance for children with cerebral palsy (CP) according to evidence-based standards of care. Systematic hip surveillance commenced in Queensland, Australia as a state-wide program in 2005. Queensland represents a dispersed population across a large geographical area, creating unique challenges in terms of service delivery. Over five years, 1,115 children with CP were recruited, representing 73% of the expected population based on 1.9 to 2.1 per 1,000 live births. Standardized clinical and radiological assessments have been provided, with a median follow-up of 1.2 years (range 1 month -5(+8) yrs). Of the 1,115 children, 423 (38%) have been discharged and 692 (62%) remain on surveillance with 314 (28%) identified as having hip displacement with Migration Percentage (MP) equal to or greater than 30% (≥ 30). The incidence of marked hip displacement (MP ≥ 30) was directly related to gross motor function, classified according to the gross motor function classification system (GMFCS), with distribution of GMFCS I=10, (3%), II=40 (13%), III=53 (43%), IV=96 (59%), and V=115 (64%). This state-wide surveillance program has been successful in correctly identifying children with hip displacement (MP ≥ 30), fast tracking children for orthopedic review and discharging those at minimal risk. No child has progressed to dislocation while on surveillance without orthopedic review.
本研究报告了一项基于人群的前瞻性研究的五年结果，该研究按照循证护理标准对脑瘫（CP）儿童进行临床髋关节监测。2005年，作为一项全州范围的项目，系统性髋关节监测在澳大利亚昆士兰州启动。昆士兰州人口分布在广阔的地理区域，这在服务提供方面带来了独特的挑战。在五年时间里，招募了1115名脑瘫儿童，占预期人群的73%，预期人群是基于每1000例活产中有1.9至2.1例。已提供标准化的临床和放射学评估，中位随访时间为1.2年（范围1个月至5（+8）年）。在这1115名儿童中，423名（38%）已出院，692名（62%）仍在接受监测，其中314名（28%）被确定存在髋关节移位，移位百分比（MP）等于或大于30%（≥30）。明显髋关节移位（MP≥30）的发生率与根据粗大运动功能分类系统（GMFCS）分类的粗大运动功能直接相关，GMFCS I类有10名（3%），II类有40名（13%），III类有53名（43%），IV类有96名（59%），V类有115名（64%）。这项全州范围的监测项目成功地正确识别出髋关节移位（MP≥30）的儿童，快速将儿童转介至骨科进行评估，并让风险最小的儿童出院。在接受监测且未经骨科评估的情况下，没有儿童进展为髋关节脱位。
