Page 29 - Delaware Medical Journal - March/April 2019
P. 29
CASE REPORT
Table 1. Radiographic measurement of 53 hips (from 53 children) with the largest migration percentage at any radiograph reviewed during the study period, divided into age groups
Age group (years)
1 (<2)
2 (2-4.9)
3 (5-7)
4 (≥8)
Number of hips
12
17
13
11
Migration percentagea, %
26 (8)*
24 (10)*
31 (15)
38 (14)
Acetabular indexa, °
24 (6)
19 (5)**
19 (3)**
21 (8)
aMeasurements presented as mean (standard deviation). Analysis of variance and post hoc analysis used at a significance level of 0.05.
*Statistically different (p<0.05) than group 4; **Statistically different (p<0.05) than group 1.
excluded. Due to the variety of underlying diagnoses and the inability to identify
the cause of hypotonia in many cases, children included in this study formed
a heterogeneous group regarding the underlying pathologies. It was not possible to divide the patients based
on the diagnosis due to the rarity of
the conditions and the small number
of patients; hence, all children were considered as one group. Since some children might develop spasticity within 1 hypotonia was diagnosed on more than one clinical examination and all included children had hypotonia throughout the study period.
Demographic, clinical, and surgical
data were recorded. Functional status was described according to the Gross (GMFCS).8 Underlying causes of hypotonia were recorded when available.
Anteroposterior radiographs of the pelvis were reviewed. One radiograph per patient per year was reviewed. Reimer’s migration percentage (MP)9,10 and acetabular index (AI)11 were measured. For every patient, the hip with the largest MP at any time during
the relation between MP and GMFCS was recorded. For surgical cases, only preoperative radiographs were included. Hips with the largest MP (one hip for
every patient) were divided into four
years). Since no previous data have been reported for hip surveillance in hypotonia, age groups were selected following
the recommendations of spastic hip surveillance programs.6,12 Differences of measurements between the groups were recorded.
A subgroup of children, who had at least two radiographs with a minimum one- patient, the hip that had the largest MP at any radiograph was used and changes of measurements for this hip, between the
Children who had hip reconstruction
level of function were recorded from the preoperative and last visits. Preoperative and last radiographs were reviewed. In acetabular center-edge angle (CEA) described by Visser13 was also measured, as well as the femoral neck shaft angle (NSA).14
Statistically, analysis of variance (ANOVA) and post hoc analysis were used to detect any difference in the radiographic measurements between the age groups. Paired t-test was used to detect changes over follow-up for the
was set at 0.05. SPSS software was used (Version 22; IBM Corp., Armonk, NY).
RESULTS
A total of 63 children with congenital
males, 48% females). Five children had ataxia and all children were older than 2 years of age at the last clinical evaluation. In 50 children (79%), no underlying cause could be found. The remaining
13 children had different underlying pathologies (chromosomal abnormalities, syndromic hypotonia, systemic diseases, and cerebral dysgenesis). Developmental delay to some level was encountered in 58 patients (92%). At the last clinical at GMFCS II, 10 at GMFCS III, 12 at GMFCS IV, and three at GMFCS V. Only one patient had adductor contracture over the study period; the remaining patients had hip abduction between 45 and 70 degrees (mean of 55 degrees).
One hundred and nineteen pelvis radiographs were available for 53 children. Measurements of 53 radiographs for the 53 hips with the largest MP (one hip for every patient) were selected. The relationship between MP and GMFCS is shown in Figure 1. Measurements within each age group are shown in Table 1 and Figure 2.
Del Med J | March/April 2019 | Vol. 91 | No. 2
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