Park Jae Young, Choi Young, Cho Byung Chae, Moon Sang Young, Chung Chin Youb, Lee Kyoung Min, Sung Ki Hyuk, Kwon Soon-Sun, Park Moon Seok
Department of Orthopaedic Surgery, 21th Century Hospital, Wonju, Korea .
Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea .
J Korean Med Sci. 2016 Jul;31(7):1143-9. doi: 10.3346/jkms.2016.31.7.1143. Epub 2016 May 19.
Progression of hip displacement is common in patients with cerebral palsy (CP). We aimed to investigate the rate of progression of hip displacement in patients with CP by assessing changes in radiographic indices according to Gross Motor Function Classification System (GMFCS) level during hip surveillance. We analyzed the medical records of patients with CP aged < 20 years who underwent at least 6 months interval of serial hip radiographs before any surgical hip intervention, including reconstructive surgery. After panel consensus and reliability testing, radiographic measurements of migration percentage (MP), neck-shaft angle (NSA), acetabular index (AI), and pelvic obliquity (PO) were obtained during hip surveillance. For each GMFCS level, annual changes in radiographic indices were analyzed and adjusted for affecting factors, such as sex, laterality, and type of CP. A total of 197 patients were included in this study, and 1,097 radiographs were evaluated. GMFCS classifications were as follows: 100 patients were level I-III, 48 were level IV, and 49 were level V. MP increased significantly over the duration of hip surveillance in patients with GMFCS levels I-III, IV, and V by 0.3%/year (P < 0.001), 1.9%/year (P < 0.001), and 6.2%/year (P < 0.001), respectively. In patients with GMFCS level IV, NSA increased significantly by 3.4°/year (P < 0.001). Our results suggest that periodic monitoring and radiographic hip surveillance is warranted for patients with CP, especially those with GMFCS level IV or V. Furthermore, physicians can predict and inform parents or caregivers regarding the progression of hip displacement in patients with CP.
髋关节脱位进展在脑瘫（CP）患者中很常见。我们旨在通过评估髋关节监测期间根据粗大运动功能分类系统（GMFCS）水平的影像学指标变化，来研究CP患者髋关节脱位的进展率。我们分析了年龄小于20岁、在任何髋关节手术干预（包括重建手术）前至少间隔6个月进行系列髋关节X线片检查的CP患者的病历。经过专家小组共识和可靠性测试后，在髋关节监测期间获得了移位百分比（MP）、颈干角（NSA）、髋臼指数（AI）和骨盆倾斜度（PO）的影像学测量值。对于每个GMFCS水平，分析影像学指标的年度变化，并对性别、侧别和CP类型等影响因素进行校正。本研究共纳入197例患者，评估了1097张X线片。GMFCS分类如下：I - III级100例，IV级48例，V级49例。在GMFCS I - III级、IV级和V级患者中，MP在髋关节监测期间显著增加，每年分别增加0.3%（P < 0.001）、1.9%（P < 0.001）和6.2%（P < 0.001）。在GMFCS IV级患者中，NSA每年显著增加3.4°（P < 0.001）。我们的结果表明，CP患者有必要进行定期监测和髋关节影像学检查，尤其是GMFCS IV级或V级的患者。此外，医生可以预测并告知家长或护理人员CP患者髋关节脱位的进展情况。
