Acetabular–epiphyseal angle and hip dislocation in cerebral palsy: A preliminary study

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(A) Image obtained after combining data from the two tubes at voltages of 80kV+140kV: ileal segment with wall thickening, mucosal enhancement, and vascular ingurgitation consistent with Crohn's disease, with signs of inflammatory activity (arrow). (B) Axial image with data obtained from the tube at a voltage of 80kV. This kV enhances the visualization of contrast uptake making it useful for mucosal enhancement. (C) Axial image with data from the tube at a voltage of 140kV." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.M. Villanueva Campos, G. Tardáguila de la Fuente, E. Utrera Pérez, C. Jurado Basildo, D. Mera Fernández, C. Martínez Rodríguez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A.M." "apellidos" => "Villanueva Campos" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Tardáguila de la Fuente" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Utrera Pérez" ] 3 => array:2 [ "nombre" => "C." 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CTC in one patient with cervical carcinoma treated with radiation therapy after incomplete optical colonoscopy due to impassable stenosis. (a) CT image reconstruction in the coronal plane that reveals protrusions (arrows) and stenoses (not shown). (b) The 3D image shows one of the polypoid lesions that looks ulcerative in the optical colonoscopy (c)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J. Martínez-Sapiña Llanas, S.A. Otero Muinelo, C. Crespo García" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Martínez-Sapiña Llanas" ] 1 => array:2 [ "nombre" => "S.A." "apellidos" => "Otero Muinelo" ] 2 => array:2 [ "nombre" => "C." 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Alí-Morell, F. Zurita-Ortega, I. Davó-Jiménez, S. Segura-Biedma" "autores" => array:4 [ 0 => array:4 [ "nombre" => "O.J." "apellidos" => "Alí-Morell" "email" => array:1 [ 0 => "fisiopurisima@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Zurita-Ortega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Davó-Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "S." "apellidos" => "Segura-Biedma" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Fisioterapia, Fundación Purísima Concepción, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Área de Corporal, Universidad de Granada, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ángulo acetábulo-epifisario y luxación de cadera en la parálisis cerebral: Estudio preliminar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1175 "Ancho" => 1667 "Tamanyo" => 263011 ] ] "descripcion" => array:1 [ "en" => "Chart of force lines applied on the coxofemoral joint. Direction of the compression exerted from the pelvis to the cephalic trabecular system, or main compression group in the femoral head (A). Direction of the tension exerted from the pelvis to the cervicocephalic trabecular system, or main tension group (B). Perpendicular to the force lines applied on the acetabular roof (A′) and femoral head (B′)." ] ] ] "textoCompleto" => "IntroductionFor the coxofemoral joint to develop adequately it is necessary that the femoral head is sitting perfectly centered in the acetabulum, and there is a balanced growth both between the triradiate and acetabular cartilages.<a class="elsevierStyleCrossRef" href="#bib0100">1</a> In this sense, the vertical pressure forces of the spinal column are transmitted through the sacroiliac joints toward the hip bones, and then toward the coxofemoral joints<a class="elsevierStyleCrossRef" href="#bib0105">2</a> influencing the distribution of the trabecular bone system. This way, the trabecular pattern of the proximal femur corresponds with the lines of mechanical force,<a class="elsevierStyleCrossRef" href="#bib0110">3</a> with a main trabecular pattern containing tensile (cervicocephalic, or Gallois’ and Bosquette's arched cephalic bundle) and compressive bundles (cephalic fan-shaped bundle).<a class="elsevierStyleCrossRef" href="#bib0115">4</a> Both the morphology and direction of the cephalic and cervicocephalic bundles reveal to us the transfer of tensions toward the hip while shaping and giving inclination to the femoral epiphysis. Similarly, the angle that exists between the head and the neck with respect to the femoral diaphysis allows us to assess the transfer of tensions caudally. Finally, since the trajectory of the force lines occurs through the acetabulum (sacrocotyloid trabeculae),<a class="elsevierStyleCrossRef" href="#bib0115">4</a> the acetabular roof line is also indicative of the direction of mechanical compression at that level. Therefore, since both tensions and compressions define the external and internal structures (trabecular system), there are measures that can be used to guess the direction of the tensions withstood by the coxofemoral joint (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>When it comes to the inclination of the femoral epiphysis, traditionally the Hilgenreiner epiphyseal angle (HEA) has been considered a good prognostic indicator of the anomalies occurring during the development of the proximal femur.<a class="elsevierStyleCrossRef" href="#bib0120">5</a> When it comes to the angulation of the acetabular roof, the most widely used measure is the acetabular index (AI).<a class="elsevierStyleCrossRef" href="#bib0125">6</a>However, although such measures show the inclination of the acetabulum and the epiphysis, separately, the assessment of the angulation between the two—the acetabular–epiphyseal angle (AEA) is not standardized.Lastly, in order to measure the degrees of femoral neck with respect to the diaphysis, the cervical–diaphyseal angle (CDA) is commonly used.<a class="elsevierStyleCrossRef" href="#bib0130">7</a>In individuals with neurological alterations, above all, cerebral palsy, the hip is one of the joints most commonly affected associating coxofemoral alterations in the gross motor function, and a high percentage of non-ambulatory subjects with cerebral palsy (levels IV and V of the Gross Motor Function Classification System [GMFCS]<a class="elsevierStyleCrossRef" href="#bib0135">8</a>) have luxations and subluxations.<a class="elsevierStyleCrossRef" href="#bib0140">9</a>That is why to be able to quantify the stability of the hip in this population, although the CDA is sometimes used, the radiological measure most widely used is Reimers’ hip migration percentage (MP) that measures the lack of coverage of the femoral head by the acetabulum.<a class="elsevierStyleCrossRef" href="#bib0145">10</a>However, although such radiological measures are relevant when monitoring hip alterations, they are not definitive<a class="elsevierStyleCrossRef" href="#bib0150">11</a> since, in most cases, these alterations progress fast and their etiology is complex.For all these reasons, these are the goals of this study:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Correlate the AI, HEA, and CDA with the MP in individuals with cerebral palsy categorized at levels IV and V of the GMFCS.</li><li class="elsevierStyleListItem" id="lsti0010">•Correlate the MP with a proposed measure – the AE in the aforementioned population.