A Composite Profile for Decision Making in Surgery of the Hip in Cerebral Palsy

有助於決定腦性麻痺患髖部手術方式的一套綜合測量表

黃世傑(Shier-Chieg Huang) ； 羅勃埃勒(Robert E. Eilert)

《Journal of Orthopaedic Surgery Taiwan》 1卷2期 (1984/06) Pp. 64-82

摘要

本研究之目的在於確定腦性麻痺病患的髖關節在發育不良、半脫位及脫臼的發展過程中放射學上的形態，以及其在手術後的變化。作者希望藉由此放射學上的定量，配合臨床的觀察，而能知道疾病的嚴重度，適當的手術或治療方式，以及髖部可能的預後。
作者檢視87位因髖部攣縮、半脫位、及脫臼而在美國科羅拉多州丹佛市兒童醫院手術腦性麻痺病人的髖部X光及病歷，設法找出臨床上的情況與放射學上變化之關係。臨床上檢查的包括(一)年齡、(二)腦性麻痺的種類、(三)腦性麻痺的嚴重度、(四)病人的活動能力、(五)幼兒型反射之持續與否、(六)髖關節的活動範圍、以及(七)與髖部有關之變形及症狀。放射學上則注重與髖部發育不良有關的指標：(一)股骨頭中心點–髖臼邊緣角度 ( C- E angle )、(二)股骨頭暴露之柳分比、(三)髖臼傾斜指標 (acet-abular index )、(四)髖臼頂部骨質分佈之形態 (髖臼「眉毛」，法文sourcil )、(五)髖臼底部形態 ( 髖臼 「淚珠」tear-drop ) 、(六)股骨頭形狀、以及(七)股骨頸–股骨幹之顯然角度。
經由本研究，作者訂出四種髖臼「 眉毛 」形態、三種髖臼「 淚珠 」形態、及三種股骨頭形態，用以區分髖部發育不良之不同時期。這些程度上的分類在彼此之間，以及與髖部的覆蓋、發育情形相當有關聯。根據詳細的放射學上之測量，臨床上之觀察，作者設計出一套綜合測量表。此表能夠測量任何一個時候某一病人髖部變化的嚴重度，其隨時間之變化，以及手術的影響。
這洜二量表對髖部脫臼自然演變以及不同手術效果之描述非常有用，並可預測某一手術如髖內收肌–屈肌鬆解術或股轉子間切骨術是否有效，因此對臨床上之判估及決策相當有用。具高分點的病人需要夜積極、廣泛的手術或早一點接受手術，以求較理想的結果。

並列摘要

Our purpose in this study was to define the radiographic pattern of the development of hip dysplasia and dislocation in cerebral palsy and the alternation of that pattern by operation. We wanted to quantitate the radiographic changes such that the stage of disease and prognosis of the hip could be predicted.
Eighty-seven cases of spastic and mixed diplegic and quadriplegic patients who were operated for hip contracture, subluxation or dislocation in The Children’s Hospital, Denver, Colorado, U.S.A were reviewed. The clinical condition of cerebral palsy was correlated with the radiographic changes in the hip over a period of years. Important clinical parameters studied were: 1 ) age, 2 ) type of cerebral palsy, 3 ) severity of cerebral palsy, 4 ) ambulatory status, 5 ) neonatal reflex, 6 ) femoral head shape and 7 ) apparent neck shaft angle.
Four types of acetabulr “sourcil”, 3 types of acetabular “tear-drop” and 3 types of femoral head shape were used to classify the stages of dysplasia in this study. They correlated with uncoverage and development of the hip, and with each other quite well. Based on careful analysis of radiographic changes and correlation with the clinical examination, a composite profile was developed to rate the hip at any point in time. The effect of time and a variety of operative procedures was followed by rating clinical parameters and serial x-rays.
The rating profile was very useful in describing the natural history of hip dislocation and the effect of different operative procedures. The profile was predictive as to the efficacy of specific operations, such as adductor-flexor release or femoral osteotomy; and therefore, useful for clinical assessment and decision making as patients with higher scores require a more extensive operation or operation done in earlier age.

並列關鍵字

cerebrl palsy ； paralytic hip ； composite profile