Presedo Ana, Rutz Erich, Howard Jason J, Shrader Michael Wade, Miller Freeman
Department of Pediatric Orthopaedics, Robert Debré University Hospital, 75019 Paris, France.
Department of Orthopaedics, The Royal Children's Hospital, Melbourne 3052, Australia.
Children (Basel). 2024 Jul 11;11(7):844. doi: 10.3390/children11070844.
This study summarizes the current knowledge of the etiology of hip dysplasia in children with neuromuscular disease and the implications for management. This article is based on a review of development of the hip joint from embryology through childhood growth. This knowledge is then applied to selective case reviews to show how the understanding of these developmental principles can be used to plan specific treatments. The development of the hip joint is controlled by genetic shape determination, but the final adult shape is heavily dependent on the mechanical environment experienced by the hip joint during growth and development. Children with neuromuscular conditions show a high incidence of coxa valga, hip dysplasia, and subluxation. The etiology of hip pathology is influenced by factors including functional status, muscular tone, motor control, child's age, and muscle strength. These factors in combination influence the development of high neck-shaft angle and acetabular dysplasia in many children. The hip joint reaction force (HJRF) direction and magnitude determine the location of the femoral head in the acetabulum, the acetabular development, and the shape of the femoral neck. The full range of motion is required to develop a round femoral head. Persistent abnormal direction and/or magnitude of HJRF related to the muscular tone can lead to a deformed femoral head and a dysplastic acetabulum. Predominating thigh position is the primary cause defining the direction of the HJRF, leading to subluxation in nonambulatory children. The magnitude and direction of the HJRF determine the acetabular shape. The age of the child when these pathomechanics occur acts as a factor increasing the risk of hip subluxation. Understanding the risk factors leading to hip pathology can help to define principles for the management of neurologic hip impairment. The type of neurologic impairment as defined by functional severity assessed by Gross Motor Function Classification System and muscle tone can help to predict the risk of hip joint deformity. A good understanding of the biomechanical mechanisms can be valuable for treatment planning.
本研究总结了目前关于神经肌肉疾病患儿髋关节发育不良病因的知识及其对治疗的影响。本文基于对髋关节从胚胎学至儿童期生长发育过程的综述。然后将这些知识应用于选择性病例回顾，以展示如何利用对这些发育原理的理解来规划具体治疗方案。髋关节的发育由遗传形状决定控制，但最终的成人形状在很大程度上取决于髋关节在生长发育过程中所经历的力学环境。神经肌肉疾病患儿的髋外翻、髋关节发育不良和半脱位发生率较高。髋关节病变的病因受功能状态、肌张力、运动控制、患儿年龄和肌肉力量等因素影响。这些因素共同作用影响许多患儿高颈干角和髋臼发育不良的发生。髋关节反应力（HJRF）的方向和大小决定股骨头在髋臼中的位置、髋臼发育以及股骨颈的形状。需要全范围的运动来发育出圆形股骨头。与肌张力相关的HJRF持续异常方向和/或大小可导致股骨头变形和髋臼发育不良。大腿的主要位置是定义HJRF方向的主要原因，导致非行走儿童出现半脱位。HJRF的大小和方向决定髋臼形状。这些病理力学发生时患儿的年龄是增加髋关节半脱位风险的一个因素。了解导致髋关节病变的危险因素有助于确定神经源性髋关节损伤的治疗原则。由粗大运动功能分类系统评估的功能严重程度和肌张力所定义的神经功能障碍类型有助于预测髋关节畸形的风险。对生物力学机制的深入理解对治疗规划很有价值。
