脑瘫患者骨盆倾斜的影像学评估及其对髋关节发育的影响。
The radiological assessment of pelvic obliquity in cerebral palsy and the impact on hip development.
作者信息
Heidt C, Hollander K, Wawrzuta J, Molesworth C, Willoughby K, Thomason P, Khot A, Graham H K
机构信息
University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, 8032, Switzerland.
University of Hamburg, Turmweg 2, 20148 Hamburg, Germany.
出版信息
Bone Joint J. 2015 Oct;97-B(10):1435-40. doi: 10.1302/0301-620X.97B10.35390.
Pelvic obliquity is a common finding in adolescents with cerebral palsy, however, there is little agreement on its measurement or relationship with hip development at different gross motor function classification system (GMFCS) levels. The purpose of this investigation was to study these issues in a large, population-based cohort of adolescents with cerebral palsy at transition into adult services. The cohort were a subset of a three year birth cohort (n = 98, 65M: 33F, with a mean age of 18.8 years (14.8 to 23.63) at their last radiological review) with the common features of a migration percentage greater than 30% and a history of adductor release surgery. Different radiological methods of measuring pelvic obliquity were investigated in 40 patients and the angle between the acetabular tear drops (ITDL) and the horizontal reference frame of the radiograph was found to be reliable, with good face validity. This was selected for further study in all 98 patients. The median pelvic obliquity was 4° (interquartile range 2° to 8°). There was a strong correlation between hip morphology and the presence of pelvic obliquity (effect of ITDL on Sharpe's angle in the higher hip; rho 7.20 (5% confidence interval 5.59 to 8.81, p < 0.001). This was particularly true in non-ambulant adolescents (GMFCS IV and V) with severe pelvic obliquity, but was also easily detectable and clinically relevant in ambulant adolescents with mild pelvic obliquity. The identification of pelvic obliquity and its management deserves closer scrutiny in children and adolescents with cerebral palsy.
骨盆倾斜是脑瘫青少年中的常见表现,然而,对于其测量方法或在不同粗大运动功能分类系统(GMFCS)水平下与髋关节发育的关系,目前尚无定论。本研究的目的是在一个向成人服务过渡的、基于人群的大型脑瘫青少年队列中研究这些问题。该队列是一个三年出生队列的子集(n = 98,男65例:女33例,最后一次影像学检查时的平均年龄为18.8岁(14.8至23.63岁)),其共同特征是移位百分比大于30%且有内收肌松解手术史。对40例患者研究了测量骨盆倾斜的不同影像学方法,发现髋臼泪滴(ITDL)与X线片水平参考框架之间的角度可靠,具有良好的表面效度。因此选择该方法在所有98例患者中进行进一步研究。骨盆倾斜的中位数为4°(四分位间距为2°至8°)。髋关节形态与骨盆倾斜的存在之间存在很强的相关性(较高髋关节中ITDL对夏普角的影响;rho为7.20(5%置信区间为5.59至8.81,p < 0.001)。这在非行走型脑瘫青少年(GMFCS IV和V级)且骨盆倾斜严重的患者中尤为明显,但在轻度骨盆倾斜的行走型脑瘫青少年中也易于检测且具有临床相关性。对于脑瘫儿童和青少年,骨盆倾斜的识别及其处理值得更深入的研究。