</li></ul>Material and methodsParticipants and designThis is a descriptive, observational, transversal study. The sample was taken from the total of school children from the Purísima Concepción Center of Special Education in Granada, Spain who used to attend regularly to physical therapy.The inclusion criteria were a diagnosis of child cerebral palsy, being categorized as level IV or V of the GMFCS, and having one radiological study of bilateral hips in the anteroposterior projection conducted in the decubitus supine position during the last year. The exclusion criteria were having another diagnosis, being categorized in a different GMFCS group of the ones specified in the inclusion criteria, and not having a recent radiological study. This way the sample included 15 individuals, all of them of ages between 3 and 9 years old.In order to control the possible inter-observer variation, the presence of four professionals was requested who reached the maximum possible consensus in their judgements, which is why both the inter and intra-observer variabilities were below 5%.VariablesIn the study, the independent variables were determined by the AI, HEA, CDA, and AEA. On the other hand, the MP was the dependent variable.ToolsDifferent radiological measures were used to quantify the variables (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>):<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015">•The Hilgenreiner (H) line: line that runs from the triradiate cartilage to the contralateral cartilage drawn from the most distal end of the ossified iliac cartilages.<a class="elsevierStyleCrossRef" href="#bib0155">12</a></li><li class="elsevierStyleListItem" id="lsti0020">•Perkins (P) line: line perpendicular to the H-line in the most lateral segment of the ossified acetabulum.<a class="elsevierStyleCrossRef" href="#bib0155">12</a></li><li class="elsevierStyleListItem" id="lsti0025">•Hilgenreiner epiphyseal angle (HEA): angle found between the intersection of Hilgenreiner (H) line and another line running through the femoral physeal plate.<a class="elsevierStyleCrossRef" href="#bib0160">13</a></li><li class="elsevierStyleListItem" id="lsti0030">•Acetabular index (AI): it corresponds to the angle made up by the Hilgenreiner line and a line tangent to the acetabulum.<a class="elsevierStyleCrossRef" href="#bib0125">6</a></li><li class="elsevierStyleListItem" id="lsti0035">•Acetabular–epiphyseal angle (AEA): angle made up by the line tangent to the acetabulum (used in the measure of the AI) and the line of the femoral physeal plate (used in the HEA).</li><li class="elsevierStyleListItem" id="lsti0040">•Cervical–diaphyseal angle (CDA): according to the methodology described by Doherty et al.,<a class="elsevierStyleCrossRef" href="#bib0130">7</a> it is the angle found between the line that connects the center of the femoral head and middle side of the neck to another line drawn between two intermediate segments of the diaphysis underneath the lesser trochanter.</li><li class="elsevierStyleListItem" id="lsti0045">•Reimers’ hip migration percentage (MP): according to Reimers,<a class="elsevierStyleCrossRef" href="#bib0145">10</a> after drawing the H and P-lines, the length of the femoral head that stays outside P-line (A) is measured. The uncovered length of the femoral head (A) is divided by the total length of the femoral head (B) and then multiplied by 100: MP=A/B×100.</li></ul><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Lastly, in order to group the hip radiological findings based on the MP, Robin et al.’s classification was used,<a class="elsevierStyleCrossRef" href="#bib0165">14</a> and two (2) different groups were established: normal or close to normal hips (MP≤15%), and altered hips (displasic, subluxated, or luxated; MP>15%).ProcedureThe study was conducted following the protocols established by our center after obtaining prior written informed consent from the legal representatives of the boys/girls, and approval by the hospital ethics committee.Statistical analysisThe statistical analysis was conducted using the SPSS 20.0 software for Windows. The techniques used for the analysis were, in the first place, descriptive by determining the frequencies and percentages. In order to check whether this or that correlation was actually there, Pearson's correlation coefficient was used.ResultsThe sample included 15 individuals (30 hips), all of them between 3 and 9 years of age (average: 5.6; typical deviation: 2.57). The sex distribution was 53.3% (n=8; 16 hips) boys, and 46.7% (n=7; 14 hips) girls.The data obtained are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The correlations between the different unilateral variables are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Positive correlations were confirmed between the AI and the MP (p=0.581), and also between the AEA and the variables IA (p=0.748) and CDA (p=0.307). The strongest association with the MP occurs with the AEA (p=0.813).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Negative correlations were confirmed between the HEA, on the one hand, and the CDA (p=−0.439), AEA (p=−0.824), and MP (p=−0.693) on the other hand.With respect to the group with normal or close to normal hips (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), all possible positive correlations between the HEA and the AI (p=0.508), and between the entre el AEA and the CDA (p=0.559) were confirmed. On the contrary, there is a negative correlation between the HEA and the CDA, on the one hand (p=−0.599), and between the HEA and the AEA (p=−0.749) on the other hand.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>When it comes to displasic, subluxated and luxated hips (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>), all correlations happen with the AEA – the positive ones relative to the AI (p=0.774), and the negative ones relative to the HEA (p=−0.731).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionIn light of the results obtained in our population, there is an association between the CDA and the HEA. Thus, as the CDA grows bigger, the HEA grows smaller, and vice versa.Based on these results, the formations of the CDA and the femoral epiphysis would be somehow related, which is consistent with what has already been reported in studies conducted in populations with hip alterations due to skeletal disorders, where the inclination of the femoral epiphysis is associated with the development of the CDA.