New Method for Determining the Anatomical Location of the Acetabulum in Children with Cerebral Palsy

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Abstract

BACKGROUND: At present, the available methods for studying the degree of acetabular deformity in patients with cerebral palsy allow for assessment of its shape alone. Moreover, disturbances in the spatial orientation of the acetabulum within the pelvic ring during joint destabilization remain unexplored.

AIM: This study aimed to assess the spatial orientation parameters of the acetabulum relative to elements of the pelvic ring in stable and unstable hip joints in children with cerebral palsy using linear measurement techniques.

METHODS: This cross-sectional study included 21 children (42 hip joints) with cerebral palsy aged 9–15 years. In all the patients, one hip joint was stable (21 joints, first group of joints), and the contralateral joint was unstable (subluxation or dislocation; 21 joints, second group of joints). The proposed method for determining acetabular spatial orientation was applied using four novel linear indices on spiral computed tomography, for stable and unstable joints.

RESULTS: Testing of the null hypothesis revealed no significant group differences in acetabular spatial orientation. However, compared with the stable hip joints group, the second group with unstable hip joints demonstrated a decreased distance from the most anterior point of the first sacral vertebra (S1) to points on the anterior inferior iliac spine, ischial spine, and intersection of the Y-shaped cartilage growth zone with the obturator crest, and increased distance from S1 to the intersection of the Y-shaped cartilage growth zone with the pubic crest. Pairwise comparison within patients showed differences >5% in 33%–42% of cases, depending on the index.

CONCLUSION: A new diagnostic technique for determining the spatial orientation of the acetabulum within the pelvic ring is proposed. This approach enables the detection of multiplanar acetabular displacement, independent of morphological changes. The discrepancy between group-level and individual data indicates the need for further research.

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About the authors

Valery V. Umnov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: umnovvv@gmail.com
ORCID iD: 0000-0002-5721-8575
SPIN-code: 6824-5853

MD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg

Vladimir A. Novikov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: novikov.turner@gmail.com
ORCID iD: 0000-0002-3754-4090
SPIN-code: 2773-1027

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Dmitry S. Zharkov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: zds05@mail.ru
ORCID iD: 0000-0002-8027-1593
SPIN-code: 5908-7774

MD

Russian Federation, Saint Petersburg

Alina R. Mustafaeva

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: alina.mys23@yandex.ru
ORCID iD: 0009-0003-4108-7317
SPIN-code: 1099-7340

MD

Russian Federation, Saint Petersburg

Olga S. Loboda

Peter the Great Saint Petersburg Polytechnic University

Email: loboda_o@mail.ru
ORCID iD: 0000-0002-4849-8165
SPIN-code: 4970-7018

Cand. Sci. (Physics and Mathematics), Assistant Professor

Russian Federation, Saint Petersburg

Dmitry M. Pashkovsky

Peter the Great Saint Petersburg Polytechnic University

Email: dmpashkovsky@mail.ru
ORCID iD: 0000-0002-2218-6649

MD

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Sharp's angle for different pelvic positions with changes in pelvic inclination on an anteroposterior radiograph.

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3. Fig. 2. Method for measuring the acetabulum version.

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4. Fig. 3. Method for measuring pelvic bone parameters: a — medial surface of the right pelvic bone; b — lateral surface of the right pelvic bone; c — pelvis. 1 — anterior inferior spine; 2 — intersection of the growth plate of the Y-shaped cartilage with the pubic crest; 3 — intersection of the growth plate of the Y-shaped cartilage with the obturator crest line; 4 — sciatic spine; 5 — point on the SI body.

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5. Fig. 4. Gardner-Altman plot for the linear parameter "SI-anterior inferior spine". The black dot is the difference between the medians of the parameters of the two groups. The black line is the confidence interval. The orange curve illustrates the distribution of the difference between the two samples' values, or the effect size. The difference between the medians is –1.5 (95.0% confidence interval is –13.0–13.1).

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6. Figure 5. Gardner-Altman plot for the linear "SI-ischial spine" parameter. The black dot represents the difference between the medians of the two groups' values. The black line is the confidence interval. The orange curve illustrates the distribution of the difference between the two samples' values, or the effect size. The difference between the medians is –4.8 (95.0% confidence interval is –18.1–7.0).

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7. Figure 6. Gardner-Altman plot for the linear "SI-obturator foramen growth zone" parameter. The black dot represents the difference between the medians of the two groups' values. The black line is the confidence interval. The orange curve illustrates the distribution of the difference between the two samples' values, or the effect size. Difference between medians: –1.8 (95.0% confidence interval –13.6–6.1).

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8. Fig. 7. Gardner-Altman plot for the linear "SI-pubic bone growth zone" parameter. The black dot is the difference between the medians of the two groups. The black line is the confidence interval. The orange curve illustrates the distribution of the difference between the two samples' values, or the effect size. The difference between the medians is +1.5 (95.0% confidence interval: -10.7–7.9).

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9. Fig. 8. Correlogram. Results of the correlation analysis in the first group. *Significant correlations.

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10. Fig. 9. Correlogram. Results of the correlation analysis in the second group. *Significant correlations.

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