Bakhtiyar Muhammed, Iljazi Afrim, Petersen Michael Mørk, Odgaard Anders, Wong Christian
Department of Orthopedic Surgery, Rigshospitalet, 2100 Copenhagen, Denmark.
Children (Basel). 2024 Aug 10;11(8):964. doi: 10.3390/children11080964.
This study aims to assess the incidence of hip displacement and dislocation (denominated as hip migration) among ambulant and non-ambulant Danish children with cerebral palsy (CP) by estimating their cumulative incidence of migrated hips. A secondary objective is to compare the prevalence across different Danish regions.
Data were obtained from the Danish Cerebral Palsy Follow-Up Program (CPOP) from the years 2008 to 2021. This population-based cohort study included 1388 children with CP (58% male; 42% female) as subjects; aged 0-15 years; with an average age of 5.4 years at their last follow-up. The children were categorized according to their Gross Motor Function Classification System (GMFCS) level into ambulators (GMFCS I-III) and non-ambulators (GMFCS IV-V). The Kaplan-Meier estimator was employed to calculate the cumulative incidence of migrated hips from birth until the date of their last radiographic follow-up. Differences between ambulatory and non-ambulatory children and regional differences were assessed with the Log-rank test.
Median radiological follow-up for ambulators was 51 months and 94 months for non-ambulators. The cumulative incidence of hip dislocation was 0.3% (95% CI: 0-0.8%) and 22.0% (95% CI: 9.2-34.8%) for ambulators and non-ambulators, respectively ( < 0.0001), whereas the incidence of hip displacement was 21.1% (95% CI: 16.3-25.9%) and 76.7% (95% CI: 68.6-84.7%) for ambulators and non-ambulators, respectively ( < 0.0001). There were no significant regional differences in the incidence of hip dislocation among ambulators, but there were significant differences for non-ambulators. Moreover, significant regional differences were detected in hip displacement for both ambulators and non-ambulators.
The prevalence of hip migration in Danish children with CP is significantly higher among non-ambulators, who are at an increased risk of hip migration compared to their ambulant counterparts. However, the low frequency of radiographic follow-up for ambulators might cause the incidence of hip migration to be underestimated. This study highlights the necessity of continued targeted surveillance and interventions in Danish non-ambulators.
本研究旨在通过估算丹麦行走能力正常和行走能力受限的脑瘫（CP）儿童髋关节移位和脱位（称为髋关节迁移）的累积发病率，评估其发生率。次要目标是比较丹麦不同地区的患病率。
数据来自2008年至2021年的丹麦脑瘫随访项目（CPOP）。这项基于人群的队列研究纳入了1388名CP儿童（58%为男性；42%为女性）作为研究对象；年龄在0至15岁之间；最后一次随访时的平均年龄为5.4岁。根据粗大运动功能分类系统（GMFCS）水平，将儿童分为行走能力正常者（GMFCS I - III）和行走能力受限者（GMFCS IV - V）。采用Kaplan - Meier估计量计算从出生到最后一次影像学随访日期髋关节迁移的累积发病率。采用对数秩检验评估行走能力正常和行走能力受限儿童之间的差异以及地区差异。
行走能力正常者的中位影像学随访时间为51个月，行走能力受限者为94个月。行走能力正常者和行走能力受限者的髋关节脱位累积发病率分别为0.3%（95%CI：0 - 0.8%）和22.0%（95%CI：9.2 - 34.8%）（<0.0001），而行走能力正常者和行走能力受限者的髋关节移位发病率分别为21.1%（95%CI：16.3 - 25.9%）和76.7%（95%CI：68.6 - 84.7%）（<0.0001）。行走能力正常者中髋关节脱位的发病率在各地区之间无显著差异，但行走能力受限者有显著差异。此外，在行走能力正常者和行走能力受限者的髋关节移位方面均检测到显著的地区差异。
丹麦CP儿童中，行走能力受限者的髋关节迁移患病率显著高于行走能力正常者，与行走能力正常的儿童相比，他们髋关节迁移的风险更高。然而，行走能力正常者影像学随访频率较低可能导致髋关节迁移的发病率被低估。本研究强调了对丹麦行走能力受限儿童持续进行针对性监测和干预的必要性。