<a class="elsevierStyleCrossRef" href="#bib0170">15</a>On the other hand, when it comes to the AEA, our data associate it with the AI and the HE, since, precisely, it is a measure that establishes a connection between the two and expresses the angle that exists between the acetabular roof (measured in the AI), and the femoral epiphysis (measured in the HEA).Similarly, and also based on our results, we can confirm the association between the MP and the directionality measures of the acetabulum and the epiphysis.Thus, there would be a correlation between an increased acetabular angle and the migration of the femoral head, which is consistent with Terjesen's studies<a class="elsevierStyleCrossRef" href="#bib0175">16</a> that establish clear associations between the AI and the instability of the hip, especially for AI>27°.As Herring<a class="elsevierStyleCrossRef" href="#bib0180">17</a> describes it, this process may be related with a change of direction in the pressures exerted on the femoral head from the acetabulum.The data also show a correlation between a reduced HEA and less joint stability. The horizontalization of the femoral head would facilitate the luxation of the hip following the opinion of some authors who say that the alterations in the femoral head sphericity and orientation are determining factors in the development of hip dysplasia.<a class="elsevierStyleCrossRef" href="#bib0185">18</a>Finally, in our population, when the hip looks normal or is close to normal, there is a correlation between the acetabular angle and the HEA in such a way that an increase of the former leads to an increase of the latter, and vice versa. Such relation is not observed in the complete group, or the altered hips (displasic, subluxated, or luxated).In the subjects of this study, the right orientation of the pressures exerted on the acetabulum and the proximal femoral epiphysis, separately, is associated with joint stability, meaning that the angular correlation between the two can be an important piece of information for the prognosis of hip alterations in individuals with cerebral palsy. In this sense, some authors say that the development of the hip depends on the interaction between the acetabulum and the femoral head.<a class="elsevierStyleCrossRef" href="#bib0190">19</a>Consistent with all this, although we have been able to confirm the correlations between the AI and the HEA with the MP, the strongest association of all occurs with the measure that describes the relation between the two, that is, the AEA.This way, the bigger the angulation between the acetabulum and the femoral epiphysis, the bigger the MP. Also, with acetabular roof inclinations parallel or close to those of the epiphysis, smaller MPs.Thus, it seems that joint stability is somehow based on this correlation between the development of the acetabulum and the epiphysis and, therefore, the inclination between the two, being the AEA a possible indicator of such development and stability.These are some of the conclusions we can draw:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0050">•In this study, the development of the CDA is associated with the development of the femoral epiphysis.</li><li class="elsevierStyleListItem" id="lsti0055">•The MP would be associated, on the one hand, with the acetabular inclination and, on the other hand, with the epiphyseal inclination.</li><li class="elsevierStyleListItem" id="lsti0060">•In our population, the measure proposed of angulation between the acetabular and the epiphyseal inclinations is the measure that has the strongest association with the MP.</li></ul>Limitations, future perspectives, and observationsBasically, the limitations of this study come from the number of participants, and the conclusions drawn cannot be extrapolated or generalized to other groups of patients.Authors<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065">1.Manager of the integrity of the study: OJAM, FZO, IDJ and SSB.</li><li class="elsevierStyleListItem" id="lsti0070">2.Study idea: OJAM, IDJ, SSB and FZO.</li><li class="elsevierStyleListItem" id="lsti0075">3.Study design: FZO, OJAM, SSB and IDJ.</li><li class="elsevierStyleListItem" id="lsti0080">4.Data mining: OJAM, IDJ, SSB and FZO.</li><li class="elsevierStyleListItem" id="lsti0085">5.Data analysis and interpretation: FZO, OJAM, IDJ and SSB.</li><li class="elsevierStyleListItem" id="lsti0090">6.Statistical analyses:</li><li class="elsevierStyleListItem" id="lsti0095">7.Reference: IDJ, SSB, OJAM and FZO.</li><li class="elsevierStyleListItem" id="lsti0100">8.Writing: OJAM, FZO, IDJ and SSB.</li><li class="elsevierStyleListItem" id="lsti0105">9.Critical review of the manuscript with intellectually relevant remarks: OJAM, FZO, IDJ and SSB.</li><li class="elsevierStyleListItem" id="lsti0110">10.Approval of final version: OJAM, FZO, IDJ and SSB.</li></ul>Conflicts of interestsThe authors declare no conflict of interests associated with this article whatsoever." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1022335" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec980507" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1022334" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec980506" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants and design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Variables" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Tools" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Procedure" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0045" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Limitations, future perspectives, and observations" ] ] ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Authors" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-24" "fechaAceptado" => "2018-02-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec980507" "palabras" => array:3 [ 0 => "Cerebral palsy" 1 => "Hip dislocation" 2 => "Radiography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec980506" "palabras" => array:3 [ 0 => "Parálisis cerebral" 1 => "Luxación de cadera" 2 => "Radiografía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo relate, in non-ambulatory subjects with palsy, Reimers’ migration percentage with standardized radiological measurements, including the acetabular–epiphyseal angle. MethodDescriptive, observational and transversal study of 15 individuals with cerebral palsy at levels IV and V of the Gross Motor Function Classification System, aged between 3 and 9 years. Radiological measurements of the acetabular index, Hilgenreiner's epiphyseal angle, acetabular–epiphyseal angle, neck-shaft angle and Reimers’ migration percentage of each of the hips were performed. ResultsCorrelations between acetabular index, epiphyseal angle and acetabular–epiphyseal angle were obtained with respect to the Reimers migration percentage. For hips with a migration rate of 15% or less, a positive correlation was observed between acetabular and epiphyseal angles. ConclusionsIn our population, the measurement between acetabular and epiphyseal inclination represents the highest association with the hip migration percentage." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoRelacionar, en sujetos con parálisis cerebral no deambulantes, el porcentaje de migración de Reimers con medidas radiológicas estandarizadas, incluyendo el ángulo acetábulo-epifisario. MétodoEstudio descriptivo, observacional y transversal de 15 individuos, de edades comprendidas entre 3 y 9 años, con parálisis cerebral, pertenecientes a los niveles IV y V del Gross Motor Function Classification System. Se realizaron medidas radiológicas del índice acetabular, el ángulo epifisario de Hilgenreiner, el ángulo acetábulo-epifisario, el ángulo cérvico-diafisario y el porcentaje de migración de Reimers de cada una de las caderas. ResultadosSe obtuvieron correlaciones entre el índice acetabular, el ángulo epifisario y el ángulo acetábulo-epifisario respecto al porcentaje de migración de Reimers. Para las caderas con un porcentaje de migración igual o menor del 15% se observó correlación positiva entre los ángulos acetabular y epifisario. ConclusionesEn nuestra población, la medida entre la inclinación acetabular y epifisaria es la que mayor asociación presenta con el porcentaje de migración de la cadera." