Almeida da Silva Luiz Carlos, Hori Yusuke, Kaymaz Burak, Howard Jason J, Trionfo Arianna, Shrader Michael Wade, Miller Freeman
Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE 19803, USA.
Children (Basel). 2025 Mar 15;12(3):367. doi: 10.3390/children12030367.
Knowledge of the relative contributions to different growth areas in the proximal femur and acetabulum is limited due to the complex anatomy and lack of growth markers in children. There is increasing interest in using guided growth to improve hip joint stability and decrease dysplasia in children with neurological disability. Some children with cerebral palsy (CP) are treated with bisphosphonates for bone insufficiency, which leaves a dense growth arrest band in the bone at the time of treatment. The aim of this study was to develop a novel approach to understand the growth and maturation impact on hip development in children with CP using this growth arrest band.
Pelvic radiographs of children with CP Gross Motor Function Classification System (GMFCS) level IV/V treated with bisphosphonate were analyzed. We measured neck-shaft angle (NSA), head-shaft angle (HSA), and migration percentage (MP) based on pamidronate bands (PamMP), NSA based on pamidronate bands (PamNSA), and HSA based on pamidronate bands (PamHSA). These measurements were compared using -test.
Seven children (two GMFCS IV and five GMFCS V) were included. The mean age of the radiographic assessment was 11.4 ± 1.3 (range, 8.6-12.5) years, mean MP 22 ± 7% (range, 13-39%), PamMP 33 ± 7% (range, 18-46%), NSA 151 ± 7° (range, 140-161°), PamNSA 153 ± 4° (range, 142-163°), HSA 164 ± 12° (range, 142-175°), and PamHSA 169 ± 8° (range, 154-175°). MP decreased by 10.5% compared with PamMP ( < 0.001). NSA compared with PamNSA ( = 0.117) and HSA compared with PamHSA ( = 0.325) were not statistically different.
This novel assessment method demonstrates that ossification of the lateral acetabulum and femoral head in children with CP GMFCS IV/V from age 8 to 12 years undergoes a mean decrease of 10% MP. A decrease of 10% MP after proximal femoral-guided growth has been reported as a positive outcome. However, based on the current measurements, this may be due to normal development. HSA and NSA remained unchanged.
由于近端股骨和髋臼不同生长区域的相对贡献情况的相关知识因儿童解剖结构复杂且缺乏生长标记而受限。人们越来越关注使用引导性生长来改善神经功能障碍儿童的髋关节稳定性并减少发育异常。一些患有脑瘫（CP）的儿童因骨量不足接受双膦酸盐治疗，这在治疗时会在骨骼中留下致密的生长停滞带。本研究的目的是开发一种新方法，利用这种生长停滞带来了解生长和成熟对CP儿童髋关节发育的影响。
对接受双膦酸盐治疗的CP Gross运动功能分类系统（GMFCS）IV/V级儿童的骨盆X线片进行分析。我们基于帕米膦酸带测量颈干角（NSA）、头干角（HSA）和移位百分比（MP）（PamMP），基于帕米膦酸带测量NSA（PamNSA），基于帕米膦酸带测量HSA（PamHSA）。使用t检验对这些测量值进行比较。
纳入7名儿童（2名GMFCS IV级和5名GMFCS V级）。影像学评估的平均年龄为11.4±1.3（范围8.6 - 12.5）岁，平均MP为22±7%（范围13 - 39%），PamMP为33±7%（范围18 - 46%），NSA为151±7°（范围140 - 161°），PamNSA为153±4°（范围142 - 163°），HSA为164±12°（范围142 - 175°），PamHSA为169±8°（范围154 - 175°）。与PamMP相比，MP降低了10.5%（P<0.001）。NSA与PamNSA相比（P = 0.117）以及HSA与PamHSA相比（P = 0.325）无统计学差异。
这种新的评估方法表明，8至12岁CP GMFCS IV/V级儿童髋臼外侧和股骨头的骨化使MP平均降低10%。据报道，股骨近端引导性生长后MP降低10%是一个积极结果。然而，基于目前的测量，这可能是由于正常发育。HSA和NSA保持不变。
