Pei Yinzhi,Huang Peng,Wu Chunxing,et al.Application of MRI-Bony teardrop and sourcil line in predicting residual acetabular dysplasia after closed reduction of developmental dysplasia of the hip[J].Journal of Clinical Pediatric Surgery,,():940-945.[doi:10.3760/cma.j.cn101785-202403002-008]
Application of MRI-Bony teardrop and sourcil line in predicting residual acetabular dysplasia after closed reduction of developmental dysplasia of the hip
- Keywords:
- Developmental Hip Dysplasia; Residual Acetabular Dysplasia; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the feasibility of using magnetic resonance imaging (MRI) to measure the teardrop and sourcil line (TSL) for predicting the occurrence of residual acetabular dysplasia (RAD) after closed reduction (CR) in children with developmental dysplasia of the hip (DDH). Methods This study measured and recorded the continuity of the bony TSL and the maximum acetabular distance (AD) on MRI in 54 children, totaling 68 hips (40 unilateral cases and 14 bilateral cases) clinically diagnosed with DHH and who underwent CR.X-ray images were used to observe and record the acetabular index (AI) at the time of CR, as well as the International Hip Dysplasia Institute (IHDI) classification.According to the modified Severin classification, the affected hips were divided into RAD and non-RAD groups, and differences between the two groups were compared.Additionally, patients were categorized into MRI-bony TSL continuous and non-continuous groups to compare differences in indicators between these groups.The receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of the AD difference in predicting the occurrence of RAD. Results Among the 68 hips, 2 were classified as Severin type Ⅰ, 15 as type Ⅱ, 46 as type Ⅲ, and 5 as type Ⅳ;51 hips in the RAD group, and 17 in the non-RAD group.Univariate analysis showed that IHDI classification, the continuity of the bony TSL, and the AD difference between the normal and affected sides were related factors for the occurrence of RAD after CR in DHH children.Multivariate logistic regression analysis revealed that IHDI classification (OR=0.090, 95%CI:0.010-0.794), MRI-bony TSL continuity (OR=0.015, 95%CI:0.002-0.128), and AD difference between the normal and affected sides (OR=7.1×108, 95%CI:370.6-1.4×1015) were independent factors influencing the occurrence of RAD after CR in DHH children (P<0.05).ROC curve analysis showed that the difference between normal side and affected side AD predicted the onset of RAD by 0.31cm, corresponding sensitivity and specificity were 0.900 and 0.833, respectively, and AUC was 0.917. Conclusions IHDI classification, MRI-bony TSL continuity, and the AD difference between the normal and affected sides can serve as indicators for predicting RAD occurrence after CR in DDH children.Compared to X-ray TSL, MRI-bony TSL can predict the occurrence of RAD earlier and more accurately.
References:
[1] Shipman SA, Helfand M, Moyer VA, et al.Screening for developmental dysplasia of the hip:a systematic literature review for the US Preventive Services Task Force[J].Pediatrics, 2006, 117(3):e557-e576.DOI:10.1542/peds.2005-1597.
[2] Kuitunen I, Uimonen MM, Haapanen M, et al.Incidence of neonatal developmental dysplasia of the hip and late detection rates based on screening strategy:a systematic review and meta-analysis[J].JAMA Netw Open, 2022, 5(8):e2227638.DOI:10.1001/jamanetworkopen.2022.27638.
[3] Ortiz-Neira CL, Paolucci EO, Donnon T.A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns[J].Eur J Radiol, 2012, 81(3):e344-e351.DOI:10.1016/j.ejrad.2011.11.003.
[4] Sharrock MN, Whelton CR, Paton RW.Selective sonographic scree-ning for developmental dysplasia of the hip-increasing trends in late diagnosis[J].Acta Orthop Belg, 2023, 89(1):15-19.DOI:10.52628/89.1.8636.
[5] Morris WZ, Hinds S, Worrall H, et al.Secondary surgery and residual dysplasia following late closed or open reduction of developmental dysplasia of the hip[J].J Bone Joint Surg Am, 2021, 103(3):235-242.DOI:10.2106/JBJS.20.00562.
[6] Albinana J, Dolan LA, Spratt KF, et al.Acetabular dysplasia after treatment for developmental dysplasia of the hip.Implications for secondary procedures[J].J Bone Joint Surg Br, 2004, 86(6):876-886.DOI:10.1302/0301-620x.86b6.14441.
[7] Farsetti P, Caterini R, De Maio F, et al.T nnis triple pelvic osteotomy for the management of late residual acetabular dysplasia:mid-term to long-term follow-up study of 54 patients[J].J Pediatr Orthop B, 2019, 28(3):202-206.DOI:10.1097/BPB.0000000000000575.
[8] Grissom L, Harcke HT, Thacker M.Imaging in the surgical management of developmental dislocation of the hip[J].Clin Orthop Relat Res, 2008, 466(4):791-801.DOI:10.1007/s11999-008-0161-3.
