Evaluation of Radiological Parameters of the Spino-Pelvic Complex in Children with Hip Subluxation in Legg-Calve-Perthes Disease
- Authors: Bortulev P.I.1, Vissarionov S.V.1,2, Barsukov D.B.1, Pozdnikin I.Y.1, Baskov V.E.1, Baskaeva T.V.1, Poznovich M.S.1
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Affiliations:
- H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
- Mechnikov North-Western State Medical University
- Issue: Vol 27, No 3 (2021)
- Pages: 19-28
- Section: Clinical studies
- URL: https://journal-vniispk.ru/2311-2905/article/view/124919
- DOI: https://doi.org/10.21823/2311-2905-2021-27-3-19-28
- ID: 124919
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Abstract
Background. The natural course of Legg-Calve-Perthes disease (LCPD) in children with subtotal or total lesion, which correspond to group III-IV according to the Catterall classification, it often leads to hip subluxation. Any changes in the vertebral-pelvic complex lead to mutual transformation and aggravation of existing deformities. In the Russian literature, there are no data on the assessment of the state of the frontal and sagittal spino-pelvic ratios in children with hip subluxation in LCPD. Purpose — to evaluate the radiological parameters of the frontal and sagittal spino-pelvic relations in children with hip subluxation in LCPD. Materials and Methods. The study is based on the results of radiometry of 20 patients (20 hip joints) at an average age of 8.9±0.6 years with LCPD. Radiometry of the main frontal and sagittal spino-pelvic indices was performed and the type of vertical posture was determined according to P. Rousoully, as well as correlations between the studied parameters. Results. All patients had a pelvic distortion in the frontal plane. The values of PI had insignificant changes in comparison with similar values in the asymptomatic child population, the values of SS and SSA exceeded them, and the values of PT were significantly lower, which indicates the presence of excessive pelvic anteversion. The GLL values significantly exceeded the average statistical indicators. The global sagittal balance indicator (SVA) had negative values. The correlation analysis showed the presence of a strong positive relationship between PI and SS, SS and GLL, SSA and SS, a moderately pronounced positive relationship between PI and PT and a moderately pronounced negative relationship between PO and SS, PO and GLL. Conslusion. In children with LCPD in the fragmentation stage with subtotal or total epiphysis lesion (Catterall group III-IV) and hip subluxation, excessive pelvic anteversion is characteristic, which is expressed in an increase in the angle of inclination of the sacrum (SS) in combination with hyperlordosis of the lumbar spine and negative imbalance, as well as a pelvic distortion towards the affected limb. The totality of these changes corresponds to the IV type of vertical posture according to R. Roussouly, which can contribute to the development of degenerative-dystrophic processes in the lumbar spine.
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##article.viewOnOriginalSite##About the authors
Pavel I. Bortulev
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Author for correspondence.
Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
Cand. Sci. (Med.)
Russian Federation, St. PetersburgSergei V. Vissarionov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Mechnikov North-Western State Medical University
Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
Corresponding member of RAS, Dr. Sci. (Med.), Professor
Russian Federation, St. PetersburgDmitry B. Barsukov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634
Cand. Sci. (Med.)
Russian Federation, St. PetersburgIvan Y. Pozdnikin
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
Cand. Sci. (Med.)
Russian Federation, St. PetersburgVladimir E. Baskov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: dr.baskov@mail.ru
ORCID iD: 0000-0003-0647-412X
Cand. Sci. (Med.)
Russian Federation, St. PetersburgTamila V. Baskaeva
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: tamila-baskaeva@mail.ru
ORCID iD: 0000-0001-9865-2434
врач-травматолог - ортопед отделения патологии тазобедренного сустава
Russian Federation, St. PetersburgMakhmud S. Poznovich
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: poznovich@bk.ru
ORCID iD: 0000-0003-2534-9252
научный сотрудник генетической лаборатории центра редких и наследственных заболеваний у детей
Russian Federation, St. PetersburgReferences
- Loder R.T., Skopelja E.N. The epidemiology and demographics of Legg-Calvé-Perthes disease. ISRN Orthop. 2011;2011:504393. doi: 10.5402/2011/504393.
- Perry D.C., Hall A.J. The epidemiology and etiology of Perthes disease. Orthop Clin North Am. 2011;42(3):279-283, v. doi: 10.1016/j.ocl.2011.03.002.
- Leroux J., Abu Amara S., Lechevallier J. Legg-Calvé-Perthes disease. Orthop Traumatol Surg Res. 2018;104(1S):S107-S112. doi: 10.1016/j.otsr.2017.04.012.
- Guerado E., Caso E. The physiopathology of avascular necrosis of the femoral head: an update. Injury. 2016;47 Suppl 6:S16-S26. doi: 10.1016/S0020-1383(16)30835-X.