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Alí-Morell OJ, Zurita-Ortega F, Davó-Jiménez I, Segura-Biedma S. Ángulo acetábulo-epifisario y luxación de cadera en la parálisis cerebral: Estudio preliminar. Radiología. 2018;60:217–222." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1175 "Ancho" => 1667 "Tamanyo" => 263011 ] ] "descripcion" => array:1 [ "en" => "Chart of force lines applied on the coxofemoral joint. Direction of the compression exerted from the pelvis to the cephalic trabecular system, or main compression group in the femoral head (A). Direction of the tension exerted from the pelvis to the cervicocephalic trabecular system, or main tension group (B). Perpendicular to the force lines applied on the acetabular roof (A′) and femoral head (B′)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 935 "Ancho" => 1667 "Tamanyo" => 155847 ] ] "descripcion" => array:1 [ "en" => "Radiological measures conducted: acetabular index (IA), Hilgenreiner epiphyseal angle (HEA), acetabular–epiphyseal angle (AEA), cervical–diaphyseal angle (CDA), Hilgenreiner (H) line, Perkins (P) line, uncovered length of the femoral head (A), and total length of the femoral head (B)." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AEA: acetabular–epiphyseal angle; CDA: cervical–diaphyseal angle; HEA: Hilgenreiner epiphyseal angle; AI: acetabular index; MP: Reimers’ hip migration percentage." 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entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">172° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−4° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">178° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">165° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−8° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">175° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">165° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">145° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">166° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">172° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−4° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">154° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">170° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−8° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">158° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−6° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">158° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">145° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">174° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−4° \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.643 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Typical deviation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737443.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Radiological measures for every single hip." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "AEA: acetabular–epiphyseal angle; CDA: cervical–diaphyseal angle; HEA: Hilgenreiner epiphyseal angle; AI: acetabular index; MP: Reimers’ hip migration percentage." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MP \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CDA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HEA \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.581<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CDA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.259 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.240 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.693<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.439<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AEA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.748<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.813<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.307<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.824<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737444.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "p≤0.01 (unilateral)." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "p≤0.05 (unilateral)." ] ] ] "descripcion" => array:1 [ "en" => "Correlation matrix between unilateral variables." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "AEA: acetabular–epiphyseal angle; CDA: cervical–diaphyseal angle; HEA: Hilgenreiner epiphyseal angle; AI: acetabular index; MP: Reimers’ hip migration percentage." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CDA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HEA \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CDA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.162 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.508<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.599<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AEA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.190 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.559<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.749<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737441.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "p≤0.05 (unilateral)." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "p≤0.01 (unilateral)." ] ] ] "descripcion" => array:1 [ "en" => "Correlation matrix between unilateral variables of hips with migration percentages ≤15%." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "AEA: acetabular–epiphyseal angle; CDA: cervical–diaphyseal angle; HEA: Hilgenreiner epiphyseal angle; AI: acetabular index; MP: Reimers’ hip migration percentage." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CDA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HEA \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CDA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.227 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.133 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AEA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0,774<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.731<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737442.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "p≤0.01 (unilateral)." ] ] ] "descripcion" => array:1 [ "en" => "Correlation matrix among the different unilateral variables of hips with migration percentages >15%." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Displasia del desarrollo de la cadera" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. 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Ángulo acetábulo-epifisario y luxación de cadera en la parálisis cerebral: Estudio preliminar

O.J. Alí-Morella,

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fisiopurisima@gmail.com

Corresponding author.

