CLINICAL AND ROENTGENOLOGICAL CRITERIA OF SPINE-PELVIS RATIOS IN CHILDREN WITH DYSPLASTIC FEMUR SUBLUXATION

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Abstract

Aim of the study — to identify clinical and roentgenological criteria of the sagittal profile status of spine-pelvis segment in children with dysplastic femur subluxation.

Material and Methods. The present study included 40 female patients (50 hip joints) aged from 12 to 17 years (14.7±1.58) with unilateral and bilateral hip joint instability due to dysplasia. Children were divided into two groups – the first group included 30 patients (30 hip joints) with unilateral femur subluxation, the second group – 10 patients (20 hip joints) with bilateral femur subluxation. All patients underwent a standard orthopaedic clinical examination using a specialized scale to objectify complaints. All patients underwent X-ray examination of hip joints in AP and Lauenstein projections, CT scanning as well as lateral panoramic roentgenography of C1-S1 including femoral bones in standing position of the patient.

Results. The authors observed a strong positive correlation between sacrum inclination and lumbar lordosis curvature, antetorsion angle of proximal femur and sacrum inclination angle, severity of pain syndrome during impingement test and sacrum tilt: Pearson correlation coefficient was 0.71, 0.81 and 0.88 respectively. The authors reported in all patients a thoracic normokyphosis and lumbar hyperlordosis with excessive pelvis anteversion. Global sagittal disbalance was observed in all patients.

Conclusion. Apart from typical anatomical and roentgenological changes in pelvic and femoral componentsof the joint the children with dysplastic femur subluxation are characterized by excessive pelvic anteversion. Criteria of above parameters are identical and do not depend on the number of joints involved into the pathological process. Cranial dislocation of femoral head results to abnormalities of sagittal spine-pelvis ratios. Pathological process in hip joints and abnormality of spine-pelvis ratios results in negative changes of sagittal spine profile in the form of hyperlordosis, of physiological criteria of thoracic kyphosis and of the global sagittal disbalance. All of the above leads to overload of spinal motion segments and development of spine degenerative and dystrophic changes at early age.

About the authors

P. I. Bortulev

Turner Scientific and Research Institute for Children’s Orthopedics.

Author for correspondence.
Email: fake@neicon.ru

Pavel I. Bortulev — research associate, Department of Hip Pathology.

Parkovaya ul., 64 68, 196603, Pushkin, St. Petersburg.

Russian Federation

S. V. Vissarionov

Turner Scientific and Research Institute for Children’s Orthopedics; Mechnikov North-Western State Medical University.

Email: fake@neicon.ru

Sergei V. Vissarionov — Dr. Sci. (Med.), professor, deputy director for science, head of the Department of Spinal Pathology and Neurosurgery; professor of Traumatology and Orthopaedics Department,

Parkovaya ul., 64 68, 196603, Pushkin, St. Petersburg; 41, Kirochnaya ul., 191015, St. Petersburg.

Russian Federation

V. E. Baskov

Turner Scientific and Research Institute for Children’s Orthopedics.

Email: fake@neicon.ru

Vladimir E. Baskov — Cand. Sci. (Med.), head of the Department of Hip Pathology.

Parkovaya ul., 64 68, 196603, Pushkin, St. Petersburg.

Russian Federation

A. V. Ovechkina

Turner Scientific and Research Institute for Children’s Orthopedics.

Email: fake@neicon.ru

Alla V. Ovechkina — Cand. Sci. (Med.), academic secretary.

Parkovaya ul., 64 68, 196603, Pushkin, St. Petersburg.

Russian Federation

D. B. Barsukov

Turner Scientific and Research Institute for Children’s Orthopedics.

Email: fake@neicon.ru

Dmitry B. Barsukov — Cand. Sci. (Med.), senior research associate, the Department of Hip Pathology.

Parkovaya ul., 64 68, 196603, Pushkin, St. Petersburg.

Russian Federation

I. Y. Pozdnikin

Turner Scientific and Research Institute for Children’s Orthopedics.

Email: fake@neicon.ru

Ivan Y. Pozdnikin — Cand. Sci. (Med.), research associate of the Department of Hip Pathology.

Parkovaya ul., 64 68, 196603, Pushkin, St. Petersburg/

Russian Federation

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