Lu Chan,Ma Na,Xie Rui,et al.Therapeutic advances of developmental dysplasia of the hip in children aged 18-24 months[J].Journal of Clinical Pediatric Surgery,2024,(05):489-492.[doi:10.3760/cma.j.cn101785-202305045-018]
18~24月龄发育性髋关节脱位的治疗研究进展
- Title:
- Therapeutic advances of developmental dysplasia of the hip in children aged 18-24 months
- 摘要:
- 发育性髋关节脱位(developmental dysplasia of the hip,DDH)是指髋关节结构及功能上的异常,其治疗目的在于恢复髋臼和股骨头的同心圆复位,保证其正常的生长发育。国内外对不同年龄段DDH患儿的治疗方式比较成熟,但对于18~24月龄DDH患儿的治疗方式选择存在较大争议,由于疾病预后以及手术创伤、费用、时长等因素影响着治疗方式的选择,因此至今尚没有明确的治疗方案。目前采用的手术方法主要包括闭合复位、单纯切开复位及骨盆截骨术,然而每种治疗方式下都有部分患儿存在严重并发症,如残余发育不良(residualacetabular dysplasia,RAD)和股骨头缺血性坏死(avascular necrosis,AVN)。由于DDH患儿术后并发症的影响因素复杂,且18~24月龄这一年龄段髋臼发育的特殊性,如何选择适合不同患儿的手术方法已成为当前临床治疗的难点。本文就18~24月龄DDH患儿的手术治疗研究进展进行综述,旨在为该年龄段患儿选择合适的手术方案提供参考依据。
- Abstract:
- Developmental dysplasia of the hip (DDH) refers to structural and functional abnormality of the hip.The objective is restoring concentric reduction of acetabulum and femoral head and enabling normal growth and development of the hip.At home and abroad,treatment of DDH children of different ages is relatively mature.However,there is an ongoing controversy over therapeutic options for DDH children aged (18-24) months.Outcomes,surgical traumas,costs and durations affect the options of treatment.Currently there is no definite therapeutic protocol.Major closed surgical procedures include reset,open reduction alone and pelvic osteotomy.During many follow-up studies,each option has such serious complications as residual acetabular dysplasia,ascular necrosis (RAD) and avascular necrosis (AVN) of femoral head.Due to complex factors affecting postoperative complications and a great specificity of acetabulum development at an age of (18-24) month,individualizing surgical approaches has become a clinical dilemma and a hot topic of recent researches.This review summarized the latest surgical researches for DDH children aged 18 to 24 months.The goal was to provide rationales for selecting appropriate surgical approaches.
参考文献/References:
[1] St George J,Kulkarni V,Bellemore M,et al.Importance of early diagnosis for developmental dysplasia of the hip:a 5-year radiological outcome study comparing the effect of early and late diagnosis[J].J Paediatr Child Health,2021,57(1):41-45.DOI:10.1111/jpc.15111.
[2] Kural B,Devecio?lu Karap?nar E,Y?lmazba? P,et al.Risk factor assessment and a ten-year experience of DDH screening in a well-child population[J].Biomed Res Int,2019,2019:7213681.DOI:10.1155/2019/7213681.
[3] Yang S,Zusman N,Lieberman E,et al.Developmental dysplasia of the hip[J].Pediatrics,2019,143(1):e20181147.DOI:10.1542/peds.2018-1147.
[4] Murphy RF,Kim YJ.Surgical management of pediatric developmental dysplasia of the hip[J].J Am Acad Orthop Surg,2016,24(9):615-624.DOI:10.5435/JAAOS-D-15-00154.
[5] Baghdadi S,Sankar WN.Residual acetabular dysplasia in the reduced hip[J].Indian J Orthop,2021,55(6):1480-1489.DOI:10.1007/s43465-021-00515-1.
[6] Al Faleh AF,Jawadi AH,Sayegh SA,et al.Avascular necrosis of the femoral head:assessment following developmental dysplasia of the hip management[J].Int J Health Sci (Qassim),2020,14(1):20-23.