[9] Li YQ, Guo YM, Li M, et al.Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip[J].Int Orthop, 2018, 42(3):631-640.DOI:10.1007/s00264-017-3726-5.
[10] Zhang ZL, Fu Z, Yang JP, et al.Intraoperative arthrogram predicts residual dysplasia after successful closed reduction of DDH[J].Orthop Surg, 2016, 8(3):338-344.DOI:10.1111/os.12273.
[11] Takeuchi R, Kamada H, Mishima H, et al.Evaluation of the cartilaginous acetabulum by magnetic resonance imaging in developmental dysplasia of the hip[J].J Pediatr Orthop B, 2014, 23(3):237-243.DOI:10.1097/BPB.0000000000000032.
[12] Wakabayashi K, Wada I, Horiuchi O, et al.MRI findings in residual hip dysplasia[J].J Pediatr Orthop, 2011, 31(4):381-387.DOI:10.1097/BPO.0b013e31821a556e.
[13] Druschel C, Placzek R, Selka L, et al.MRI evaluation of hip containment and congruency after closed reduction in congenital hip dislocation[J].Hip Int, 2013, 23(6):552-559.DOI:10.5301/hipint.5000070.
[14] Kim HT, Kim JI, Yoo CI.Diagnosing childhood acetabular dysplasia using the lateral margin of the sourcil[J].J Pediatr Orthop, 2000, 20(6):709-717.DOI:10.1097/00004694-200011000-00003.
[15] Erkula G, Celikbas E, Kilic BA, et al.The acetabular teardrop and ultrasonography of the hip[J].J Pediatr Orthop B, 2004, 13(1):15-20.DOI:10.1097/00009957-200401000-00003.
[16] Smith JT, Matan A, Coleman SS, et al.The predictive value of the development of the acetabular teardrop figure in developmental dysplasia of the hip[J].J Pediatr Orthop, 1997, 17(2):165-169.DOI:10.1097/00004694-199703000-00005.
[17] Walter SG, Endler CHJ, Remig AC, et al.Correction to:risk factors for failed closed reduction in dislocated developmental dysplastic hips[J].Int Orthop, 2021, 45(11):3009.DOI:10.1007/s00264-021-05124-z.
[18] Walter SG, Bornemann R, Koob S, et al.Closed reduction as therapeutic gold standard for treatment of congenital hip dislocation[J].Z Orthop Unfall, 2020, 158(5):475-480.DOI:10.1055/a-0979-2346.
[19] Huang P, Wang DH, Mo YQ, et al.Teardrop and sourcil line (TSL):a novel radiographic sign that predicts residual acetabular dysplasia (RAD) in DDH after closed reduction[J].Transl Pediatr, 2022, 11(4):458-465.DOI:10.21037/tp-21-401.
[20] Morbi AHM, Carsi B, Gorianinov V, et al.Adverse outcomes in infantile bilateral developmental dysplasia of the hip[J].J Pediatr Orthop, 2015, 35(5):490-495.DOI:10.1097/BPO.0000000000000310.
[21] Narayanan U, Mulpuri K, Sankar WN, et al.Reliability of a new radiographic classification for developmental dysplasia of the hip[J].J Pediatr Orthop, 2015, 35(5):478-484.DOI:10.1097/BPO.0000000000000318.
[22] Mansour E, Eid R, Romanos E, et al.The management of residual acetabular dysplasia:updates and controversies[J].J Pediatr Orthop B, 2017, 26(4):344-349.DOI:10.1097/BPB.0000000000000358.
[23] Kim HT, Kim JI, Yoo CI.Acetabular development after closed reduction of developmental dislocation of the hip[J].J Pediatr Orthop, 2000, 20(6):701-708.DOI:10.1097/00004694-200011000-00002.
[24] Gotoh E, Tsuji M, Matsuno T, et al.Acetabular development after reduction in developmental dislocation of the hip[J].Clin Orthop Relat Res, 2000, 378:174-182.DOI:10.1097/00003086-200009000-00027.
[25] Zamzam MM, Kremli MK, Khoshhal KI, et al.Acetabular cartilaginous angle:a new method for predicting acetabular development in developmental dysplasia of the hip in children between 2 and 18 months of age[J].J Pediatr Orthop, 2008, 28(5):518-523.DOI:10.1097/BPO.0b013e31817c4e6d.
[26] Miyake T, Tetsunaga T, Endo H, et al.Predicting acetabular gro-wth in developmental dysplasia of the hip following open reduction after walking age[J].J Orthop Sci, 2019, 24(2):326-331.DOI:10.1016/j.jos.2018.09.015.
Memo
收稿日期:2024-3-2。
基金项目:国家自然科学基金(82272441);上海市科学技术委员会科技创新行动计划(22Y11912200)
通讯作者:宁波,Email:ningbo@fudan.edu.cn