- Douglas G., Rang M. The role of trauma in the pathogenesis of the osteochondroses. Clin Orthop Relat Res. 1981;(158):28-32.
- Catterall A. The natural history of Perthes’ disease. J Bone Joint Surg Br. 1971;53(1):37-53.
- Vaz G., Roussouly P., Berthonnaud E., Dimnet J. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J. 2002;11(1):80-87. doi: 10.1007/s005860000224.
- Shefi S., Soudack M., Konen E., Been E. Development of the lumbar lordotic curvature in children from age 2 to 20 years. Spine (Phila Pa 1976). 2013;38(10):E602-608. doi: 10.1097/BRS.0b013e31828b666b.
- Hasegawa K., Okamoto M., Hatsushikano S., Shimoda H., Ono M., Watanabe K. Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects. Eur Spine J. 2016;25(11):3675-3686. doi: 10.1007/s00586-016-4702-2.
- Mac-Thiong J.M., Roussouly P., Berthonnaud E., Guigui P. Age- and sex-related variations in sagittal sacropelvic morphology and balance in asymptomatic adults. Eur Spine J. 2011;20 Suppl 5(Suppl 5):572-577. doi: 10.1007/s00586-011-1923-2.
- Roussouly P., Pinheiro-Franco J.L. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J. 2011;20 Suppl 5(Suppl 5):609-618. doi: 10.1007/s00586-011-1928-x.
- Бортулёв П.И., Виссарионов С.В., Басков В.Е., Овечкина А.В., Барсуков Д.Б., Поздникин И.Ю. Клинико-рентгенологические показатели позвоночно- тазовых соотношений у детей с диспластическим подвывихом бедра. Травматология и ортопедия России. 2018;24(3):74-82. doi: 10.21823/2311-2905-2018-24-3-74-82 Bortulev P.I., Vissarionov S.V., Baskov V.E., Ovechkina A.V., Barsukov D.B., Pozdnikin I.Yu. [Clinical and roentgenological criteria of spine-pelvis ratios in children with dysplastic femur subluxation]. Travmatologiya i Ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2018;24(3):74-82. (In Russian). doi: 10.21823/2311-2905-2018-24-3-74-82
- Виссарионов С.В., Кокушин Д.Н., Картавенко К.А., Ефремов А.М. Хирургическое лечение детей с врожденной деформацией поясничного и пояснично-крестцового отделов позвоночника. Хирургия позвоночника. 2012;(3):33-37. Vissarionov S.V., Kokushin D.N., Kartavenko K.A., Efremov A.M. [Surgical Treatment of Children with Congenital Deformity of the Lumbar and Lumbosacral Spine]. Khirurgiya pozvonochnika [Spine Surgery]. 2012;(3):33-37 (In Russian).
- Продан А.И., Радченко В.А., Хвисюк А.Н., Куценко В.А. Закономерности формирования вертикальной осанки и параметров сагиттального позвоночно – тазового баланса у пациентов с хронической люмбалгией и люмбоишиалгией. Хирургия позвоночника. 2006;(4):61-69 Prodan A.I., Radchenko V.A., Khvisyuk A.N., Kutsenko V.A. [Mechanism of vertical posture formation and parameters of sagittal spinopelvic balance in patients with chronic low back pain and sciatica]. Khirurgiya pozvonochnika [Spine Surgery]. 2006;(4):61-69. (In Russian).
- Murray K.J., Le Grande M.R. et. al Characterisation of the correlation between standing lordosis and degenerative joint disease in the lower lumbar spine in women and men: a radiographic study. BMC Musculoskelet Disord. 2017;18(1):330. doi: 10.1186/s12891-017-1696-9.
- Fukushima K., Miyagi M., Inoue G., Shirasawa E., Uchiyama K., Takahira N., Takaso M. Relationship between spinal sagittal alignment and acetabular coverage: a patient-matched control study. Arch Orthop Trauma Surg. 2018;138(11):1495-1499. doi: 10.1007/s00402-018-2992-z.
- Аверкиев В.А., Кудяшев А.Л., Артюх В.А., Надулич К.А., Теремшонок А.В., Нагорный Е.Б. Особенности сагиттальных позвоночно-тазовых взаимоотношений у пациентов с коксовертебральным синдромом. Хирургия позвоночника. 2012;(4): 49-54. Averkiev V.A., Kudyashev A.L., Artyukh V.A., Nadulich K.A., Teremshonok A.V., Nagornyi E.B. [Features of spino - pelvic realtions in patients with hip – spine syndrome]. Khirurgiya pozvonochnika [Spine Surgery]. 2012;(4):49-54. (In Russian).
