AIM To see if three-dimensional (3D) methods could bring new understanding to acetabular changes in shape and orientation in the spastic hip and in which direction(s) acetabular orientation might change, which is crucial for planning appropriate hip correction surgery. METHOD We performed a retrospective study of pelvic computed tomography (CT) examinations in 20 consecutive patients (10 females, 10 males). The mean age of patients was 12 years 9 months (SD 2y; range: 9-16y) at the time of the CT examination. The control group consisted of 18 consecutive pelvic CT examinations (36 acetabula) of deceased individuals (six females, 12 males) aged 4 to 17 years (mean age: 10y 6mo; SD 5y 2mo) whose whole-body CT scans were taken shortly after their death. We compared 3D CT reconstructions of 28 unstable and dislocated hips in children with bilateral cerebral palsy (Gross Motor Function Classification System levels IV and V) with the unaffected side and typically developing controls to assess spatial orientation (inclination, anteversion, and tilt), acetabular volume, and surface area. Additionally, we analysed the multiple factors that may lead to structural and spatial changes of the acetabulum. RESULTS Patients with dislocated and spastic hips had significantly lower anteversion (-3.2° and -1.4° respectively, p<0.001), increased inclination (85.2° and 85.3° respectively, p<0.001), and decreased tilt (24.6° [p=0.014] and 20.7° [p=0.013] respectively) compared with typically developing individuals. Regarding acetabular volume and surface area, dislocated and unstable hips had significantly lower volume (17.6ml vs 31.5ml respectively, p<0.001) and surface area (28.9cm2 vs 36.2cm2 respectively, p<0.001) than unaffected hips. Among several factors, only Reimer's migration index had an influence on acetabular orientation (i.e. anteversion, p=0.01), volume (p<0.001), and surface (p=0.004). INTERPRETATION Acetabula in patients with spastic hip disease were severely retroverted with increased steepness; acetabular orientation was distorted superoposteriorly. In rare cases, acetabular orientation was distorted only superiorly or superoanteriorly.

中文翻译：

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脑瘫儿童痉挛髋的髋臼形状和方向

目的 看看三维 (3D) 方法是否可以为痉挛性髋关节中髋臼形状和方向的变化以及髋臼方向可能改变的方向带来新的理解，这对于规划适当的髋关节矫正手术至关重要。方法 我们对连续 20 名患者（10 名女性，10 名男性）的盆腔计算机断层扫描 (CT) 检查进行了回顾性研究。CT检查时患者的平均年龄为12岁9个月（SD 2y；范围：9-16y）。对照组由 4 至 17 岁（平均年龄：10 岁 6 个月；SD 5 岁 2 个月）的死者（6 名女性，12 名男性）的 18 次连续盆腔 CT 检查（36 髋臼）组成，他们在不久后进行全身 CT 扫描。他们的死亡。我们比较了双侧脑瘫儿童的 28 个不稳定和脱臼髋部的 3D CT 重建（大运动功能分类系统级别 IV 和 V）与未受影响的一侧，并且通常开发控制以评估空间方向（倾斜、前倾和倾斜）、髋臼体积和表面积。此外，我们分析了可能导致髋臼结构和空间变化的多种因素。结果 髋关节脱位和痉挛患者的前倾角显着降低（分别为 -3.2° 和 -1.4°，p<0.001），倾斜度增加（分别为 85.2° 和 85.3°，p<0.001），倾斜度降低（24.6° [p= 0.014] 和 20.7° [p=0.013]）与典型发育个体相比。关于髋臼体积和表面积，与未受影响的髋部相比，脱臼和不稳定的髋部的体积（分别为 17.6 毫升和 31.5 毫升，p<0.001）和表面积（分别为 28.9 平方厘米和 36.2 平方厘米，p<0.001）显着降低。在几个因素中，只有 Reimer 的迁移指数对髋臼方向（即前倾角，p=0.01）、体积（p<0.001）和表面（p=0.004）有影响。解释 痉挛性髋关节疾病患者的髋臼严重后倾，陡度增加；髋臼方向被超后扭曲。在极少数情况下，髋臼方向仅向上或向上扭曲。s 迁移指数对髋臼方向（即前倾角，p=0.01）、体积（p<0.001）和表面（p=0.004）有影响。解释 痉挛性髋关节疾病患者的髋臼严重后倾，陡度增加；髋臼方向被超后扭曲。在极少数情况下，髋臼方向仅向上或向上扭曲。s 迁移指数对髋臼方向（即前倾角，p=0.01）、体积（p<0.001）和表面（p=0.004）有影响。解释 痉挛性髋关节疾病患者的髋臼严重后倾，陡度增加；髋臼方向被超后扭曲。在极少数情况下，髋臼方向仅向上或向上扭曲。