摘要
目的研究骨盆截骨治疗发育性髋关节发育不良(developmental dysplasia of the hip,DDH)闭合复位术后残余畸形的疗效及影响因素。方法回顾性分析广州市妇女儿童医疗中心、重庆医科大学附属儿童医院、佛山市中医院、厦门大学附属福州市第二医院2006年1月至2015年7月采用闭合复位治疗后残余畸形并接受骨盆截骨矫形的81例(85髋)DDH患儿资料,其中男6例,女75例,年龄(17.0±4.7)个月。在骨盆正位X线上评估Tönnis分度、髋臼指数(acetabular index,AI)、中心边缘角(center edge angle,CEA)、Reimer指数(Reimer's index,RI)、股骨缺血性坏死(avascular necrosis of the femoral head,AVN)。末次随访时根据Severin评级分为满意组(SeverinⅠ/Ⅱ)和不满意组(SeverinⅢ/Ⅳ)。采用t检验、χ^(2)检验、logistic回归分析研究骨盆截骨治疗DDH闭合复位术后残余畸形的疗效及其影响因素。结果末次随访时,根据Severin分级,Ⅰ级57髋(67.0%),Ⅱ级22髋(25.9%),Ⅲ级5髋(5.9%),Ⅳ级1(1.2%)。结局满意组有79髋(92.9%),不满意组有6髋(7.1%)。满意组骨盆截骨前的RI(31.1±12.6)%显著低于不满意组(49.1±8.9)%,P=0.001。总AVN发生率为25.9%(22/85),无AVN的患儿末次随访时100%(63髋)获得满意的影像学结果,有AVN的患儿72.7%(16/22)获得满意的影像学结果(P<0.001)。结局满意组和不满意组的复位年龄、性别、侧别、Tönnis分度、复位前AI、骨盆截骨时间、截骨前AI和CEA差异均无统计学意义(均P>0.05)。logistic回归分析显示,AVN和骨盆截骨前的RI是结局不满意的风险因素。骨盆截骨前RI<33%的47髋100%获得满意的结局。骨盆截骨前RI>33%的38髋中,接受切开复位患儿(9髋)末次随访时的满意率(7髋,77.8%)与没有接受切开复位的患儿(29髋)的满意率(25髋,86.2%)差异无统计学意义(P=0.613);接受股骨截骨的患儿(25髋)末次随访时的满意率(19髋,76%)与没有接受股骨截骨的患儿(13髋)的满意率(100%)差异无统�
Objective To explore the outcomes and influencing factors of pelvic osteotomy(PO)for residual acetabular dysplasia after closed reduction in children with developmental dysplasia of the hip(DDH).Methods The relevant clinical data were retrospectively reviewed for 81 DDH children undergoing PO for residual deformity after closed reduction from January 2006 to July 2015 at four centers.There were 6 boys and 75 girls with a total of 85 hips and an age range of(17.0±4.7)months.Tönnis grade,acetabular index(AI),center edge angle(CEA),Reimer's index(RI)and avascular necrosis of femoral head(AVN)were assessed on anteroposterior pelvic films.They were assigned into two groups of satisfactory(SeverinⅠ/Ⅱ)and unsatisfactory(SeverinⅢ/Ⅳ)according to Severin grade at the final follow-up.T test,chi-square test and Logistic regression analysis were performed for examining the outcomes and its influencing factors of PO for residual deformity after closed reduction of DDH.Results At the final follow-up,according to the Severin classification scheme,57 hips(67.0%)were in gradeⅠ,22 hips(25.9%)gradeⅡ,5 hips(5.9%)gradeⅢand 1(1.2%)gradeⅣ.The outcome was satisfactory in 79 hips(92.9%)and unsatisfactory in 6 hips(7.1%).RI pre-PO was significantly lower in satisfactory group(31.1%±12.6%)than that in unsatisfactory group(49.1%±8.9%)(P=0.001).The overall incidence of AVN was 25.9%,all children without AVN had satisfactory outcomes at the final follow-up and 72.7%of AVN patients had satisfactory outcomes(P<0.001).No significant inter-group differences existed in reduction age,gender,sideness,Tönnis grade,AI pre-reduction,time of PO or AI/CEA pre-osteotomy(P>0.05).Logistic regression analysis revealed that AVN/RI pre-PO was risk factor for unsatisfactory outcomes.Satisfactory outcomes were obtained in 47 hips with RI<33%pre-PO.Among 38 hips with RI>33%pre-PO,satisfaction rate at the final follow-up(77.8%)in patients with open reduction(9 hips,23.7%)was not statistically different from that(86.2%)in those without open redu
作者
黎艺强
刘行
郭跃明
陈顺有
刘雁寒
吴剑平
李敬春
袁哲
周庆和
刘远忠
陈伟东
徐宏文
中国儿童骨科多中心研究协作组
Li Yiqiang;Liu Hang;Guo Yueming;Chen Shunyou;Liu Yanhan;Wu jianping;Li Jingchun;Yuan Zhe;Zhou Qinghe;Liu Yuanzhong;Chen Weidong;Xu Hongwen;Chinese Multicenter Pediatric Orthopaedic Study Group(CMPOS)(Department of Pediatric Orthopedics,Municipal Women&Children's Medical Center,Guangzhou 510623,China;Department of Pediatric Orthopedics,Affiliated Children's Hospital,Chongqing Medical University,Chongqing 401122,China;Department of Pediatric Orthopedics,Municipal Hospital of TCM,Foshan 528000,China;Department of Pediatric Orthopedics,Second Municipal Hospital,Fuzhou 350007,China;不详)
出处
《中华小儿外科杂志》
CSCD
北大核心
2023年第9期828-833,共6页
Chinese Journal of Pediatric Surgery
基金
广州市妇女儿童医疗中心/儿科研究所临床研究基金(GWCMC2020-6-005)。
关键词
髋脱位
发育性髋关节发育不良
闭合复位术
截骨术
疗效
Hip dislocation
Developmental dislocation of the hip
Closed reduction
Osteotomy
Efficacy