, F. Zurita-Ortegab, I. Davó-Jiméneza, S. Segura-Biedmaa

a Servicio de Fisioterapia, Fundación Purísima Concepción, Granada, Spain

b Área de Corporal, Universidad de Granada, Granada, Spain

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Chart of force lines applied on the coxofemoral joint&#46; Direction of the compression exerted from the pelvis to the cephalic trabecular system&#44; or main compression group in the femoral head &#40;A&#41;&#46; Direction of the tension exerted from the pelvis to the cervicocephalic trabecular system&#44; or main tension group &#40;B&#41;&#46; Perpendicular to the force lines applied on the acetabular roof &#40;A&#8242;&#41; and femoral head &#40;B&#8242;&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">For the coxofemoral joint to develop adequately it is necessary that the femoral head is sitting perfectly centered in the acetabulum&#44; and there is a balanced growth both between the triradiate and acetabular cartilages&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> In this sense&#44; the vertical pressure forces of the spinal column are transmitted through the sacroiliac joints toward the hip bones&#44; and then toward the coxofemoral joints<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> influencing the distribution of the trabecular bone system&#46; This way&#44; the trabecular pattern of the proximal femur corresponds with the lines of mechanical force&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> with a main trabecular pattern containing tensile &#40;cervicocephalic&#44; or Gallois&#8217; and Bosquette&#39;s arched cephalic bundle&#41; and compressive bundles &#40;cephalic fan-shaped bundle&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> Both the morphology and direction of the cephalic and cervicocephalic bundles reveal to us the transfer of tensions toward the hip while shaping and giving inclination to the femoral epiphysis&#46; Similarly&#44; the angle that exists between the head and the neck with respect to the femoral diaphysis allows us to assess the transfer of tensions caudally&#46; Finally&#44; since the trajectory of the force lines occurs through the acetabulum &#40;sacrocotyloid trabeculae&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> the acetabular roof line is also indicative of the direction of mechanical compression at that level&#46; Therefore&#44; since both tensions and compressions define the external and internal structures &#40;trabecular system&#41;&#44; there are measures that can be used to guess the direction of the tensions withstood by the coxofemoral joint &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">When it comes to the inclination of the femoral epiphysis&#44; traditionally the Hilgenreiner epiphyseal angle &#40;HEA&#41; has been considered a good prognostic indicator of the anomalies occurring during the development of the proximal femur&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> When it comes to the angulation of the acetabular roof&#44; the most widely used measure is the acetabular index &#40;AI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">However&#44; although such measures show the inclination of the acetabulum and the epiphysis&#44; separately&#44; the assessment of the angulation between the two&#8212;the acetabular&#8211;epiphyseal angle &#40;AEA&#41; is not standardized&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Lastly&#44; in order to measure the degrees of femoral neck with respect to the diaphysis&#44; the cervical&#8211;diaphyseal angle &#40;CDA&#41; is commonly used&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In individuals with neurological alterations&#44; above all&#44; cerebral palsy&#44; the hip is one of the joints most commonly affected associating coxofemoral alterations in the gross motor function&#44; and a high percentage of non-ambulatory subjects with cerebral palsy &#40;levels IV and V of the Gross Motor Function Classification System &#91;GMFCS&#93;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a>&#41; have luxations and subluxations&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">That is why to be able to quantify the stability of the hip in this population&#44; although the CDA is sometimes used&#44; the radiological measure most widely used is Reimers&#8217; hip migration percentage &#40;MP&#41; that measures the lack of coverage of the femoral head by the acetabulum&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However&#44; although such radiological measures are relevant when monitoring hip alterations&#44; they are not definitive<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> since&#44; in most cases&#44; these alterations progress fast and their etiology is complex&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">For all these reasons&#44; these are the goals of this study&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Correlate the AI&#44; HEA&#44; and CDA with the MP in individuals with cerebral palsy categorized at levels IV and V of the GMFCS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Correlate the MP with a proposed measure &#8211; the AE in the aforementioned population&#46;</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants and design</span><p id="par0055" class="elsevierStylePara elsevierViewall">This is a descriptive&#44; observational&#44; transversal study&#46; The sample was taken from the total of school children from the Pur&#237;sima Concepci&#243;n Center of Special Education in Granada&#44; Spain who used to attend regularly to physical therapy&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The inclusion criteria were a diagnosis of child cerebral palsy&#44; being categorized as level IV or V of the GMFCS&#44; and having one radiological study of bilateral hips in the anteroposterior projection conducted in the decubitus supine position during the last year&#46; The exclusion criteria were having another diagnosis&#44; being categorized in a different GMFCS group of the ones specified in the inclusion criteria&#44; and not having a recent radiological study&#46; This way the sample included 15 individuals&#44; all of them of ages between 3 and 9 years old&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In order to control the possible inter-observer variation&#44; the presence of four professionals was requested who reached the maximum possible consensus in their judgements&#44; which is why both the inter and intra-observer variabilities were below 5&#37;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables</span><p id="par0070" class="elsevierStylePara elsevierViewall">In the study&#44; the independent variables were determined by the AI&#44; HEA&#44; CDA&#44; and AEA&#46; On the other hand&#44; the MP was the dependent variable&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Tools</span><p id="par0075" class="elsevierStylePara elsevierViewall">Different radiological measures were used to quantify the variables &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">The