Influence of gait analysis on decision-marketing for lower extremity surgery

The effectof hamstring stretching on hip displacement in cerebral palsy

YY CHEN MS A, CH CHANG MD A, CJ WANG MD B

  1. 1. Department of Orthopedics;
  2. 2. Department of Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Objectives: The purpose of this study is to detect the changes in hip displacement when hamstrings are stretched in the hip flexion position for children with cerebral palsy (CP).

Design: Prospective case series.

Participants: A purposeful sample of children with spastic diplegic and spastic quadriplegic CP (between 4 and 10y) and hip displacement with Reimer’s migration percentage (MP) more than 30% in at least one hip seen on pelvis x-ray. Participants were supine on a special frame with one hip in flexion and one hip in extension to undergo computer tomography (CT) of the pelvis.

Method: Two sets of CT studies were performed for hip flexion resting and hip flexion stretching. The medial edge of triradiate cartilage to the centre of femoral epiphysis (T-C distance), the medical edge of triradiate cartilage to the lateral edge of femoral epiphysis (T-L distance), and the perpendicular distance from a basic line that connects bilateral triradiate cartilage to the posterior margin of epiphysis (PD distance) were collected from the 2D CT images.

Result: Thirteen children with spastic CP were recruited in this study at the age of 6 years 7 months (range 4y-8y 8mo). Displacement between resting and stretching set were significantly different in all the measurements (p<0.001), and the changes of displacement were more than 10%.

Conclusion: A significant displacement of the femoral head was produced by hamstrings  stretching in the hip flexion position. Stretching hamstrings for children with CP by passive hip abduction at hip extension position is recommended, to prevent further deterioration of hip displacement. (Table C:7): PD distance also correlated significantly with MP (r=0.63, p<0.005)

 
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