Relevance. Significant incidence of hip pathology in different groups of patients with cerebral palsy and factors that may affect its formation are relevant objects of the study. The goal of the study. To establish the features of the hip joint’s formation, examining the clinical and radiographic dependences of the functional status and indices of the hip joint in patients with cerebral palsy. Materials and methods. The total number of patients was 47 persons (86 joints). We conducted a clinical and radiographic examination of the hip joints using our own methods and standard anterior-posterior radiography, as well as a statistical analysis of hip parameters and factors that may have influenced their formation. Results. Correlation relationships have been established between hip parameters and factors that may affect them: Gross Motor Function Classification System (GMFCS), gait function, level of lesion, developmental dysplasia of the hip, and adductor myotomy in medical history. Conclusions. The Reimers’ index showed greater reliability compared to the Wiberg angle. Positioning of the patient’s body using our own method way can be used to screen the hip joints in cerebral palsy based upon the Reimers index while obtaining the true parameters of the femoral neck–shaft angle and torsion of the femur.
Background. The difficulties of diagnosis that arise when choosing therapeutic measures aimed at preventing sublu-xation, dislocation, and contractures of the hip joint in patients with cerebral palsy are a topical object of the research. The purpose was to improve the results of the diagnosis of the hip joint pathology by establishing objective radiographic parameters. Materials and methods. The total number of patients was 20 (40 joints), 10 boys and 10 girls aged 3 to 15 years. Sixteen joints were operated. Radiographically, we have determined neck-shaft angle and torsion of the thigh, projection and true according to Koval (using tables), acetabular angle, angle of inclination (Sharpe’s angle). Hip torsion was determined clinically according to Ruwe. Torsion was evaluated intraoperatively in our own way (patent No. a200512793). All patients were examined using our method (patent No. 137567). Results. Using the Student’s t-test for independent samples, the parameters of the hip joints were compared and significant differences were found between the neck-shaft angle in the standard position and the neck-shaft angle in our own position (p < 0.05), as well as between the neck-shaft angle in the standard position and the neck-shaft angle true according to Koval (p < 0.05). According to Fisher’s test, it was found that the torsion according to Ruwe and the torsion according to Koval are significantly different (p < 0.05): Femp 1.87 > Fkr 1.7. Using the method of odds ratio (OR), we determined that the sensitivity of torsion measurement by Ruwe was 0.7, the specificity of torsion measurement by Ruwe was 0.83 (OR = 11.67, confidence interval [1.94–70.18]) indicating that the chance of getting a coincidence by measuring torsion by Ruwe is 11.67 times higher than accor-ding to Koval, compared with intraoperative data. A well-defined amount of torsion of the thigh according to Ruwe provides true indicators of the hip joint using our own method. Conclusions. The own method provides the determination of objective clinical and radiographic (diagnostic) parameters in patients with patho-logy of the hip joint. When performing one roentgenogram, it is possible to define all basic parameters of the hip joint (torsion of the hip, neck-shaft angle, Wiberg’s angle, Reimers’ index, index of vertical migration, acetabular angle, angle of inclination) and to standardize examinations of patients with cerebral palsy who are subject to screening throughout the whole period of their development. In this way, you can get radiographic indicators of patients with severe neuromuscular disorders (Gross Motor Function Classification System levels III and IV).
Summary. There is no doubt that obtaining the true parameters of the hip joint makes it possible to determine the tactics of treatment of patients with cerebral palsy and it is a relevant object of studying. Objective: to improve the results of diagnostics of pathology of the hip joint in patients with cerebral palsy by developing our own method. Materials and Methods. The study included 20 patients (40 joints): 10 boys and 10 girls. Sixteen joints were operated on. The patients were 3-15 years of age. Femoral torsion according to Ruwe was clinically determined in all the patients; also, our own method for determining the clinical and roentgenogrammetric parameters of the hip joint (utility model patent No. 137567) was used. Results. Our own method is simple, available and cheap; it may be used in all medical institutions with X-ray rooms for the diagnosis of hip joint pathology, as well as for screening. Conclusions. Our own method is simple and reliable for determining the parameters of the hip joint in patients with cerebral palsy (femoral torsion, neck shaft angle, Wiberg's angle, Reimer's index, vertical migration index, acetabular angle, the angle of inclination of the acetabulum) in patients with cerebral palsy. Obtaining radiographic parameters of both hip joints after only one radiograph also significantly reduce the radiation load on the patient, since patients with cerebral palsy are the subject of screening throughout the entire period of their development. This method can be also applied during the examination and screening the patients with developmental disorders and other diseases of the hip joint.
Relevance: Obtaining true radiographic parameters of the hip joint helps to choose therapeutic tactics for children with cerebral palsy. Goal of the study: Improvement of the diagnostic results in pathology of the hip joint among patients with cerebral palsy by using our original method. Materials and methods: The number of examined patients – 30 persons (60 joints), 15 boys and 15 girls, 26 joints were operated. The age of patients ranged between 3-15 years. All patients underwent a clinical evaluation – Ruwe's femoral torsion, as well as radiography of the hip joints using our original method (utility model patent №137567). The offered method is cheap, simple and accessible to all medical institutions with an X-ray room, for the diagnosis and screening of pathology of the hip joint. The our original method can be used to determine all the main parameters of the hip joint (femoral torsion, neck-shaft angle, Viberg angle, Reimers’ index, acetabular angle, Sharp’s angle) in patients with cerebral palsy. Making only single radiograph, one obtains true radiographic parameters of both hip joints, which significantly reduces the radiation load upon the patient. Our method can be used in the examination and screening of patients with developmental disorders and other diseases of the hip joint.
The aim: Establishment of the factors influencing the formation of femoral neck-shaft angles and femoral torsions indices among the patients with cerebral palsy. Materials and methods: The total number of patients was 46 persons (84 joints). We have examined patients using our method (patent №137567), obtained the true parameters of the femoral neck-shaft angle and femoral torsion, and conducted a statistical analysis of factors that might influence their formation. Results: A statistically significant influence of factors of age, Gross Motor Function Classification System (GMFCS) level, ambulatory status, adductor myotomy and lack of statistical significance concerning the influence of factors such as level of lesion and developmental dysplasia of the hip upon the indices of neck-shaft angle. Femoral torsion’s parameters were in statistically significant fashion affected by GMFCS levels, ambulatory status, level of lesion, and did not display statistical significance of factors of age, adductor myotomy, developmental dysplasia of the hip. Conclusions: Our research shows that gait function, as well as GMFCS level, are the important factors in the formation of the proximal femur in patients with cerebral palsy.
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