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,2020,19(07):579-585.[doi:10.3969/j.issn.1671-6353.2020.07.004]
儿童发育性髋关节脱位切开复位手术后髋关节功能不满意的风险因素分析
- Title:
- 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
- 分类号:
- R726.8;R681.6
- 摘要:
- 目的 研究发育性髋关节脱位（developmental dysplasia of the hip，DDH）切开复位术后髋关节功能不满意的风险因素。方法 回顾性分析2008年1月至2015年12月我院收治的采用切开复位治疗且符合纳入标准的63例（76髋） DDH患者临床资料，平均手术年龄（48.8±26.3）个月。按手术方式分为单纯切开复位组、骨盆Salter/Pemberton截骨组以及骨盆三联截骨组。通过X线片评估患髋术前的骨性髋臼指数（acetabular index，AI）、T?nnis分级、术后AI、中心边缘角（center edge angle，CEA）、股骨头缺血性坏死（avascular necrosis of the femoral epiphysis，AVN）和Severin影像学评级。根据患髋的功能评估结果确定髋关节是否存在关节功能不满意，并分析年龄、性别、侧别、术前AI、T?nnis分级、治疗方式（骨盆截骨方式和股骨截骨）、AVN与DDH术后髋关节功能不满意之间的关系。结果 末次随访时，22髋（28.9%）出现关节功能不满意。关节功能不满意组的年龄[（53.9±23.0）]个月显著大于功能满意组[（42.4±23.9）]个月，差异有统计学意义（P=0.036）。单纯切开复位组的关节功能不满意发生率（0%）显著低于骨盆Salter/Pemberton截骨组（34.8%）和骨盆三联截骨组（35.3%），差异有统计学意义（P=0.039）。有股骨截骨的患者髋关节功能不满意发生率（38.5%）显著高于无股骨截骨者（8.3%），差异有统计学意义（P=0.013）。18髋（23.7%）出现AVN，有AVN的患者关节功能不满意发生率（64.7%）显著高于无AVN组（19.3%），差异有统计学意义（P=0.001）。术前AI、性别、侧别、T?nnis脱位程度分级与关节功能不满意的发生率无关。结论 骨盆截骨、股骨截骨、AVN是导致DDH切开复位术后髋关节功能不满意的风险因素。
- 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.
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备注/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