Yu Jinghang,Li Lianyong,Zhang Lijun,et al.Surgical necessity of proximal femoral osteotomy for developmental dysplasia of the hip[J].Journal of Clinical Pediatric Surgery,,18():927-934.[doi:10.3969/j.issn.1671—6353.2019.11.007]
Surgical necessity of proximal femoral osteotomy for developmental dysplasia of the hip
- Keywords:
- Hip Joint/GD; Femur; Osteotomy; Femur Head Necrosis; Prognosis; Research
- CLC:
- R726.8;R683.42;R687.3+1
- Abstract:
- Objective To compare the clinical and radiographic outcomes of DDH patients undergoing open reduction plus Dega pelvic osteotomy with or without proximal femoral osteotomy and determine the necessity for simultaneous osteotomy of proximal femur.Methods Retrospective analysis was performed for 67 patients (80 hips) undergoing open reduction plus Dega pelvic osteotomy from January 2011 to December 2015.There were 58 children (67 hips) of T nnis types Ⅰ,Ⅱ and Ⅲ hips.For 33 children (38 hips) in femoral osteotomy group,there were 2 boys and 31 girls with an median operative age of 25(15-46) months.The involved side was left (n=13),right (n=15) and bilateral (n=5); For 25 patients (29 hips) in femoral non-osteotomy group,there were 5 boys and 20 girls with an median operative age of 19(6-32) months.The involved hip side was left (n=10),right (n=11) and bilateral (n=4).Compare the development of two groups,the measurements of acetabular index (AI),articulo-trochanteric distance (ATD),centre-head distance discrepancy (CHDD) and femoral epiphyseal height-to-width index (HWI) were recorded.Results All 58 patients (67 hips) were followed up for an average of 41(24-70) months.With regards to morphological parameters of acetabular side,improvement of AI (postoperative to the last follow-up) were (5.3±9.2)° and (5.0±4.7)° in osteotomy and non-osteotomy groups respectively (t=-0.183,P=0.855).Change of CEA (postoperative to the last follow-up) were (6.2±7.7)° and (9.0±11.7)° respectively (t=1.121,P=0.268).As to the morphological development of proximal femur,change of NSA (last follow-up to preoperative) were (3.2±13.0)° and (4.7±10.1)° in two groups (t=0.518,P=0.606); Alsberg angles at the last follow-up were(76.9±7.8)° and (76.2±6.9)°(t=-0.359,P=0.721); ATD values at the last follow-up (24.0±5.3) and (26.8±6.0) mm respectively (Z=-1.955,P=0.051).As to the change of CHDD (the last follow-up to postoperative) were (6.5±7.9)% and (3.0±7.1)% in two unilateral DDH groups respectively (Z=-1.594,P=0.118).As to the morphological parameters of epiphysis of femoral head,the last follow-up HWI were (55.7±6.7)% and (52.8±6.1)% respectively (t=-1.855,P=0.068).The maximal femoral head diameter ratio (r value) at the last follow-up of dislocated side and normal side were (1.12±0.13) and (1.19±0.15) in two unilateral DDH groups respectively (Z=-1.790,P=0.073).LLD at the last follow-up were (5.2±7.1) and (9.4±4.6) mm in two unilateral DDH groups respectively (t=2.331,P=0.024).No secondary dislocation occurred.According to the Kalamchi-MacEwen classification scheme,the incidence of AVN were 28.9%(11/38) and 20.7%(6/29) in two groups respectively (χ2=0.592,P=0.442).Conclusion Proximal femoral osteotomy is unnecessary when open reduction plus Dega pelvic osteotomy is performed in children of walking age with T nnis type Ⅲ or below hip dislocation.
References:
1 中华医学会骨科学分会.发育性髋关节发育不良诊疗指南(2009年版)[J].中国矫形外科杂志, 2013,21(9):953-954. Orthopedic Branch of CMA.Diagnostic & Therapeutic Guidelines of DDH(2009Edition)[J].Orthopedic Journal of China,2013,21(9):953-954.
2 El-Tayeby HM.One-stage hip reconstruction in late neglected developmental dysplasia of the hip presenting in children above 8 years of age[J].J Child Orthop,2009,3(1):11-20.DOI:10.1007/s11832-008-0135-8.
