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[Relationship between the gross motor function classification system and hip and lumbar spine development in children
1Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing 100010, China.
Insights
Higher Gross Motor Function Classification System (GMFCS) levels in children with spastic cerebral palsy correlate with poorer hip development and increased risk of lumbar kyphosis in severe cases (GMFCS III-IV).
Area of Science:
- Pediatrics
- Orthopedics
- Neurology
Context:
- Spastic cerebral palsy (CP) significantly impacts motor function.
- Hip joint and lumbar spine development are crucial for mobility and posture in children with CP.
- The Gross Motor Function Classification System (GMFCS) is a standard measure for CP severity.
Purpose:
- To analyze the relationship between GMFCS levels and hip joint and lumbar spine development in children with spastic CP.
- To identify specific radiographic parameters indicative of developmental abnormalities.
- To assess the correlation between GMFCS grading and the progression of hip and spinal deformities.
Summary:
- This study retrospectively analyzed 125 children with spastic CP, categorized by GMFCS levels (I-IV). Radiographic measurements of hip joint parameters (MP, CE, AI, NSA) and lumbar spine parameters (Cobb angle, lumbosacral angle, lordosis index, apical distance) were performed.
- Results indicated a significant correlation between higher GMFCS grades and poorer hip development, characterized by increased migration percentage (MP) and acetabular index (AI), and decreased central edge angle (CE). The neck-shaft angle (NSA) was significantly lower in GMFCS grade I compared to higher grades.
- Lumbar spine analysis revealed a significantly higher sagittal Cobb angle in GMFCS grade IV compared to other groups, suggesting an increased risk of lumbar kyphosis in severe spastic CP.
Impact:
- Findings highlight the progressive nature of hip dysplasia in relation to motor impairment severity in spastic CP.
- Identifies GMFCS grades III-IV as critical indicators for potential lumbar kyphosis, enabling targeted monitoring and intervention.
- Informs clinical practice for orthopedic management and rehabilitation strategies in children with spastic cerebral palsy.
Objective:
To investigate the relationship among the gross motor function classification system (GMFCS)and the development of hip joint and lumbar spine in children with spastic cerebral palsy.
Methods:
The clinical data of 125 children with spastic cerebral palsy admitted from January 2018 to July 2021 were retrospectively analyzed. There were 85 males and 40 females, aged from 4 to 12 years old with an average of (8.4±2.9) years. According to GMFCS, the patients were divided into gradeⅠ, Ⅱ, Ⅲ and Ⅳ groups. There were 27 cases in gradeⅠgroup, 40 cases in gradeⅡgroup, 35 cases in grade Ⅲ group and 23 cases in grade Ⅳ group. The migration percentage(MP), central edge angle(CE), neck-shaft angle(NSA), acetabular index(AI) were measured by the radiograph of pelvis, abnormal parameters were selected to evaluate the relationship between different GMFCS grades and hip joint development. Lumbar sagittal Cobb angle, lumbar sacral angle, lumbar lordosis index and apical distance were measured by lateral lumbar radiographs to evaluate the relationship between different GMFCS grades and lumbar spine development.
Results:
①Among the 125 spastic cerebral palsy children, there were 119 cases of pelvic radiographs that met the measurement standards. In the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, MP was (22.72±3.88), (26.53±4.36), (33.84±4.99), and (49.54±7.87)%, CE was(30.10±6.99) °, ( 22.92±4.19) °, ( 17.91±5.50) °, and (-0.70±17.33)°, AI was (16.41±2.77) °, (20.46±4.63) °, (23.76±5.10) °, and ( 29.15±7.35)°, respectively, there were significant differences between the two comparisons (P<0.05). And the higher GMFCS grade, the greater MP and AI, and the smaller CE.The NSA was(142.74±10.03) °, (148.66±9.09) °, (151.66±10.52) °, and (153.70±8.05)° in four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, respectively. The differences between the two comparisons of the GMFCS gradeⅠgroup and the other three groups were statistically significant (P<0.05). NSA of GMFCSⅠgroup was significantly lower than that of the others, there was no significant difference among other groups(P>0.05). ② Among the 125 spastic cerebral palsy children, there were 88 cases of lumbar spine radiographs that met the measurement standards. ③The lumbar sagittal Cobb angle was(32.62±11.10) °, (29.86±9.90) °, (31.70±11.84) °, and (39.69±6.80)° in the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, respectively;GMFSS of grade Ⅳ group was significantly higher than that of other three groups, there was significant difference between the two comparisons (P<0.05);there were no significant differences between other groups (P>0.05). In the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, the lumbosacral angle was (31.02±9.91) °, ( 26.57±9.41) °, (28.08±8.56) °, and ( 27.31±11.50)°, the lumbar lordosis index was (4.14±12.89), (8.83±13.53), (13.00±11.78), and (10.76±9.97) mm, the arch apex distance was (9.50±6.80), (6.68±3.20), (7.16±4.94), and (6.62±4.13) mm, respectively, there were no significant differences between the two comparisons(P>0.05).
Conclusion:
①In children with GMFCS gradeⅠ-Ⅳ, the higher the GMFCS grade, the worse the hip develops. ② Children with GMFCS grade Ⅲ-Ⅳ may be at greater risk for lumbar kyphosis.
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