[7] Salter RB.The classic.Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip by Robert B.Salter,J.Bone Joint Surg.(Brit) 43B:3:518,1961[J].Clin Orthop Relat Res,1978,137:2-14.
[8] Kagawa Y,Endo H,Tetsunaga T,et al.Acetabular development after open reduction to treat dislocation of the hip after walking age[J].J Orthop Sci,2016,21(6):815-820.DOI:10.1016/j.jos.2016.07.007.
[9] Gholve PA,Flynn JM,Garner MR,et al.Predictors for secondary procedures in walking DDH[J].J Pediatr Orthop,2012,32(3):282-289.DOI:10.1097/BPO.0b013e31824b21a6.
[10] 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.
[11] Terjesen T,Horn J.Management of late-detected DDH in children under three years of age:49 children with follow-up to skeletal maturity[J].Bone Jt Open,2020,1(4):55-63.DOI:10.1302/2633-1462.14.BJO-2019-0005.R1.
[12] Sibiński M,Murnaghan C,Synder M.The value of preliminary overhead traction in the closed management of DDH[J].Int Orthop,2006,30(4):268-271.DOI:10.1007/s00264-006-0080-4.
[13] Ramsey PL,Lasser S,MacEwen GD.Congenital dislocation of the hip.Use of the Pavlik harness in the child during the first six months of life[J].J Bone Joint Surg Am,1976,58(7):1000-1004.
[14] Pollet V,Van Dijk L,Reijman M,et al.Long-term outcomes following the medial approach for open reduction of the hip in children with developmental dysplasia[J].Bone Joint J,2018,100-B(6):822-827.DOI:10.1302/0301-620X.100B6.BJJ-2017-0670.R2.
[15] 杨建平.切开复位、Salter骨盆截骨、股骨近端短缩旋转截骨术治疗发育性髋关节脱位[J].中华骨科杂志,2010,30(12):1252-1258.DOI:10.3760/cma.j.issn.0253-2352.2010.12.017. Yang JP.Treatment of developmental dysplasia of the hip by open reduction,Salter osteotomy and proximal femoral osteotomy[J].Chin J Orthop,2010,30(12):1252-1258.DOI:10.3760/cma.j.issn.0253-2352.2010.12.017.
[16] ?itlak A,Sener M.Secondary bone surgery should be necessary with soft-tissue surgery in developmental dysplasia of the hip after the age of 18 months[J].J Pediatr Orthop B,2014,23(2):203.DOI:10.1097/BPB.0000000000000020.
[17] Gans I,Sankar WN.The medial dye pool revisited:correlation between arthrography and MRI in closed reductions for DDH[J].J Pediatr Orthop,2014,34(8):787-790.DOI:10.1097/BPO.0000000000000187.
[18] 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.
[19] 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.
[20] Venkatadass K,Prasad VD,Jain D,et al.Short-term outcomes of treatment in children presenting with DDH in walking age-an analysis of 84 hips[J].J Clin Orthop Trauma,2022,24:101712.DOI:10.1016/j.jcot.2021.101712.
[21] Bulut M,Karakurt L,Azboy I,et al.Comparison of soft-tissue and bone surgeries in the treatment of developmental dysplasia of the hip in 18-24-month-old patients[J].J Pediatr Orthop B,2013,22(6):521-526.DOI:10.1097/BPB.0b013e328364227e.
[22] Ibrahim S.Acetabular dysplasia after treatment for developmental dysplasia of the hip[J].J Bone Joint Surg Br,2005,87(7):1025.DOI:10.1302/0301-620X.87B7.16662.
[23] Liu YH,Xu HW,Li YQ,et al.Effect of abduction on avascular necrosis of the femoral epiphysis in patients with late-detected developmental dysplasia of the hip treated by closed reduction:a MRI study of 59 hips[J].J Child Orthop,2019,13(5):438-444.DOI:10.1302/1863-2548.13.190045.
