[Pelvic obliquity and scoliosis in non-ambulatory patients with cerebral palsy: a descriptive study of 234 patients over 15 years of age].
OBJECTIVE
Children with cerebral palsy who cannot walk have an oblique pelvis and scoliosis. There is a certain degree of controversy in the literature on the best way to manage this difficult situation. We present a descriptive analysis of a population of non-ambulatory adults with cerebral palsy in order to formulate hypotheses concerning the factors determining scoliosis.


METHODS
This descriptive cross-sectional study was conducted in 234 patients aged over 15 years who had cerebral palsy and could not walk. Physical examination and an x-ray of the pelvis and spine in the reclining position were obtained for all patients. The following variables were recorded: luxation and subluxation of the hip, spontaneous deviation attitude, ability or not to turn over in bed, pelvic obliquity, history of bone surgery, defective hip abduction. The statistical analysis accounted for laterality and pelvis obliquity to the scoliosis convexity and the laterality of the hip excentration.


RESULTS
Scoliosis was observed in 66.2% of the patients; it was more than 60 degrees in 34.5%. Two basic groups were distinguished: thoracolumbar scoliosis (41.6%) and lumbar scoliosis (41.6%). The prevalence of oblique pelvi was 59.9% with important difference by side: 31.6% right oblique and 68.4% left oblique pelvi. We were unable to find any relationship between the side of the pelvic obliquity and the side of the scoliosis convexity, the side of the hip excentration, or the deviation attitude, but the deviation attitude appeared to be a risk factor for pelvic obliquity, which itself was a risk factor for excentration, which was a risk factor for scoliosis.


CONCLUSIONS
Scoliosis is an important problem in this population. Hip luxation is a direct risk factor for scoliosis, but the deviation attitude and pelvic obliquity are intermediary stages. The prevalence of oblique pelvi was greater on the left than the right. This finding should be confirmed in other series before hypotheses can be formulated concerning this difference.
Service de Rééducation Fonctionnelle Pédiatrique, L'Escale, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite Cedex.
I
I
Hodgkinson
C
C
Bérard
F
F
Chotel
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J
Bérard
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002547:Cerebral Palsy / Q000150:complications*; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005260:Female; D006617:Hip Dislocation / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging* / Q000473:pathology; D015995:Prevalence; D011859:Radiography; D016059:Range of Motion, Articular; D012307:Risk Factors; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016138:Walking