痉挛型脑瘫患儿发生髋关节脱位风险的观察研究

Clinical study of the risk of hip dislocation of the child with spastic cerebral pasly.

【目的】通过对痉挛型脑瘫患儿骨盆平片股骨头外移百分比(migration percentage,MP)的测定来分析脑瘫患儿髋脱位的发生风险。【方法】对2006年12月—2008年12月本中心确诊的120例痉挛型脑瘫患儿常规行双髋关节的X线正位摄片,由放射科专业医师作出诊断报告并测量股骨头外移距离;同时对他们进行粗大运动功能分级(grossmotor function classification system,GMFCS)评估。【结果】96%偏瘫患儿其MP值<25%,属正常发育范围之内,且未发生髋关节脱位;双瘫患儿中存在髋关节半脱位和全脱位,主要为半脱位;四肢瘫患儿中髋关节半脱位(10%)和全脱位(12.9%)的比例明显较偏瘫和双瘫大,且全脱位的比例明显增多。相关性分析发现GMFCS与MP值具有相关性(r=0.25,P<0.001)。【结论】痉挛型脑瘫患儿存在发生髋关节脱位的内在因素,对其应重视髋关节发育情况的动态评测。

【Objective】 To study the risk of hip dislocation of the child with spastic cerebral palsy（CP）by the measurement of the migration percentage（MP） of the femoral head on the radiograph of pelvis. 【Methods】 120 children with spastic CP were routinely taken radiograph on the pelvis from December 2006 to December 2008,diagnosed and measured the MP by the radiologist,then were followed up and rechecked;While they were evaluated with gross motor function classification system（GMFCS）. 【Results】 The MP value in most of the children with hemiplegia was below 25 percent,which was normal and without dislocation on hip joint;The children with diplegia had mainly semiluation and dislocation on hip joint,most of the children with tetraplegia had semiluation（10%） and mainly dislocation（12.8%）.The proportion of dislocation and subluxation of the hip in the children with tetraplegia were significantly more than the proportion of ones in the children with diplegia or hemiplegia,and the proportion of dislocation increased obviously.The correlation analysis showed that there was a correlation between GMFCS and MP value（r=0.27,P0.001）. 【Conclusion】 There is the internal factors for the hip dislocation of the child with spastic CP,the development conditions of their hip joints should be payed attention to.