- Камоско М.М., Баиндурашвили А.Г. Диспластический коксартроз у детей и подростков (клиника, патогенез, хирургическое лечение). Санкт-Петербург: СпецЛит, 2010. С. 54-72. Kamosko M.M., Baindurashvili A.G. [Dysplastic coxarthrosis in children and adolescents (clinical picture, pathogenesis, surgical treatment)]. Saint Petersburg: SpetsLit, 2010. p. 54-72.
- Hesarikia H., Rahimnia A. Differences between male and female sagittal spinopelvic parameters and alignment in asymptomatic pediatric and young adults. Minerva Ortopedica e traumatologica. 2018;69(2):44-48. doi: 10.23736/S0394-3410.18.03867-5.
- Продан А.И., Радченко В.А., Хвисюк А.Н., Куценко В.А. Закономерности формирования вертикальной осанки и параметров сагиттального позвоночно – тазового баланса у пациентов с хронической люмбалгией и люмбоишиалгией. Хирургия позвоночника. 2006;(4):61-69 Prodan A.I., Radchenko V.A., Khvisyuk A.N., Kutsenko V.A. Mechanism of vertical posture formation and parameters of sagittal spinopelvic balance in patients with chronic low back pain and sciatica. Khirurgiya pozvonochnika [Spine Surgery]. 2006;(4):61-69 (In Russian).
- Fukushima K., Miyagi M., Inoue G., Shirasawa E., Uchiyama K., Takahira N., Takaso M. Relationship between spinal sagittal alignment and acetabular coverage: a patient-matched control study. Arch Orthop Trauma Surg. 2018;138(11):1495-1499. doi: 10.1007/s00402-018-2992-z.
- Бортулев П.И., Виссарионов С.В., Басков В.Е., Поздникин И.Ю., Барсуков Д.Б. Оценка состояния позвоночно-тазовых соотношений у детей с двусторонним высоким стоянием большого вертела. Современные проблемы науки и образования. 2020;(1):65. Режим доступа: https://science-education.ru/ru/article/view?id=29513. Bortulev P.I., Vissarionov S.V., Baskov V.E., Pozdnikin I.Yu., Barsukov D.B. [Evaluation of conditions of spino-pelvic ratios in children with bilateral high riding trochanter]. Sovremennye problemy nauki i obrazovaniya. 2020;(1):65. (In Russian). Available from: https://science-education.ru/ru/article/view?id=29513.
- Le Huec J.C., Roussouly P. Sagittal spino-pelvic balance is a crucial analysis for normal and degenerative spine. Eur Spine J. 2011;20 Suppl 5(Suppl 5):556-557. doi: 10.1007/s00586-011-1943-y.
- Abelin K., Vialle R., Lenoir T., Thévenin-Lemoine C., Damsin J.P., Forin V. The sagittal balance of the spine in children and adolescents with osteogenesis imperfecta. Eur Spine J. 2008;17(12):1697-1704. doi: 10.1007/s00586-008-0793-8.
- Прудникова О.Г., Аранович А.М. Клинико-рентгенологические аспекты сагиттального баланса позвоночника у детей с ахондроплазией. Ортопедия, травматология и восстановительная хирургия детского возраста. 2018;6(4):6-12. doi: 10.17816/pToRS646-12. Prudnikova O.G., Aranovich A.M. [Clinical and radiological aspects of the sagittal balance of the spine in children with achondroplasia]. Ortopediya, travmatologiya i vosstanovitel’naya khirurgiya detskogo vozrasta [Pediatric Traumatology, Orthopaedics and Reconstructive Surgery]. 2018;(6)4:6-12. (in Russian). doi: 10.17816/pToRS646-12.
- Kitoh H., Kitakoji T., Katoh M., Ishiguro N. Sagittal spinal alignment in patients with Legg-Calve-Perthes disease. Pediatr Int. 2007;49(5):612-617. doi: 10.1111/j.1442-200X.2007.02428.x.
- Roussouly P., Berthonnaud E., Dimnet J. [Geometrical and mechanical analysis of lumbar lordosis in an asymptomatic population: proposed classification]. Rev Chir Orthop Reparatrice Appar Mot. 2003;89(7):632-639. (In French).
- Jackson R.P., Phipps T., Hales C., Surber J. Pelvic lordosis and alignment in spondylolisthesis. Spine (Phila Pa 1976). 2003;28(2):151-160. doi: 10.1097/00007632-200301150-00011.
- Sorensen C.J., Norton B.J., Callaghan J.P., Hwang C.T., Van Dillen L.R. Is lumbar lordosis related to low back pain development during prolonged standing? Man Ther. 2015;20(4):553-557. doi: 10.1016/j.math.2015.01.001.
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