Hilgenreiner &#40;H&#41; line&#58; line that runs from the triradiate cartilage to the contralateral cartilage drawn from the most distal end of the ossified iliac cartilages&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Perkins &#40;P&#41; line&#58; line perpendicular to the H-line in the most lateral segment of the ossified acetabulum&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Hilgenreiner epiphyseal angle &#40;HEA&#41;&#58; angle found between the intersection of Hilgenreiner &#40;H&#41; line and another line running through the femoral physeal plate&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Acetabular index &#40;AI&#41;&#58; it corresponds to the angle made up by the Hilgenreiner line and a line tangent to the acetabulum&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Acetabular&#8211;epiphyseal angle &#40;AEA&#41;&#58; angle made up by the line tangent to the acetabulum &#40;used in the measure of the AI&#41; and the line of the femoral physeal plate &#40;used in the HEA&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Cervical&#8211;diaphyseal angle &#40;CDA&#41;&#58; according to the methodology described by Doherty et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> it is the angle found between the line that connects the center of the femoral head and middle side of the neck to another line drawn between two intermediate segments of the diaphysis underneath the lesser trochanter&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Reimers&#8217; hip migration percentage &#40;MP&#41;&#58; according to Reimers&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> after drawing the H and P-lines&#44; the length of the femoral head that stays outside P-line &#40;<span class="elsevierStyleItalic">A</span>&#41; is measured&#46; The uncovered length of the femoral head &#40;<span class="elsevierStyleItalic">A</span>&#41; is divided by the total length of the femoral head &#40;<span class="elsevierStyleItalic">B</span>&#41; and then multiplied by 100&#58; MP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">A</span>&#47;<span class="elsevierStyleItalic">B</span><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#46;</p></li></ul></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Lastly&#44; in order to group the hip radiological findings based on the MP&#44; Robin et al&#46;&#8217;s classification was used&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> and two &#40;2&#41; different groups were established&#58; normal or close to normal hips &#40;MP<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>15&#37;&#41;&#44; and altered hips &#40;displasic&#44; subluxated&#44; or luxated&#59; MP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15&#37;&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Procedure</span><p id="par0120" class="elsevierStylePara elsevierViewall">The study was conducted following the protocols established by our center after obtaining prior written informed consent from the legal representatives of the boys&#47;girls&#44; and approval by the hospital ethics committee&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">The statistical analysis was conducted using the SPSS 20&#46;0 software for Windows&#46; The techniques used for the analysis were&#44; in the first place&#44; descriptive by determining the frequencies and percentages&#46; In order to check whether this or that correlation was actually there&#44; Pearson&#39;s correlation coefficient was used&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">The sample included 15 individuals &#40;30 hips&#41;&#44; all of them between 3 and 9 years of age &#40;average&#58; 5&#46;6&#59; typical deviation&#58; 2&#46;57&#41;&#46; The sex distribution was 53&#46;3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#59; 16 hips&#41; boys&#44; and 46&#46;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#59; 14 hips&#41; girls&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The data obtained are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">The correlations between the different unilateral variables are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Positive correlations were confirmed between the AI and the MP &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;581&#41;&#44; and also between the AEA and the variables IA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;748&#41; and CDA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;307&#41;&#46; The strongest association with the MP occurs with the AEA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;813&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Negative correlations were confirmed between the HEA&#44; on the one hand&#44; and the CDA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;439&#41;&#44; AEA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;824&#41;&#44; and MP &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;693&#41; on the other hand&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">With respect to the group with normal or close to normal hips &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; all possible positive correlations between the HEA and the AI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;508&#41;&#44; and between the entre el AEA and the CDA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;559&#41; were confirmed&#46; On the contrary&#44; there is a negative correlation between the HEA and the CDA&#44; on the one hand &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;599&#41;&#44; and between the HEA and the AEA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;749&#41; on the other hand&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">When it comes to displasic&#44; subluxated and luxated hips &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#44; all correlations happen with the AEA &#8211; the positive ones relative to the AI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;774&#41;&#44; and the negative ones relative to the HEA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;731&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0160" class="elsevierStylePara elsevierViewall">In light of the results obtained in our population&#44; there is an association between the CDA and the HEA&#46; Thus&#44; as the CDA grows bigger&#44; the HEA grows smaller&#44; and vice versa&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Based on these results&#44; the formations of the CDA and the femoral epiphysis would be somehow related&#44; which is consistent with what has already been reported in studies conducted in populations with hip alterations due to skeletal disorders&#44; where the inclination of the femoral epiphysis is associated with the development of the CDA&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">On the other hand&#44; when it comes to the AEA&#44; our data associate it with the AI and the HE&#44; since&#44; precisely&#44; it is a measure that establishes a connection between the two and expresses the angle that exists between the