Ann Rehabil Med.  2018 Apr;42(2):277-285. 10.5535/arm.2018.42.2.277.

Determinants of Hip and Femoral Deformities in Children With Spastic Cerebral Palsy

• Cho Y
• Park ES
• Park HK
• Park JE
• Rha DW

• KMID: 2432198
• DOI: http://doi.org/10.5535/arm.2018.42.2.277

Abstract

OBJECTIVE
To find factors affecting hip and femoral deformities in children with spastic cerebral palsy (CP) by comparing various clinical findings with imaging studies including plain radiography and computed tomography (CT) imaging.
METHODS
Medical records of 709 children with spastic CP who underwent thorough baseline physical examination and functional assessment between 2 to 6 years old were retrospectively reviewed. Fifty-seven children (31 boys and 26 girls) who had both plain radiography of the hip and three-dimensional CT of the lower extremities at least 5 years after baseline examination were included in this study.
RESULTS
The mean age at physical examination was 3.6 years (SD=1.6; range, 2-5.2 years) and the duration of follow-up imaging after baseline examination was 68.4 months (SD=22.0; range, 60-124 months). The migration percentage correlated with motor impairment and the severity of hip adductor spasticity (R1 angle of hip abduction with knee flexion). The femoral neck and shaft angle correlated with the ambulation ability and severity of hip adductor spasticity (R1 and R2 angles of hip abduction with both knee flexion and extension).
CONCLUSION
Hip subluxation and coxa valga deformity correlated with both dynamic spasticity and shortening of hip adductor muscles. However, we found no correlation between femoral deformities such as femoral anteversion, coxa valga, and hip subluxation.

Keyword

Cerebral palsy; Coxa valga; Hip dislocation; Bone anteversion; Muscle spasticity

MeSH Terms

Bone Anteversion
Cerebral Palsy*
Child*
Congenital Abnormalities*
Coxa Valga
Femur Neck
Follow-Up Studies
Hip Dislocation
Hip*
Humans
Knee
Lower Extremity
Medical Records
Muscle Spasticity*
Muscles
Physical Examination
Radiography
Retrospective Studies
Walking

Figure

• 

  Fig. 1 (A) Measurement of migration percentage (MP). MP=B/A×100. Hilgenreiner's line and Perkins line are marked as ‘H’ and ‘P’. MP is the proportion (%) of the capital epiphysis that appears to lie outside the acetabulum. (B) Measurement of the femoral neck and shaft angle (FNS). ‘a’ is the FNS measurement, performed in standard anterior-posterior X-rays of the proximal femur or pelvis, which was generated by the intersection angle between the femoral neck axis and femoral shaft axis. (C) Measurement of femoral anteversion, ‘b’ shows that the femoral anteversion is defined by the angle created by femoral neck axis and posterior condylar axis.

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