Zhou Qinghe,Li Yiqiang,Liu Yuanzhong,et al.Closed reduction and dynamic cast immobilization for children with developmental dysplasia of the hip.[J].Journal of Clinical Pediatric Surgery,2018,17(10):742-746.
闭合复位动态石膏固定治疗儿童发育性髋关节发育不良的疗效分析
- Title:
- Closed reduction and dynamic cast immobilization for children with developmental dysplasia of the hip.
- Keywords:
- Hip Joint/GD; Dislocations; Redislocation; Femur Head Necrosis; Child
- 文献标志码:
- A
- 摘要:
- 目的 研究闭合复位动态石膏固定治疗儿童发育性髋关节发育不良(developmental dysplasia of the hip,DDH)的疗效。 方法 回顾性分析广州市妇女儿童医疗中心儿童骨科采用闭合复位动态石膏固定治疗DDH患儿276例（308髋），其中男童35例，女童241例；复位时平均年龄（15.3±4.4） 个月。门诊定期行X线检查，记录再脱位发生率，采用KalamchiMacEwen法评估髋关节有无股骨头缺血性坏死 (avascular necrosis,AVN)，以及AVN 的分型。末次随访时采用Severin评级对髋关节进行分级。 结果 本研究发现276例（308髋）DDH患儿再脱位发生率为5.5%。Tnnis Ⅱ度的髋关节再脱位发生率低于Tnnis Ⅲ度和Ⅳ度 ，差异有统计学意义（P=0.027）。总体AVN发生率为11.7%，其中Ⅱ型22髋，Ⅲ型11髋，Ⅳ型3髋。末次随访时髋臼指数平均为（21.0±6.1）°。79.9%的髋关节获得满意结果（74.4% Severin评级为Ⅰ级，5.5%为Ⅱ级）；20.1%的髋关节结局为不满意（19.1% Severin评级为Ⅲ级，1%为Ⅳ级）。 结论 DDH闭合复位后采用动态石膏固定可以获得良好的疗效，该固定方式不会增加再脱位和AVN的发生率。
- Abstract:
- ObjectiveTo explore the outcomes of children with developmental dysplasia of the hip (DDH) after closed reduction and dynamic cast immobilization.MethodsWe retrospectively reviewed a total of 276 DDH children with a total of 308 hips and a mean age of 15.3±4.4 months undergoing closed reduction and dynamic cast immobilization.Radiological examination was performed during each followup visit for assessing the redislocation rate and the presence of avascular necrosis (AVN) of femoral epiphysis (Kalamchi and MacEwen method).Final radiographic results were evaluated with the Severin classification.ResultsThere was a redislocation rate of 5.5%(17/308).The redislocation rate in Tnnis grade Ⅱ hips was significantly lower than that in Tnnis grades Ⅲ & Ⅳ hips (P=0.027).The overall AVN rate was 11.7% (grade Ⅱ:22 hips; grade Ⅲ:11 hips; grade Ⅳ:3 hips).At the final followup,the mean acetabular index was 21.0°±6.1°.And 79.9% of hips achieved satisfactory outcomes (74.4% Severin type Ⅰ vs 5.5% type Ⅱ),and 20.1% had unsatisfactory outcome (19.1% type Ⅲ vs 1% type Ⅳ).ConclusionDynamic cast is a viable alternative to spica cast immobilization for DDH children after closed reduction.It has similar redislocation and AVN rates compared to standard spica cast immobilization.
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