Texas Children's Hospital, Houston, Texas; Baylor College of Medicine, Houston, TX.
J Pediatr Orthop. 2023;43(10):e798-e803. doi: 10.1097/BPO.0000000000002513. Epub 2023 Sep 9.
Adolescent idiopathic scoliosis radiographic screening will often include the hips. The purpose of this study is to evaluate the prevalence of hip dysplasia by lateral center edge angle (LCEA) on scoliosis radiographs in patients presenting with severe range (>45 deg) idiopathic curves.
We reviewed 200 consecutive patients (400 hips) with idiopathic scoliosis with major coronal curves ≥45 degrees between October 2009 and October 2022. The presenting scoliosis radiograph PA were reviewed for the following variables: major coronal curve direction, coronal balance, and lateral center edge angles. An LCEA value ≤18 was considered dysplastic. To assess potential measurement variability related to parallax of the scoliosis radiographs, the intermodality intraclass correlation coefficient (ICC) was measured from a subset of 20 hip LCEA values from patients with both scoliosis and pelvis radiographs.
A total of 200 patients [mean age: 13.6 (1.8) years; Female: 79%] were reviewed. The mean major curve (SD) was 58.6 degrees (11.4 deg). Overall 19% (37/200) patients or 11% (43/400) of hips had hip dysplasia. Of the dysplastic hips, 16% (6/43, P <0.001) were bilateral and 57% (21/43, P =0.04) were right sided. There was no association between dysplastic hip laterality and ipsilateral or contralateral coronal balance ( P =0.26) or curve direction ( P =0.49). The interobserver ICC for assessment of LCEA on scoliosis radiographs was 0.85, and the intermodality ICC between pelvic and scoliosis radiographs was 0.78.
Hip dysplasia was present in 19% of patients presenting with large major curves, and many of these patients had right sided hip dysplasia. There was no association between hip dysplasia laterality and the patient's major curve direction or coronal balance. There was good intermodality reliability (ICC=0.78) between LCEA values in patients who had both scoliosis and pelvis radiographs, and good inter-rater reliability between raters. Radiographic interpretation of adolescent idiopathic scoliosis should focus not only on the description of the curve and ruling out underlying segmentation anomalies but should also include critical assessment of the hips to exclude co-existing hip dysplasia.
Therapeutic study-level IV.
青少年特发性脊柱侧凸的放射学筛查通常包括髋关节。本研究的目的是评估在患有严重范围（> 45 度）特发性曲线的患者中，通过脊柱侧凸 X 线片上的外侧中心边缘角（LCEA）评估髋关节发育不良的患病率。
我们回顾了 200 例（400 髋）特发性脊柱侧凸患者，这些患者的主要冠状曲线≥45 度，时间为 2009 年 10 月至 2022 年 10 月。对主冠状曲线方向、冠状平衡和外侧中心边缘角进行回顾性分析。LCEA 值≤18 被认为是发育不良的。为了评估与脊柱侧凸 X 线片视差相关的潜在测量变异性，我们从具有脊柱和骨盆 X 线片的患者的 20 个髋部 LCEA 值中测量了组内间信度（ICC）。
共回顾了 200 例患者（平均年龄：13.6[1.8]岁；女性占 79%）。主要曲线（标准差）的平均值为 58.6 度（11.4 度）。总体而言，19%（37/200）的患者或 11%（43/400）的髋关节存在髋关节发育不良。在发育不良的髋关节中，16%（6/43，P<0.001）为双侧，57%（21/43，P=0.04）为右侧。发育不良髋关节的侧位与同侧或对侧冠状平衡（P=0.26）或曲线方向（P=0.49）无关。在脊柱侧凸 X 线上评估 LCEA 的观察者间 ICC 为 0.85，骨盆和脊柱 X 线片之间的间模态 ICC 为 0.78。
在患有大主曲线的患者中，19%存在髋关节发育不良，其中许多患者存在右侧髋关节发育不良。髋关节发育不良的侧位与患者的主要曲线方向或冠状平衡无关。在同时具有脊柱和骨盆 X 线片的患者中，LCEA 值的间模态可靠性（ICC=0.78）良好，且评分者之间的评分者间可靠性良好。青少年特发性脊柱侧凸的放射学评估不仅应侧重于描述曲线并排除潜在的节段性异常，还应包括对髋关节的关键评估，以排除并存的髋关节发育不良。
治疗性研究 IV 级。
