Chang Chia Hsieh, Wang Ying Chih, Ho Pei Chi, Hwang Ai Wen, Kao Hsuan Kai, Lee Wei Chun, Yang Wen E, Kuo Ken N
Department of Pediatric Orthopedics, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Clin Orthop Relat Res. 2015 Nov;473(11):3675-81. doi: 10.1007/s11999-015-4515-3. Epub 2015 Aug 20.
Coxa valga and femoral anteversion often are seen in patients with spastic hip displacement and osteotomy is recommended. However, the relationship between femoral deformities and hip displacement has not been clearly defined and other factors, such as joint motion and posture, should be considered before recommending treatment.
For children with cerebral palsy with Gross Motor Function Classification System Level IV or V, we questioned (1) whether hip abduction range correlates with hip displacement, (2) what the relationships are between proximal femoral deformities and hip displacement, and (3) whether the patient with a windblown posture has greater degrees of femoral anteversion?
We retrospectively studied 31 consecutive children with cerebral palsy with Level IV or V gross motor function who underwent three-dimensional CT for preoperative assessment of hip displacement between January 2010 and December 2013. Among the children, 23 had a windblown posture and eight had symmetric hip motion. Femoral anteversion and true neck-shaft angle were measured from the three-dimensional CT images. Migration percentage was the dependent variable we chose to study in relation to femoral anteversion, neck-shaft angle, maximal hip abduction, and hip flexion contracture, using correlations and multiple linear regressions. Using ANOVA and Scheffé's post hoc tests, we analyzed and compared the data of 23 abducted hips and 23 adducted hips in the 23 children with windblown posture and in 16 displaced hips in the eight children with symmetric hip abduction.
Greater migration percentage was associated with less hip abduction range (r = -0.86; p < 0.001). Femoral anteversion had a weak correlation (r = 0.28; p < 0.05) to migration percentage, and the association became insignificant after considering hip abduction motion. Adducted windblown hips had greater femoral anteversion than the symmetric displaced hips and abducted windblown hips (46° vs 36° and 38°, respectively; p < 0.05).
Our study results did not support a relationship between femoral deformities and hip displacement after considering gross motor function and hip abduction motion. Greater femoral anteversion was noted in the adducted hips of patients with windblown posture, and derotation osteotomy is especially recommended.
Level III, diagnostic study.
髋外翻和股骨前倾常见于痉挛性髋关节脱位患者，建议行截骨术。然而，股骨畸形与髋关节脱位之间的关系尚未明确界定，在推荐治疗方案之前应考虑其他因素，如关节活动和姿势。
对于粗大运动功能分级系统为IV级或V级的脑瘫患儿，我们提出以下问题：（1）髋关节外展范围与髋关节脱位是否相关？（2）股骨近端畸形与髋关节脱位之间有何关系？（3）呈“风吹”姿势的患儿股骨前倾程度是否更大？
我们回顾性研究了2010年1月至2013年12月期间连续接受三维CT检查以进行髋关节脱位术前评估的31例粗大运动功能为IV级或V级的脑瘫患儿。其中，23例呈“风吹”姿势，8例髋关节运动对称。从三维CT图像中测量股骨前倾和真颈干角。移位百分比是我们选择研究的因变量，研究其与股骨前倾、颈干角、最大髋关节外展和髋关节屈曲挛缩的关系，采用相关性分析和多元线性回归分析。使用方差分析和谢费尔事后检验，我们分析并比较了23例呈“风吹”姿势患儿的23个外展髋关节和23个内收髋关节的数据，以及8例髋关节外展对称患儿中16个脱位髋关节的数据。
移位百分比越高，髋关节外展范围越小（r = -0.86；p < 0.001）。股骨前倾与移位百分比呈弱相关（r = 0.28；p < 0.05），在考虑髋关节外展运动后，这种关联变得不显著。内收的“风吹”髋关节的股骨前倾大于对称脱位髋关节和外展的“风吹”髋关节（分别为46°、36°和38°；p < 0.05）。
在考虑粗大运动功能和髋关节外展运动后，我们的研究结果不支持股骨畸形与髋关节脱位之间存在关联。呈“风吹”姿势患儿的内收髋关节股骨前倾更大，尤其建议行去旋转截骨术。
III级，诊断性研究。
