Touro College of Osteopathic Medicine, Middletown, NY, USA.
Department of Orthopedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, 3400 Bainbridge Ave, 6th Floor, Bronx, NY, 10461, USA.
Spine Deform. 2021 Sep;9(5):1259-1265. doi: 10.1007/s43390-021-00346-y. Epub 2021 Apr 16.
STUDY DESIGN: Literature Review. OBJECTIVE: Review the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in cerebral palsy patients with neuromuscular scoliosis. Neuromuscular scoliosis (NMS) in cerebral palsy (CP) patients is rapidly progressive and often leads to an imbalance in musculoskeletal mechanics that extends to the pelvis. A horizontal misalignment of the pelvis in the frontal plane known as pelvic obliquity (PO) is a common finding in this population. When untreated, PO can exacerbate the back pain, postural strain, and walking difficulties experienced by these patients. Establishing the manifestation and treatment plan for PO in the setting of NMS can provide valuable insight for diagnosis and management. METHODS: A comprehensive literature review was performed on the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in the setting of NMS in CP. The advantages and limitations of measurement and treatment options were evaluated. RESULTS: PO is categorized into suprapelvic, infrapelvic, and intrapelvic causes, each presenting with a unique pattern of pathology. NMS in CP with hip contractures and structural deformities fall into these categories. The Maloney and O'Brien methods of pelvic measurement have demonstrated superior utility and are recommended for clinical diagnosis. The management of PO in NMS patients is focused on the cause of malalignment, with posterior fusion, contracture release, and osteotomy encompassing the mainstay of treatment. CONCLUSION: PO is commonly found in patients with NMS in cerebral palsy. There is currently no standard method for determining the PO angle. Interventions designed to reduce scoliotic curves and release tissue contractures can level the pelvis and restore proper alignment of the spine and sacrum in the coronal plane in these patients. Further understanding of the causes of PO in NMS, as well as the establishment of a standardized measuring technique and diagnostic parameters will allow for more effective treatment options and improve outcomes in patients with CP. LEVEL OF EVIDENCE: N/A.
研究设计:文献回顾。 目的:回顾脑瘫伴神经肌肉性脊柱侧凸患者骨盆倾斜的病因、临床表现、诊断和治疗。脑瘫(CP)患者的神经肌肉性脊柱侧凸(NMS)进展迅速,常导致骨骼肌肉力学失衡,延伸至骨盆。在该人群中,常见的是矢状面骨盆水平错位,称为骨盆倾斜(PO)。如果不治疗,PO 可使这些患者的背痛、姿势紧张和行走困难恶化。在 NMS 背景下确定 PO 的表现和治疗方案可为诊断和管理提供有价值的见解。 方法:对 CP 伴 NMS 中 PO 的病因、临床表现、诊断和治疗进行了全面的文献回顾。评估了测量和治疗方法的优缺点。 结果:PO 分为骨盆上、骨盆下和骨盆内原因,每种原因都有独特的病理模式。髋关节挛缩和结构性畸形的 CP 伴 NMS 属于这些类型。骨盆测量的 Maloney 和 O'Brien 方法具有优越的实用性,推荐用于临床诊断。NMS 患者的 PO 管理侧重于错位的原因,后路融合、挛缩松解和截骨术是治疗的主要方法。 结论:PO 在 CP 伴 NMS 患者中很常见。目前尚无确定 PO 角度的标准方法。旨在减少脊柱侧凸曲线和松解组织挛缩的干预措施可以使骨盆水平,并在冠状面恢复脊柱和骶骨的适当对齐,从而改善这些患者的结局。进一步了解 NMS 中 PO 的原因,以及建立标准化测量技术和诊断参数,将为 CP 患者提供更有效的治疗选择并改善其结局。 证据水平:无。
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