3 Ryan MG,Johnson LO,Quanbeck DS,et al.One-stage treatment of congenital dislocation of the hip in children three to ten years old:functional and radiographic results[J].J Bone Joint Surg Am,1998,80(3):336-344.DOI:10.2106/00004623-199803000-00005.
4 Forlin E,Munhozd CLA,Figueiredo DC.Treatment of developmental dysplasia of the hip after walking age with open reduction,femoral shortening,and acetabular osteotomy[J].Orthop Clin North Am,2006,37(2):149-160.DOI:10.1016/j.ocl.2005.11.005.
5 T?nnis D.Indications and time planning for operative interventions in hip dysplasia in child and adulthood[J].Z Orthop Ihre Grenzgeb,1985,123(4):458-461.
6 Wiberg G.Studies on dysplastic acetabula and congenital subluxation of the hip joint:with special reference to the complication of osteoarthritis[J].Acta Chir Scand,1939,115(1):81.DOI:10.1001/jama.1940.02810270083038.
7 Mose K.Methods of measuring in Legg-Calvé-Perthes disease with special regard to the prognosis[J].Clin Orthop Relat Res,1981,(150):103-109.
8 Chen IH,Kuo KN,Lubicky JP.Prognosticating factors in acetabular development following reduction of developmental dysplasia of the hip[J].J Pediatr Orthop,1994,14(1):3-8.
9 Gamble JG,Mochizuki C,Bleck EE,et al.Coxa magna following surgical treatment of congenital hip dislocation[J].J Pediatr Orthop,1985,5(5):528-533.DOI:10.1097/01241398-198509000-00004.
10 Casaletto JA,Perry DC,Foster A,et al.The height-to-width index for the assessment of femoral head deformity following osteonecrosis in the treatment of developmental dysplasia[J].J Bone Joint Surg Am,2009,91A(12):2915-2921.DOI:10.2106/JBJS.H.00954.
11 Ward WT,Vogt M,Grudziak JS,et al.Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip:A study of intraobserver and interobserver reliability[J].J Bone Joint Surg Am,1997,79(5):656-663.
12 McKay DW.A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip[J].Clin Orthop Relat Res,1974,(98):124-132.
13 Salter RB,Kostuik J,Dallas S.Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children:a clinical and experimental investigation[J].Can J Surg,1969,12(1):44-61.
14 Kalamchi A,MacEwen GD.Avascular necrosis following treatment of congenital dislocation of the hip[J].J Bone Joint Surg Am,1980,62(6):876-888.DOI:10.2106/00004623-198062060-00002.
15 张立军,李连永.髋臼发育不良的手术适应证与手术时机[J].临床小儿外科杂志, 2012,11(5):386-388.DOI:10.3969/j.issn.1671-6353.2012.05.023. Zhang LJ,Li LY.Operative indications and timing of acetabular dysplasia[J].J Clin Ped Sur,2012,11(5):386-388.DOI:10.3969/j.issn.1671-6353.2012.05.023.
16 Salter RB.Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip[J].Clinical Orthopaedics & Related Research,1978,43(137):2-14.
17 Pemberton PA.Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dysplasia of the hip[J].J Bone Joint Surg Am,1965,47(2):65-86.
18 Dega W.Schwierigkeiten in der chirurgischen reposition der veraltetenkongenitalen subluxation des hüftgelenke-sbeikindern[J].Beitr Orthop Traumatol,1964,11:642-647.
19 Ombredanne L.Precis clinique et operatoire de chirugie infantile[Z].1932.
20 Tezeren G,Tukenmez M,Bulut O,et al.The surgical treatment of developmental dislocation of the hip in older children:a comparative study[J].Acta Orthop Belg,2005,71(6):678-685.
21 Mootha AK,Saini R,Dhillon MA,et al.Do we need femoral derotation osteotomy in DDH of early walking age group? A clinico-radiological correlation study[J].Arch Orthop Trauma Surg,2010,130(7):853-858.DOI:10.1007/s00402-009-1020-8.
