Huang Yiyong,Fu Kai,Hong Cong,et al.Value of combining osteopontin and leptin with clinical features in predicting femoral head necrosis after closed reduction of developmental dislocation of the hip[J].Journal of Clinical Pediatric Surgery,,():210-215.[doi:10.3760/cma.j.cn101785-202210020-002]
Value of combining osteopontin and leptin with clinical features in predicting femoral head necrosis after closed reduction of developmental dislocation of the hip
- Keywords:
- Ossified Nucleus of Femoral Head; Developmental Dysplasia of The Hip; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the value of osteopontin (OPN) and leptin plus clinical features in predicting avascular necrosis (AVN) of femoral head in children with developmental hip dislocation (DHD) after closed reduction.Methods From January 2018 to January 2021,the relevant clinical data were retrospectively reviewed for 130 hospitalized DHD children undergoing closed reduction under general anesthesia.They were assigned into two groups of AVN and non-AVN.Basic demographics were collected,including gender,age,side of affected hip,degree of dislocation,adductor muscle release,presence/absence of ossification nucleus,vascular classification,number of blood vessels,femoral head perfusion change and preoperative acetabular index.Height,anterioposterior (AP) and left/right diameters of femoral head were measured.The influencing factors of AVN were examined by unconditional Logistic stepwise regression.Receiver operating characteristic (ROC) curve was utilized for examining the values of femoral head diameter,AP diameter and serum OPN/leptin in predicting AVN.Results The proportion of patients with vascular type I in AVN group and without AVN group was 14 (26.92%) and 6 (7.69%), respectively. The proportion of B patients with femoral head perfusion changes was 28 (53.85%) and 28 (35.90%), respectively. The proportion of type C changes in femoral head perfusion was 13 cases (25.00%) and 4 cases (5.13%), respectively. The diameter of femoral head was (1.65±0.26) cm in AVN group and (1.88±0.25) cm without AVN group, respectively. The anteroposterior diameter of femoral head was (1.74±0.32) cm and (1.95±0.29) cm, respectively. OPN was (11.36±3.72) μg/L and (6.52±2.17) μg/L, respectively. Leptin levels were (44.29±8.35) μg/L and (28.52±6.37) μg/L, respectively.Logistic regression analysis indicated that vascular classification type Ⅰ,femoral head perfusion change class B/C,left/right diameter of femoral head ≤1.782 cm,AP diameter of femoral head ≤1.856 cm,OPN ≥8.049 μg/L and leptin ≥38.075 μg/L were risk factors for AVN (P<0.05).ROC analysis revealed that area under the curve for predicting AVN was 0.851 (95%CI:0.788-0.914),0.787 (95%CI:0.711-0.863) and 0.978 (95%CI:0.711-0.863).0.959-0.997),0.926(95%CI:0.884-0.967) with a sensitivity of 0.788,0.673,0.885,0.788 and a specificity of 0.769,0.692,0.833,0.795 respectively.Conclusions AVN may be correlated with immature vascular development and poor perfusion of femoral head after closed reduction in DHD children.Left/right and AP diameters of femoral head are measured clinically.And serum level of OPN/leptin may be quantified to provide references for predicting AVN.
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Memo
收稿日期:2022-10-13。
基金项目:海南省临床医学中心建设项目资助(琼卫医函〔2021〕75号);海南自然科学基金面上项目(20168326)
通讯作者:黄乙勇,Email:hh52136@163.com