Syed Akbar N, Zheng Jenny L, Goodbody Christine, Cahill Patrick J, Spiegel David A, Baldwin Keith
Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Children (Basel). 2024 Jan 2;11(1):63. doi: 10.3390/children11010063.
Spinopelvic malignment is commonly seen with non-ambulatory cerebral palsy (CP). Axial plane deformation is not well described in the literature. The purpose of this study was to describe and quantify the axial plane deformity in CP using CT scans and compare it to normal controls. We retrospectively collected data using CT scans of the abdomen and pelvis of 40 patients with GMFCS IV/V CP and neuromuscular scoliosis (CPP) and normal controls (NP) matched by age and sex. Pre-operative Cobb angle was recorded for the CP patients. Pelvic anatomy was evaluated at the supra-acetabular region of bone using two angles-iliac wing angle and sacral ala angle, measured for each hemipelvis. The larger of each hemipelvis angle was considered externally rotated while the smaller angle was considered internally rotated, termed as follows-iliac wing external (IWE) and internal (IWI); sacral ala external (SAE), and internal (SAI). Differences were noted using an independent t-test while correlations with Cobb angle were performed using Pearson's correlation. Iliac wing measurements showed the externally rotated hemipelvis showed a significantly greater magnitude compared with normal controls at 47.3 ± 18.1 degrees vs. 26.4 ± 3.7 degrees in NP ( < 0.001) while no internal rotation was observed ( > 0.05). Sacral ala measurements showed greater magnitude in both external and internal rotation. SAE was 119.5 ± 9.5 degrees in CPP vs. 111.2 ± 7.7 degrees in NP ( < 0.001) while SAI was 114.1 ± 8.5 degrees in CPP vs. 107.9 ± 7.5 degrees in NP ( = 0.001). In the CP cohort, the mean Cobb angle was 61.54 degrees ( = 37/40). Cobb angle correlated with the degree of external iliac wing rotation-IWE (r = 0.457, = 0.004) and degree of absolute difference in the rotation of the iliac wing (r = 0.506, = 0.001). The pelvis in a patient with CP scoliosis is asymmetrically oriented exhibiting a greater external rotation of one hemipelvis relative to normal controls. The severity of neuromuscular scoliosis is related to the pelvic axial rotation in CP patients. Axial plane deformity exists in the CP pelvis and this deformity warrants consideration when considering spinopelvic instrumentation strategies and outcomes of supra-pelvic and infra-pelvic pathologies.
脊柱骨盆畸形常见于非行走型脑瘫（CP）患者。关于轴向平面变形的文献报道较少。本研究旨在通过CT扫描描述和量化CP患者的轴向平面畸形，并与正常对照组进行比较。我们回顾性收集了40例GMFCS IV/V级CP合并神经肌肉型脊柱侧弯（CPP）患者以及年龄和性别匹配的正常对照组（NP）的腹部和骨盆CT扫描数据。记录CP患者术前的Cobb角。在骨盆骨髋臼上区域评估骨盆解剖结构，测量每个半骨盆的两个角度——髂骨翼角和骶骨翼角。每个半骨盆中较大的角度被认为是外旋，较小的角度被认为是内旋，分别称为髂骨翼外旋（IWE）和内旋（IWI）；骶骨翼外旋（SAE）和内旋（SAI）。使用独立t检验分析差异，使用Pearson相关分析与Cobb角的相关性。髂骨翼测量显示，外旋半骨盆与正常对照组相比，差异有统计学意义，CPP组为47.3±18.1度，NP组为26.4±3.7度（<0.001），而未观察到内旋差异（>0.05）。骶骨翼测量显示外旋和内旋角度均增大。CPP组的SAE为119.5±9.5度，NP组为111.2±7.7度（<0.001）；CPP组的SAI为114.1±8.5度，NP组为107.9±7.5度（=0.001）。在CP队列中，平均Cobb角为61.54度（=37/40）。Cobb角与髂骨翼外旋程度-IWE（r=0.457，=0.004）以及髂骨翼旋转绝对差异程度（r=0.506，=0.001）相关。CP脊柱侧弯患者的骨盆呈不对称取向，相对于正常对照组，一个半骨盆表现出更大程度的外旋。CP患者神经肌肉型脊柱侧弯的严重程度与骨盆轴向旋转有关。CP骨盆存在轴向平面畸形，在考虑脊柱骨盆内固定策略以及骨盆上、下病变的治疗效果时，这种畸形值得关注。