22 Wenger DR.Surgical treatment of developmental dysplasia of the hip[J].Instr Course Lect,2014,63:313-323.
23 何金鹏,梅海波,徐宏文,等.18个月到3岁发育性髋关节脱位患儿初次开放复位股骨截骨与不截骨近期疗效的比较研究[J].中华小儿外科杂志, 2016,37(12):888-892.DOI:10.3760/cma.j.issn.0253-3006.2016.12.003. He JP,Mei HB,Xu HW,et al.Short-term efficacies of femoral osteotomy for developmental dislocation of the hip in children[J].Chin J Ped Sur,2016,37(12):888-892.DOI:10.3760/cma.j.issn.0253-3006.2016.12.003.
24 刘卫东,吉士俊,周永德,等.股骨旋转截骨术在先天性髋脱位治疗中作用的评价[J].中华骨科杂志, 1995,13(2):69-71. Liu WD,Ji SJ,Zhou YD,et al.Evaluation of rotational osteotomy of the femur in the treatment of congenital dislocation of the hip[J].Chin J Orthop,1995,13(2):67-71.
25 Spence G,Hocking R,Wedge JH,et al.Effect of innominate and femoral varusderotation osteotomy on acetabular development in developmental dysplasia of the hip[J].J Bone Joint Surg Am,2009,91(11):2622-2636.DOI:10.2106/JBJS.H.01392.
26 Kothari A,Grammatopoulos G,Hopewell SA.How does bony surgery affect results of anterior open reduction in walking-age children with developmental hip dysplasia?[J].Clin Orthop Relat Res,2016,474(5):1199-1208.DOI:10.1007/s11999-015-4598-x.
27 Eyre-Brook AL.Osteochondritis deformans coxae juvenilis or Perthes’disease:The results of treatment by traction in recumbency[J].British Journal of Surgery,1936,24(93):166-182.DOI:10.1002/bjs.1800249322.
28 Sibi?ski M,Synder M.Lateral growth disturbances of the capital femoral epiphysis after nonoperative treatment of late developmental dislocation of the hip:thirty-five cases followed to skeletal maturity[J].J Pediatr Orthop,2006,26(3):307-309.DOI:10.1097/01.bpo.0000217731.46911.e6.
29 Oh CW,Joo SY,Kumar SJ,et al.A radiological classification of lateral growth arrest of the proximal femoral physis after treatment for developmental dysplasia of the hip[J].J Pediatr Orthop,2009,29(4):331-335.DOI:10.1097/BPO.0b013e3181a5b09c.
30 刘双,张立军,李连永,等.正常儿及发育性髋脱位患儿保守治疗后股骨Alsberg角的演变规律研究[J].中华小儿外科杂志,2016,37(8):577-581.DOI:10.3760/cma.j.issn.0253-3006.2016.08.005. Liu S,Zhang LJ,Li LY,et al.Early prediction of lateral growth disturbances of proximal femoral physis after conservative treatment of developmental dysplasia of the hip[J].Chin Pediatr Surg,2016,37(8):577-581.DOI:10.3760/cma.j.issn.0253-3006.2016.08.005.
31 吉士俊,周永德,赵群,等.先天性髋脱位治疗后股骨头增大[J].中华小儿外科杂志, 1989,10(4):200-201.DOI:10.3760/cma.j.issn.0253-3006.1989.04.004. Ji SJ,Zhou YD,Zhao Q,et al.Coxa magna following the treatment for congenital dislocation of hip[J].Chin J Pediatr Surge,1989,10(4):200-201.DOI:10.3760/cma.j.issn.0253-3006.1989.04.004.
32 罗殿中,程徽,何建军,等.单侧发育性髋关节脱位下肢长度的放射学观察[J].中国矫形外科杂志, 2013,21(15):1556-1561.DOI:10.3977/j.issn.1005-8478.2013.15.15. Luo DZ,Cheng H,He JJ,et al.Radiological observation of leg length discrepancy and knee deformity among unilateral developmental hip dislocation patients[J].Orthopedic Journal of China,2013,21(15):1556-1561.DOI:10.3977/j.issn.1005-8478.2013.15.15.
Memo
收稿日期:2019-05-20。
基金项目:国家自然科学基金（编号：81371918）；国家自然科学基金（编号：81772296）
通讯作者:李连永,Email:loyo_ldy@163.com