acetabular roof &#40;measured in the AI&#41;&#44; and the femoral epiphysis &#40;measured in the HEA&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Similarly&#44; and also based on our results&#44; we can confirm the association between the MP and the directionality measures of the acetabulum and the epiphysis&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Thus&#44; there would be a correlation between an increased acetabular angle and the migration of the femoral head&#44; which is consistent with Terjesen&#39;s studies<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> that establish clear associations between the AI and the instability of the hip&#44; especially for AI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>27&#176;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">As Herring<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> describes it&#44; this process may be related with a change of direction in the pressures exerted on the femoral head from the acetabulum&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">The data also show a correlation between a reduced HEA and less joint stability&#46; The horizontalization of the femoral head would facilitate the luxation of the hip following the opinion of some authors who say that the alterations in the femoral head sphericity and orientation are determining factors in the development of hip dysplasia&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Finally&#44; in our population&#44; when the hip looks normal or is close to normal&#44; there is a correlation between the acetabular angle and the HEA in such a way that an increase of the former leads to an increase of the latter&#44; and vice versa&#46; Such relation is not observed in the complete group&#44; or the altered hips &#40;displasic&#44; subluxated&#44; or luxated&#41;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In the subjects of this study&#44; the right orientation of the pressures exerted on the acetabulum and the proximal femoral epiphysis&#44; separately&#44; is associated with joint stability&#44; meaning that the angular correlation between the two can be an important piece of information for the prognosis of hip alterations in individuals with cerebral palsy&#46; In this sense&#44; some authors say that the development of the hip depends on the interaction between the acetabulum and the femoral head&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Consistent with all this&#44; although we have been able to confirm the correlations between the AI and the HEA with the MP&#44; the strongest association of all occurs with the measure that describes the relation between the two&#44; that is&#44; the AEA&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">This way&#44; the bigger the angulation between the acetabulum and the femoral epiphysis&#44; the bigger the MP&#46; Also&#44; with acetabular roof inclinations parallel or close to those of the epiphysis&#44; smaller MPs&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Thus&#44; it seems that joint stability is somehow based on this correlation between the development of the acetabulum and the epiphysis and&#44; therefore&#44; the inclination between the two&#44; being the AEA a possible indicator of such development and stability&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">These are some of the conclusions we can draw&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0225" class="elsevierStylePara elsevierViewall">In this study&#44; the development of the CDA is associated with the development of the femoral epiphysis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0230" class="elsevierStylePara elsevierViewall">The MP would be associated&#44; on the one hand&#44; with the acetabular inclination and&#44; on the other hand&#44; with the epiphyseal inclination&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0235" class="elsevierStylePara elsevierViewall">In our population&#44; the measure proposed of angulation between the acetabular and the epiphyseal inclinations is the measure that has the strongest association with the MP&#46;</p></li></ul></p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Limitations&#44; future perspectives&#44; and observations</span><p id="par0240" class="elsevierStylePara elsevierViewall">Basically&#44; the limitations of this study come from the number of participants&#44; and the conclusions drawn cannot be extrapolated or generalized to other groups of patients&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Authors</span><p id="par0245" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">1&#46;</span><p id="par0250" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study&#58; OJAM&#44; FZO&#44; IDJ and SSB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">2&#46;</span><p id="par0255" class="elsevierStylePara elsevierViewall">Study idea&#58; OJAM&#44; IDJ&#44; SSB and FZO&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">3&#46;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Study design&#58; FZO&#44; OJAM&#44; SSB and IDJ&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">4&#46;</span><p id="par0265" class="elsevierStylePara elsevierViewall">Data mining&#58; OJAM&#44; IDJ&#44; SSB and FZO&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">5&#46;</span><p id="par0270" class="elsevierStylePara elsevierViewall">Data analysis and interpretation&#58; FZO&#44; OJAM&#44; IDJ and SSB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">6&#46;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Statistical analyses&#58;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">7&#46;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Reference&#58; IDJ&#44; SSB&#44; OJAM and FZO&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">8&#46;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Writing&#58; OJAM&#44; FZO&#44; IDJ and SSB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">9&#46;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks&#58; OJAM&#44; FZO&#44; IDJ and SSB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">10&#46;</span><p id="par0295" class="elsevierStylePara elsevierViewall">Approval of final version&#58; OJAM&#44; FZO&#44; IDJ and SSB&#46;</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interests</span><p id="par0300" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests associated with this article whatsoever&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Material and methods"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-10-24"
    "fechaAceptado" => "2018-02-01"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec980507"
          "palabras" => array:3 [
            0 => "Cerebral palsy"
            1 => "Hip dislocation"
            2 => "Radiography"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec980506"
          "palabras" => array:3 [
            0 => "Par&#225;lisis cerebral"
            1 => "Luxaci&#243;n de cadera"
            2 => "Radiograf&#237;a"
