Liu Yuanzhong,Li Yiqiang,Xun Fuxing,et al.Risk factors for unsatisfactory postoperative hip function in children with developmental dysplasia of the hip after open reduction[J].Journal of Clinical Pediatric Surgery,,19():579-585.[doi:10.3969/j.issn.1671-6353.2020.07.004]
Risk factors for unsatisfactory postoperative hip function in children with developmental dysplasia of the hip after open reduction
- Keywords:
- Hip Dislocation/SU; Hip Joint/RH; Patient Satisfaction
- CLC:
- R726.8;R681.6
- Abstract:
- Objective To explore the risk factors of unsatisfactory postoperative hip function after open reduction for developmental dysplasia of the hip (DDH).Methods From 2008 to 2015,a retrospective review was performed for clinical and radiographic data of 63 hospitalized children after open reduction.There were 76 hips with a mean age of (48.8±26.3) months.Pre-operative acetabular index (AI),T?nnis grade,final AI,center edge angle (CEA),avascular necrosis of femoral epiphysis (AVN) and Severin grade were evaluated by radiographic measurements.Unsatisfactory hip function was determined according to functional evaluation.Chi-square test,t-test and logistic regression were employed for analyzing the correlation of rate of unsatisfactory hip function with age,gender,sideness,T?nnis grade,treatment method (pelvic/femoral osteotomy) and AVN.Results During the final follow-up,22 hips (28.9%) were diagnosed as having unsatisfactory hip function.The age was significantly higher in children with unsatisfactory hip function than that without (53.9±23.0 vs.42.4±23.9 months,P=0.036).The incidence of unsatisfactory hip function undergoing open reduction alone (0%) was significant lower than that of open reduction plus Salter/Pemberton (34.8%) or triple pelvic osteotomy (35.3%) (P=0.039).Femoral osteotomy also boosted the incidence of unsatisfactory hip function (38.5% vs.8.3%) (P=0.013).AVN occurred in 18 hips (23.7%).The rate of unsatisfactory hip function in children with AVN was significantly higher than those without AVN (64.7% vs.19.3%,P=0.001).There was no correlation of rate of unsatisfactory hip function with preoperative AI,gender,sideness or T?nnis grade.Conclusion Pelvic osteotomy,femoral osteotomy and AVN are independent risk factors of unsatisfactory hip function in children after open reduction for late-detected DDH.
References:
1 徐宏文.儿童发育性髋关节发育不良的治疗:闭合复位还是开放复位?[J].临床小儿外科杂志,2018,17(10):721-725.DOI:10.3969/j.issn.1671-6353.2018.10.001. Xu HW.Management of pediatric DDH:closed versus open reduction?[J].J Clin Ped Sur,2018,17(10):721-725.DOI:10.3969/j.issn.1671-6353.2018.10.001.
2 梅海波,王军.儿童发育性髋关节发育不良的外科治疗原则[J].中华小儿外科杂志,2017,38(7):481-484.DOI:10.3760/cma.j.issn.0253-3006.2017.07.001. Mei HB,Wang J.Principle of surgical treatment of developmental dysplasia of the hip in children[J].Chin J Pediatr Surg,2017,38(7):481-484.DOI:10.3760/cma.j.issn.0253-3006.2017.07.001.
3 刘莹,王恩波,史立伟,等.全麻下手法关节授动治疗髋关节僵硬患儿193例[J].中国组织工程研究与临床康复,2009,13(20):3997-4000.DOI:10.3969/j.issn.1673-8225.2009.20.041. Liu Y,Wang EB,Shi LW,et al.Passive manipulation under general anesthesia for treating postoperative hip stiffness in 193 children[J].Journal Of Clinical Rehabilitative Tissue Engineering Research,2009,13(20):3997-4000.DOI:10.3969/j.issn.1673-8225.2009.20.041.
4 Salter RB.Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip[J].J Bone Joint Surg,1961,43B:518.
5 Pemberton PA.Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip[J].J Bone Joint Surg Am,1965,47:65-86.
6 Li Y,Xu H,Slongo T,et al.Bernese-type triple pelvic osteotomy through a single incision in children over five years:a retrospective study of twenty eight cases[J].Int Orthop,2018,42(12):2961-2968.DOI:10.1007/s00264-018-3946-3.
7 Kumar SJ. Congenital Dysplasia and Dislocation of the Hip in Children and Adults[J]. Clinical Radiology,1987,39(3):277.DOI:10.1016/S0009-9260(88)80531-2.
8 Kalamchi A,MacEwen GD.Avascular necrosis following tre-atment of congenital dislocation of the hip[J].J Bone Joint Surg Am,1980,62(6):876-888.
9 Gage JR,Winter RB.Avascular necrosis of the capital femoral epiphysis as a complication of closed reduction of congenital dislocation of the hip.A critical review of twenty years’ experience at Gillette Children’s Hospital[J].J Bone Joint Surg Am,1972,54(2):373-388.
10 Severin E.Contribution to the knowledge of congenital dislocation of the hip joint:late results of closed reduction and arthrographic studies of recent cases[J].Acta Chir Scand,1941,118(7):565-566.DOI:10.1001/jama.1942.02830070071035.
11 周永德,吉士俊.先天性髋脱位疗效评定标准及说明[J].中华骨科杂志,1994,14(1):55. Zhou YD,Ji SJ.Outcome evaluation criteria and instructions for congenital dislocation of the hip[J].Chin J Orthop,1994,14(1):55.
