摘要
目的探讨不同年龄组发育性髋关节发育不良(DDH)患儿接受闭合复位术(CR)的临床疗效,并分析和确定该手术的时机选择和影响治疗结局的临床因素。方法回顾性分析2016年1月至2018年6月诊断的108例DDH患儿的临床资料。根据初始治疗年龄分为3组:第一组(≤12个月)、第二组(13~17个月)及第三组(≥18个月)。观察医源性大腿骨缺血性坏死症(AVN)、再脱位、残余髋臼发育不良(RAD)和进一步手术概率。通过单因素Logistic回归模型分析影响上述治疗结局的风险因素,并用受试者操作特征(ROC)曲线评价月龄、术前髋臼指数(AI)和术后AI值对CR治疗失败的预测价值。结果共有108例DDH患儿(156髋)接受CR手术,初次手术时平均月龄为(13.0±5.4)个月(4~28个月)。平均随访时间为(6.7±0.8)年(3~5.5年)。AVN、RAD和再脱位的发生率分别为14.7%(23/156)、15.4%(24/156)和15.4%(24/156),其主要危险因素分别为术前IHDI分级IV级、年龄≥18个月、术前IHDI分级IV级(P<0.05)。月龄、术前AI值和术后AI值预测CR治疗失败的曲线下面积分别为0.682(95%CI:0.577~0.806)、0.718(95%CI:0.593~0.873)、0.874(95%CI:0.764~0.984)。结论DDH患儿CR术治疗结局与月龄、术前IHDI分级有关,18个月以上的患儿进行CR手术可能会增加术后RAD和进一步矫正手术的概率。
Objective To investigate the evaluate the clinical effect of closed reduction(CR)for developmental dysplasia of the hip(DDH)among different age groups,and to analyze the treatment time and identify risk factors for the failure of this procedure.Methods The data of 108 children(156 hips)with DDH who received CR treatment in our hospital from January 2016 to June 2018 were retrospectively reviewed,including Group 1(≤12 months),Group 2(13-17 months),Group 3(≥18 months)according to the initial treatment months.The presence of iatrogenic avascular necrosis(AVN),residual acetabular dysplasia(RAD),re-dislocation,and further surgeries were observed.The risk factors were identified for those outcomes aforementioned using univariable Logistic regression models.Receiver operating characteristics(ROC)curve was used to identify the prediction of months,pre-op acetabular index(AI)and post-op AI for CR failure.Results A total of 108 DDH children(156 hips)undergoing CR procedure were evaluated with a median age at initial reduction of(13.0±5.4)months(range from 4 to 28 months).Mean follow-up time in this study was(6.7±0.8)years(Range from 3 to 5.5 years).The incidence of AVN,RAD and re-dislocation was 14.7%(23/156),15.4%(24/156),15.4%(24/156),whose significant risk factors were respectively pre-op IHDI IV,age,pre-op IHDI IV(P<0.05).The areas under the ROC curve of age,pre-op AI and post-op AI for predicting CR failure were 0.682(95%CI:0.577-0.806),0.718(95%CI:0.593-0.873),0.874(95%CI:0.764-0.984).Conclusion The outcome of CR in DDH children is related to age and pre-op IHDI grade.For DDH children over 18 months,CR may increase the rate of RAD and further surgeries.
作者
周晓康
冯彦华
毛振
ZHOU Xiaokang;FENG Yanhua;MAO Zhen(Department of Traumatology,Hebei Children's Hospital,Shijiazhuang,Hebei 050031,China;Department of Orthopedics,Hebei Children's Hospital,Shijiazhuang,Hebei 050031,China)
出处
《中国优生与遗传杂志》
2022年第1期80-84,共5页
Chinese Journal of Birth Health & Heredity
基金
河北省医学科学研究课题计划(20190791)。
