Yamaguchi O
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Miyagi, Japan.
Nihon Seikeigeka Gakkai Zasshi. 1993 Jan;67(1):1-11.
In cerebral palsy (CP), abnormal posture, contracture of the hip and dislocation occur during a long period of the course. In order to clarify the factors of tendency to dislocation, radiological survey was undertaken for the patients of CP. These data were analyzed from the respects of weight bearing, position of leg and developed deformity at the neck of the femur. One hundred seventy eight hips of 90 patients with an average of 26 years of age and 64 hips of normal individual as a control. Kai's method was used for measuring angles of tilting at neck and anteversion. The incidence of dislocations of the hip joints was more frequent in patients who were incapable of weight bearing than in patients who were capable of weight bearing (p < 0.01). However, there was no difference between spastic type and athetotic type of CP. In patients who were incapable of weight bearing inclination (the neck-shaft angle), anteversion of the femoral neck to the shaft showed larger than in patients who were capable of weight bearing (p < 0.01). Anteversion of patients who were capable of weight bearing of CP was larger than that of the normal control (p < 0.01), but extent of inclination was the same. From these findings the present investigator has concluded that femoral neck becomes valgus with an increased anteversion in longstanding CP patients who are especially unable to stand or walk. Furthermore, such hip joints are found to dislocate easily if adducted.
在脑瘫（CP）患者中，长期病程中会出现异常姿势、髋关节挛缩和脱位。为了阐明脱位倾向的因素，对CP患者进行了影像学检查。从负重、腿部位置以及股骨颈发育畸形等方面对这些数据进行了分析。90例患者共178个髋关节，平均年龄26岁，以64个正常个体的髋关节作为对照。采用凯氏方法测量颈部倾斜角和前倾角。不能负重的患者髋关节脱位的发生率高于能够负重的患者（p<0.01）。然而，痉挛型和手足徐动型CP之间没有差异。不能负重的患者股骨颈相对于股骨干的倾斜度（颈干角）和前倾角大于能够负重的患者（p<0.01）。能够负重的CP患者的前倾角大于正常对照组（p<0.01），但倾斜程度相同。基于这些发现，本研究者得出结论，在长期无法站立或行走的CP患者中，股骨颈会随着前倾角增加而外翻。此外，发现此类髋关节内收时容易脱位。
