Aroojis Alaric, Mantri Nihit, Johari Ashok N
Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, Maharashtra 400012 India.
Paediatric Orthopaedics, Balabhai Nanavati Super Speciality Hospital, Mumbai, India.
Indian J Orthop. 2020 Jun 11;55(1):5-19. doi: 10.1007/s43465-020-00162-y. eCollection 2021 Feb.
Hip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment.
Several population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients' age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement.
Despite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context.
髋关节脱位在脑瘫（CP）中很常见，且与神经和功能损害的严重程度相关。它是一种隐匿但渐进性的疾病，如果不治疗，会导致严重的发病率并降低生活质量。脑瘫中髋关节脱位的病理生理学是髋关节屈肌 - 内收肌痉挛、外展肌无力和负重延迟共同作用的结果，导致股骨近端畸形和进行性髋臼发育不良。由于髋关节脱位早期缺乏症状，很容易漏诊。认识到这种情况并通过临床检查和髋关节系列X线片进行定期监测是早期诊断和治疗的关键。
世界各地的多项基于人群的研究表明，对脑瘫患儿进行普遍的髋关节监测可早期发现髋关节脱位并进行适当的早期干预，从而减少疼痛性脱位的发生。全球髋关节监测模型基于患者的年龄、由粗大运动功能分类系统（GMFCS）确定的功能水平、步态分类、标准化临床检查以及诸如迁移百分比（MP）等放射学指标，这些是髋关节进行性脱位的关键指标。
尽管有25年的证据表明既定的髋关节监测方案有效，但印度的医疗保健专业人员对脑瘫患儿定期进行髋关节监测的重要性认识不足。专业组织需要制定与印度实际情况相关的基于证据的髋关节监测指南。