12 李海冰,叶文松,徐璐杰,等.分期Salter骨盆截骨术治疗儿童双侧发育性髋关节脱位的疗效分析[J].中华小儿外科杂志,2018,39(3):190-195.DOI:10.3760/cma.j.issn.0253-3006.2018.03.006. Li HB,Ye WS,Xu LJ,et al.Outcomes of bilateral developmental dysplasia of the hip after a two-stage procedure of open reduction and Salter osteotomy[J].Chin J Pediatr Surg,2018,39(3):190-195.DOI:10.3760/cma.j.issn.0253-3006.2018.03.006.
13 Ning B,Yuan Y,Yao J,et al.Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip:864 hips followed for 3.2 to 8.9 years[J].BMC Musculoskelet Disord,2014,15(1):401.DOI:10.1186/1471-2474-15-401.
14 Barrett WP,Staheli LT,Chew DE.The effectiveness of the Salter innominate osteotomy in the treatment of congenital dislocation of the hip[J].J Bone Joint Surg,1986,68(1):79-87.DOI:10.1590/S0034-8910.2014048004923.
15 刘帅,张敏刚,李天友,等.Dega截骨术治疗学龄前儿童发育性髋关节脱位的疗效分析[J].中华小儿外科杂志,2018,39(3):183-189.DOI:10.3760/cma.j.issn.0253-3006.2018.03.005. Liu S,Zhang MG,Li TY,et al.Outcomes of Dega osteotomy for developmental dislocation of hip in pre-school children[J].Chin J Pediatr Surg,2018,39(3):183-189.DOI:10.3760/cma.j.issn.0253-3006.2018.03.005.
16 Eamsobhana P,Kamwong Saisamorn,Sisuchinthara T,et al.The factor causing poor results in late developmental dysplasia of the hip (DDH)[J].J Med Assoc Thai,2015,8:S32-37.
17 Chen Q,Deng Y,Fang B.Outcome of one-stage surgical treatment of developmental dysplasia of the hip in children from 1.5 to 6 years old.A retrospective study[J].Acta Orthop Belg,2015,81(3):375-383.
18 刘昆,梅海波,伍江雁,等.学龄儿童发育性髋关节脱位术后关节僵硬的前瞻性研究[J].临床小儿外科杂志,2009,8(3):8-10.DOI:10.3969/j.issn.1671-6353.2009.03.003. Liu K,Mei HB,Wu JY,et al.Prospective study of preventing postoperative stiffness of the hip in school-age children with developmental dislocation of the hip[J].J Clin Ped Sur,2009,8(3):8-10.DOI:10.3969/j.issn.1671-6353.2009.03.003.
19 肖洪勋,侯宗秀.手法松解治疗小儿先天性髋关节脱位术后关节僵硬[J].中医正骨,2002,14(4):41.DOI:10.3969/j.issn.1001-6015.2002.04.027. Xiao HX,Hou ZX.Manipulation for postoperative joint stiffness in congenital dislocation of the hip[J].Journal of Traditional Chinese Orthopedics and Traumatology,2002,14(4):41.DOI:10.3969/j.issn.1001-6015.2002.04.027.
20 Baranowski A,Schlemmer L,F?rster K,et al.A novel rat model of stable posttraumatic joint stiffness of the knee[J].J Orthop Surg Res,2018,13(1):185.DOI:10.1186/s13018-018-0894-y.
21 Kaneguchi A,Ozawa J,Kawamata S,et al.Development of arthrogenic joint contracture as a result of pathological changes in remobilized rat knees[J].J Orthop Res,2017,35(7):1414-1423.DOI:10.1002/jor.23419.
22 Kalson NS,Brock TM,Mangino M,et al.Reduced telomere length is associated with fibrotic joint disease suggesting that impaired telomere repair contributes to joint fibrosis[J].PLoS One,2018,13(1):e0190120.DOI:10.1371/journal.pone.0190120.
23 Romero-Mu?oz LM,Barriga-Martín A,DeJuan-García J.Surgical treatment of hip ankylosis due to heterotopic ossification secondary to spinal cord injury[J].Rev Esp Cir Ortop Traumatol,2018,62(6):458-466.DOI:10.1016/j.recot.2018.01.003.
24 Klein C,Fontanarosa A,Khouri N,et al.Anterior and lateral overcoverage after triple pelvic osteotomy in childhood for developmental dislocation of the hip with acetabular dysplasia:Frequency,features,and medium-term clinical impact[J].Orthop Traumatol Surg Res,2018,104(3):383-387.DOI:10.1016/j.otsr.2017.12.020.
25 Guerado E,Caso E.The physiopathology of avascular necrosis of the femoral head:an update[J].Injury,2016,47(6):S16-S26.DOI:10.1016/S0020-1383(16)30835-X.
26 张晶,李春文,张超.小儿发育性髋关节脱位术后的康复训练探讨[J].中国伤残医学,2017,25(20):99-100.DOI:10.13214/j.cnki.cjotadm.2017.20.062. Zhang J,Li CW,Zhang C.Postoperative nursing interventions for joint movement function of children with developmental dislocation of the hip (DDH)[J].Chinese Journal of Trauma and Disability Medicine,2017,25(20):99-100.DOI:10.13214/j.cnki.cjotadm.2017.20.062.
27 李星慧,孙群英,张会.儿童先天性髋关节脱位63例康复治疗措施及效果评价[J].中国医药指南,2015,13(11):30-31. Li XH,Sun QY,Zhang H.Evaluations of rehabilitation measures and outcomes of 63 cases of children with congenital dislocation of the hip[J].Guide of China Medicine,2015,13(11):30-31.
Memo
收稿日期:2020-01-04。
基金项目:广东省卫生和计划生育委员会医学科学基金（编号：A2015487）
通讯作者:徐宏文,Email:xuhongwen@gwcmc.org