Analysis Of Risk Factors For Hip Dislocation In Children With Spastic Cerebral Pals

Background:Cerebral palsy is the most common cause of limb deformity and motor disorders in children,and hip dislocation is the second most common secondary limb deformity in cerebral palsy children.The hip joint structure is normal at birth in children with cerebral palsy,but about 30%of them will experience progressive dislocation as they age.Due to the atypical clinical symptoms of early dislocation and the lack of related concepts,many children are not diagnosed until the disease progresses to complete dislocation,which greatly increases the difficulty of treatment and seriously affects the quality of life of the affected children.In recent years,Nordic and Australian countries have taken the lead in carrying out hip dislocation monitoring projects in cerebral palsy populations with the aim of early screening,active intervention,and delaying dislocation.This project has been proven to reduce the incidence of hip dislocation in children with cerebral palsy and delay the progression of dislocation.However,there are still shortcomings such as heavy workload and insufficient accuracy in identifying high-risk populations for dislocation.China has the largest number of children with cerebral palsy in the world,but there has not yet been a corresponding hip joint monitoring project.This is due to China being the world’s most populous developing country and the lack of clinical research on cerebral palsy hip dislocation,as well as the shortcomings of the current hip dislocation monitoring project.In response to these shortcomings,foreign scholars have recently conducted in-depth research on predicting the risk population for hip dislocation in cerebral palsy,and have identified some factors that may predict dislocation in clinical settings.However,there is currently a lack of relevant large-sample studies,particularly in China.Therefore,in order to explore the influencing factors of hip dislocation in children with spastic cerebral palsy and better improve the accuracy of identifying high-risk populations for the disease,and to provide more help to high-risk populations for dislocation under the premise of reducing monitoring costs,this study combines the special pathological mechanism of the disease to discuss the influencing factors of hip dislocation in children with spastic cerebral palsy.Objective:Explore the relevant influencing factors of hip dislocation in spastic cerebral palsy children,aiming to improve the understanding of the pathogenesis and disease progression of cerebral palsy hip dislocation,and thus enhance the accuracy of identifying high-risk individuals for dislocation,while reducing monitoring costs and providing the possibility of early diagnosis and prevention for children in need.Methods:Retrospective observational analysis was conducted on 235 cases(470 hips)of spastic cerebral palsy children who were treated at our hospital between January 2014 and December 2021,including 172 males and 63 females,with a mean age of(8.29±3.24)years.All patients completed comprehensive medical history data collection and pelvic X-ray examination after admission.Clinical information such as age,gender,and Gross Motor Function Classification System(GMFCS)were collected from medical records,and imaging indicators such as Migration Percentage(MP),Head Shaft Angle(HSA),Neck Shaft Angle(NSA),and Acetabular Index(AI)were measured from the pelvic X-ray.The MP values were used to divide the dislocation group and the non-dislocation group,and the relevant data were compared and analyzed by grouping and regression analysis.Results:The correlation between clinical and imaging data was compared between two groups,a dislocated group and a non-dislocated group.Compared with the non-dislocated group,there was no significant difference in age(P>0.05)or gender(P>0.05)in the dislocated group,indicating no significant correlation between age,gender,and dislocation.However,the dislocated group had significantly higher GMFCS classification(P<0.01)and MP(P<0.01),as well as significantly increased HSA and AI(P<0.01)and a significant increase in NS A(P<0.05)compared with the non-dislocated group.These results indicate that high GMFCS classification,HSA,NSA,and AI are positively correlated with hip dislocation in patients with cerebral palsy.Using dislocation as the dependent variable,a binary multiple factor logistic regression analysis was conducted with positive factors such as HSA,NSA,AI,and GMFCS as independent variables in a stepwise forward regression equation.The model’s classification ability was 36.70%,and the chi-square test showed that the model was effective(χ2=9.982,P=0.266),indicating successful establishment of the regression equation.The regression analysis results showed that variables such as AI(OR=1.131,P<0.05),HSA(OR=1.076,P<0.05),and GMFCS(OR=1.478,P<0.05)were independent risk factors for hip dislocation,while NSA was not an independent risk factor for hip dislocation(P>0.05).This indicates that high HSA,high AI,and high GMFCS classification will increase the risk of hip dislocation in patients with cerebral palsy.Pearson or Spearman analysis was used to analyze the correlation between age,GMFCS,and clinical outcomes,as well as MP,HSA,NSA,and AI imaging indicators.The statistical results showed that age had a negative correlation with HSA(r=-0.287,P<0.01),NSA(r=-0.306,P<0.01),and AI(r=-0.264,P<0.01);GMFCS classification had a positive correlation with MP(r=0.375,P<0.01),HSA(r=0.192,P<0.01),NSA(r=0.235,P<0.01),and AI(r=0.355,P<0.01).Conclusion:In children with spastic cerebral palsy,the decline in gross motor function and developmental dysplasia of the proximal femur and acetabulum are closely related to the occurrence of hip dislocation.GMFCS,HSA,and AI are independent risk factors for hip dislocation.Children with high GMFCS levels and larger HSA and AI angles may have an increased risk of hip dislocation.Therefore,clinical and radiographic examinations and follow-up should be intensified for this population to assess their hip joint development.