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      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To relate&#44; in non-ambulatory subjects with palsy&#44; Reimers&#8217; migration percentage with standardized radiological measurements&#44; including the acetabular&#8211;epiphyseal angle&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descriptive&#44; observational and transversal study of 15 individuals with cerebral palsy at levels IV and V of the Gross Motor Function Classification System&#44; aged between 3 and 9 years&#46; Radiological measurements of the acetabular index&#44; Hilgenreiner&#39;s epiphyseal angle&#44; acetabular&#8211;epiphyseal angle&#44; neck-shaft angle and Reimers&#8217; migration percentage of each of the hips were performed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Correlations between acetabular index&#44; epiphyseal angle and acetabular&#8211;epiphyseal angle were obtained with respect to the Reimers migration percentage&#46; For hips with a migration rate of 15&#37; or less&#44; a positive correlation was observed between acetabular and epiphyseal angles&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our population&#44; the measurement between acetabular and epiphyseal inclination represents the highest association with the hip migration percentage&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
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            "titulo" => "Method"
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          2 => array:2 [
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            "titulo" => "Results"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Relacionar&#44; en sujetos con par&#225;lisis cerebral no deambulantes&#44; el porcentaje de migraci&#243;n de Reimers con medidas radiol&#243;gicas estandarizadas&#44; incluyendo el &#225;ngulo acet&#225;bulo-epifisario&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo&#44; observacional y transversal de 15 individuos&#44; de edades comprendidas entre 3 y 9 a&#241;os&#44; con par&#225;lisis cerebral&#44; pertenecientes a los niveles IV y V del <span class="elsevierStyleItalic">Gross Motor Function Classification System</span>&#46; Se realizaron medidas radiol&#243;gicas del &#237;ndice acetabular&#44; el &#225;ngulo epifisario de Hilgenreiner&#44; el &#225;ngulo acet&#225;bulo-epifisario&#44; el &#225;ngulo c&#233;rvico-diafisario y el porcentaje de migraci&#243;n de Reimers de cada una de las caderas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se obtuvieron correlaciones entre el &#237;ndice acetabular&#44; el &#225;ngulo epifisario y el &#225;ngulo acet&#225;bulo-epifisario respecto al porcentaje de migraci&#243;n de Reimers&#46; Para las caderas con un porcentaje de migraci&#243;n igual o menor del 15&#37; se observ&#243; correlaci&#243;n positiva entre los &#225;ngulos acetabular y epifisario&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En nuestra poblaci&#243;n&#44; la medida entre la inclinaci&#243;n acetabular y epifisaria es la que mayor asociaci&#243;n presenta con el porcentaje de migraci&#243;n de la cadera&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as&#58; Al&#237;-Morell OJ&#44; Zurita-Ortega F&#44; Dav&#243;-Jim&#233;nez I&#44; Segura-Biedma S&#46; &#193;ngulo acet&#225;bulo-epifisario y luxaci&#243;n de cadera en la par&#225;lisis cerebral&#58; Estudio preliminar&#46; Radiolog&#237;a&#46; 2018&#59;60&#58;217&#8211;222&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Chart of force lines applied on the coxofemoral joint&#46; Direction of the compression exerted from the pelvis to the cephalic trabecular system&#44; or main compression group in the femoral head &#40;A&#41;&#46; Direction of the tension exerted from the pelvis to the cervicocephalic trabecular system&#44; or main tension group &#40;B&#41;&#46; Perpendicular to the force lines applied on the acetabular roof &#40;A&#8242;&#41; and femoral head &#40;B&#8242;&#41;&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Radiological measures conducted&#58; acetabular index &#40;IA&#41;&#44; Hilgenreiner epiphyseal angle &#40;HEA&#41;&#44; acetabular&#8211;epiphyseal angle &#40;AEA&#41;&#44; cervical&#8211;diaphyseal angle &#40;CDA&#41;&#44; Hilgenreiner &#40;H&#41; line&#44; Perkins &#40;P&#41; line&#44; uncovered length of the femoral head &#40;A&#41;&#44; and total length of the femoral head &#40;B&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AEA&#58; acetabular&#8211;epiphyseal angle&#59; CDA&#58; cervical&#8211;diaphyseal angle&#59; HEA&#58; Hilgenreiner epiphyseal angle&#59; AI&#58; acetabular index&#59; MP&#58; Reimers&#8217; hip migration percentage&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">145&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">174&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">142&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;4&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;643&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Typical deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Radiological measures for every single hip&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">AEA&#58; acetabular&#8211;epiphyseal angle&#59; CDA&#58; cervical&#8211;diaphyseal angle&#59; HEA&#58; Hilgenreiner epiphyseal angle&#59; AI&#58; acetabular index&#59; MP&#58; Reimers&#8217; hip migration percentage&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CDA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HEA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;581<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CDA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;259&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;693<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;439<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AEA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;748<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;813<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;307<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;824<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlation matrix between unilateral variables&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CDA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HEA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CDA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;508<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;599<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AEA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;190&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;559<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
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              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HEA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;731<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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Article information

ISSN: 21735107
Original language: English

DOI:10.1016/j.rxeng.2018.03.005

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