Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector127010.17816/psaic1270Original Study ArticlesОригинальные исследованияResearch ArticlePrediction Model for Contralateral Hip Dislocation in Cerebral Palsy Patients with Unilateral Hip Dislocation: A Scoring System to Guide Decision MakingМодель прогнозирования вывиха контралатерального бедра у пациентов с церебральным параличом и односторонним вывихом бедра: система оценки для принятия решенийhttps://orcid.org/0000-0003-0346-7135TangadulratPasin
Thailand

МD, Department of Orthopedics surgery, Faculty of Medicine Mahidol University; Department of Orthopedics surgery, Faculty of medicine Prince of Songkhla University

доктор медицины

P.tangadulrat@gmail.comhttps://orcid.org/0000-0001-5663-1889AdulkasemNath
Thailand

МD, Department of Orthopedics surgery, Faculty of Medicine Mahidol University

доктор медицины

Adukasem.n@gmail.comhttps://orcid.org/0000-0002-0929-651XSuganjanasateKuntalee
Thailand

МD, Department of Orthopedics surgery, Faculty of Medicine Mahidol University

доктор медицины

kuntalee1212@gmail.comhttps://orcid.org/0000-0001-8986-7943WongcharoenwatanaJidapa
Thailand

МD, Department of Orthopedics surgery, Faculty of Medicine Mahidol University

доктор медицины

jidapa.wongcha@gmail.comhttps://orcid.org/0000-0001-6009-1838AriyawatkulThanase
Thailand

МD, Assistant Professor, Department of Orthopedics surgery, Faculty of Medicine Mahidol University

доктор медицины; доцент кафедры ортопедии

thanaseortho@gmail.comhttps://orcid.org/0000-0002-2634-1175EamsobhanaPerajit
Thailand

МD, Associated Professor, Department of Orthopedics surgery, Faculty of Medicine Mahidol University

доктор медицины; адъюнкт-профессор

peerajite@gmail.comhttps://orcid.org/0000-0002-1209-744XChotigavanichayaChatupon
Thailand

МD, Associated Professor, Department of Orthopedics surgery, Faculty of Medicine Mahidol University

доктор медицины; адъюнкт-профессор

chatuponc@gmail.comMahidol UniversityPrince of Songkhla University24092022021120221232893002206202231082022Copyright ©; 2022, Eco-VectorCopyright ©; 2022, Эко-Вектор2022Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/1270

BACKGROUND: Cerebral palsy (CP) patients commonly present with unilateral hip dislocation. However, the decision for concurrent prophylaxis surgery on the contralateral hip in this condition is still controversial.

AIM: This study aims to explore the prognostic factors for contralateral hip dislocation and develop a scoring system.

MATERIALS AND METHODS: Data on CP patients with unilateral hip dislocation between January 2005 to January 2019 were reviewed. We explored the difference of preoperative parameters between the group in which the contralateral hip is eventually dislocated or remains stable. A multivariable logistic regression analysis was performed to develop a model for predicting contralateral hip dislocation.

RESULTS: Seven of included 30 patients (23.3%) developed contralateral hip dislocation. Pre-operative contralateral hip’s Reimer’s Migration Index (RMI), Acetabular Index (AI), Lateral Center Edge Angle of Wiberg (CEA), and Pelvic obliquity (PO) were significantly different (p = 0.049, 0.019, 0.030 and 0.038 respectively). The multivariable logistic regression analysis reveals that RMI > 25% (mOR 36.66, 95% CI 1.13–1185.50, p = 0.042) and age <9 years old (mOR = 22.55, 95% CI 0.76–665.37, p = 0.071) are significant predictors. Both parameters were included in the model, which revealed an AuROC of 0.84 (95% CI 0.69–0.99). Each factor was assigned a score of 1. There was no contralateral hip displacement in patients with a score of 0. Two out of 15 patients (28.6%) with a score of one developed contralateral hip displacement. Five out of eight (71.4%) patients with a score of 2 developed contralateral hip dislocation.

CONCLUSIONS. Significant predictors for contralateral hip dislocation in CP patients are RMI >25% and age <9 years old. The proposed scoring system might help guide the surgeon’s decision to perform contralateral prophylactic surgery.

Актуальность. В комплексе проблем, выявляемых у пациентов с церебральным параличом, часто встречается односторонний вывих бедра. Однако вопрос необходимости одновременного превентивного оперативного вмешательства на контралатеральном бедре при центральном параличе по-прежнему вызывает дискуссии.

Цель — определение прогностических факторов развития вывиха контралатерального бедра и разработка системы оценки для принятия решения об оперативном лечении.

Материалы и методы. За период с января 2005 г. по январь 2019 г. проведен обзор пациентов с церебральным параличом и односторонним вывихом бедра. Обнаружено различие показателей до операции в группе пациентов, у которых впоследствии развился вывих контралатерального бедра или у которых контралатеральный тазобедренный сустав остался стабильным. Для разработки модели прогнозирования вывиха контралатерального бедра мы провели многофакторный анализ методом логистической регрессии.

Результаты. Из 30 пациентов, включенных в исследование, вывих контралатерального бедра развился у 7 человек (23,3 %). У этих пациентов наблюдались значимые различия показателей миграционного индекса Реймерса (RMI), ацетабулярного индекса, латерального центрально-краевого угла Виберга и перекоса таза до операции (p = 0,049, 0,019, 0,030 и 0,038 соответственно). В ходе многофакторного анализа с применением логистической регрессии мы обнаружили, что значимыми прогностическими факторами являются RMI >25 % (медиана отношения шансов 36,66, 95 % ДИ 1,13–1185, 50, p = 0,042) и возраст <9 лет (медиана отношения шансов 22,55, 95 % ДИ 0,76–665,37, p = 0,071). Оба параметра были включены в модель, в результате площадь под ROC-кривой составила 0,84 (95 % ДИ 0,69–0,99). Каждому фактору присваивали 1 балл. У пациентов с баллом 0 смещение головки контралатеральной бедренной кости отсутствовало. Среди 15 пациентов с баллом 1 смещение головки контралатеральной бедренной кости произошло у двух человек (28,6 %). Из 8 пациентов с баллом 2 вывих контралатерального бедра развился у 5 человек (71,4 %).

Выводы. Значимыми прогностическими факторами развития вывиха контралатерального бедра у пациентов с церебральным параличом являются RMI >25 % и возраст <9 лет. Предлагаемая система балльной оценки может помочь хирургам принять решение о проведении превентивного оперативного вмешательства на контралатеральном бедре.

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