脑瘫患儿髋臼发育不良所致髋关节移位和脱位的定义

Definition of hip displacement and dislocation by acetabular dysplasia in children with cerebral palsy.

作者信息

Wang Nai Kuang, Shen Shih Hsien, Chen Brian Po Jung, Chang Chia Hsieh, Kuo Ken N

机构信息

Department of Internal Medicine, Taichung Veterans General Hospital, Taichung.

Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi.

出版信息

J Child Orthop. 2023 Jul 22;17(4):315-321. doi: 10.1177/18632521231185294. eCollection 2023 Aug.

DOI:10.1177/18632521231185294

PMID:37565006

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10411378/

Abstract

PURPOSE

The acetabulum interacts with the femoral head in daily activities and may exhibit structural changes in the presence of hip disorders. This study aims to redefine hip disorders in children with cerebral palsy by structural characteristics of the acetabulum in relation to the degree of the migration percentage.

METHODS

The clinical and radiographic data of 70 patients (36 males, 34 females; mean age 8.2 years) with spastic cerebral palsy were retrospectively analyzed. The acetabular structure was measured by the acetabular index on reconstructed three-dimensional computerized tomography for precision of measurement. Any significant change in acetabular index measured on the reconstructive computerized tomography related to every 10% increment of migration percentage was regarded as clinically significant in hip disorders.

RESULTS

The acetabular index measured on the reconstructive computerized tomography showed an increasing trend with the increment of migration percentage. The most significant acetabular index measured on the reconstructive computerized tomography change occurred between the 20%-29% and 30%-39% migration percentage groups (p < 0.001), suggesting that a migration percentage of 30% is the starting point of hip disorder. A significant increase in the posterolateral acetabular index measured on the reconstructive computerized tomography occurred in migration percentages >50%, indicating posterolateral acetabular dysplasia. Hips with migration percentages from 80% to 100% had consistent acetabular indexes measured on the reconstructive computerized tomography values, suggesting complete dislocation and no more contact and interaction between the femoral head and acetabular fossa.

CONCLUSION

Structural characteristics in the acetabulum reflect hip dysfunction and potentially classify hip disorders. Results suggest the migration percentage 30% as a starting point of hip disorder and 80% as a turning point of hip dislocation in children with cerebral palsy.

LEVEL OF EVIDENCE

level IV, diagnostic study.

摘要

目的

髋臼在日常活动中与股骨头相互作用，在髋关节疾病存在时可能会出现结构变化。本研究旨在通过髋臼的结构特征与移位百分比程度的关系，重新定义脑瘫患儿的髋关节疾病。

方法

回顾性分析70例痉挛型脑瘫患者（男36例，女34例；平均年龄8.2岁）的临床和影像学资料。通过重建的三维计算机断层扫描上的髋臼指数测量髋臼结构，以提高测量精度。在重建的计算机断层扫描上测量的髋臼指数与移位百分比每增加10%相关的任何显著变化，在髋关节疾病中被视为具有临床意义。

结果

在重建的计算机断层扫描上测量的髋臼指数随移位百分比的增加呈上升趋势。在移位百分比20%-29%组和30%-39%组之间，重建的计算机断层扫描上测量的髋臼指数变化最为显著（p<0.001），表明移位百分比30%是髋关节疾病开始的临界点。在移位百分比>50%时，重建的计算机断层扫描上测量的髋臼后外侧指数显著增加，表明髋臼后外侧发育不良。移位百分比为80%-100%的髋关节在重建的计算机断层扫描值上具有一致的髋臼指数，表明完全脱位，股骨头与髋臼窝之间不再有接触和相互作用。