[24] Zhang ZQ,Li H,Li H,et al.Timing for closed reduction procedure for developmental dysplasia of the hip and its failure analysis[J].BMC Musculoskelet Disord,2020,21(1):613.DOI:10.1186/s12891-020-03635-1.
[25] 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.
[26] Dai LX,Huang P,Pei XH.Predictors of residual hip dysplasia in 12-18-month-old vs.over 18-month-old DDH patients after closed reduction and the reliability of one residual hip dysplasia criterion:a retrospective cohort study[J].Transl Pediatr,2023,12(5):861-870.DOI:10.21037/tp-22-299.
[27] Ramani N,Patil MS,Mahna M.Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months[J].Indian J Orthop,2014,48(5):458-462.DOI:10.4103/0019-5413.139841.
[28] 中华医学会小儿外科分会骨科学组,中华医学会骨科学分会小儿创伤矫形学组.发育性髋关节发育不良临床诊疗指南(0~2岁)[J].中华骨科杂志,2017,37(11):641-650.DOI:10.3760/cma.j.issn.0253-2352.2017.11.001. Group of Orthopedics,Branch of Pediatric Surgery,Chinese Medical Association;Group of Pediatric Trauma & Orthopedics,Branch of Orthopedics,Chinese Medical Association:Guidelines of Diagnosing & Treating Pediatric Developmental Dysplasia of the Hip in Children Aged up to Two Years[J].Chin J Orthop,2017,37(11):641-650.DOI:10.3760/cma.j.issn.0253-2352.2017.11.001.
相似文献/References:
[1]杜朝峻,丁力,胡英超,等.手术治疗婴幼儿法洛四联症83例[J].临床小儿外科杂志,2010,9(06):413.
DU Chao jun,DING Li,HU Ying chao,et al.Surgical treatment of Tetralogy of Fallot in infancy: Experiences of 83 cases.[J].Journal of Clinical Pediatric Surgery,2010,9(05):413.
[2]李勇,尹强,周小渔,等.术中胆道造影在先天性胆总管囊肿手术中的应用[J].临床小儿外科杂志,2010,9(06):430.
LI Yong,YIN Qiang,ZHOU Xiao yu,et al.The clinic application experience on intraoperative cholangiography in pediatric surgery.[J].Journal of Clinical Pediatric Surgery,2010,9(05):430.
[3]许芝林,王强,李琰,等.乙状结肠冗长症的术式选择探讨[J].临床小儿外科杂志,2010,9(06):432.
XU Zhi lin,WANG Qiang,LI Yan,et al.Initiatory exploration of the standard of surgical treatment methods for Dolichosigmoid.[J].Journal of Clinical Pediatric Surgery,2010,9(05):432.
[4]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[5]胡明,施诚仁,严志龙.脐环小切口治疗婴幼儿腹盆腔疾病的探讨[J].临床小儿外科杂志,2010,9(06):471.
[6]丁勇,魏华,孔燕,等.横裁包皮岛状皮瓣法在尿道下裂治疗中的应用[J].临床小儿外科杂志,2010,9(06):474.
[7]江峰赵阳孙莲萍金惠明马杰.婴幼儿阻塞性脑积水两种手术方式的疗效比较[J].临床小儿外科杂志,2011,10(01):0.
JIANG Feng,ZHAO Yang,SUN Liang ping,et al.Endoscopic third ventricul ostomy versus ventricul operitoneal shunt:clinical study of obstructive hydro cephalus in infants.[J].Journal of Clinical Pediatric Surgery,2011,10(05):0.
[8]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(05):0.
[9]景登攀张根领孙蔓丽.改良Snodgrass术治疗尿道下裂疗效观察[J].临床小儿外科杂志,2011,10(01):0.
[10]陈快 黄金狮 戴康临 陶俊峰 赖勇强 陶强. 腹腔镜与开腹Ladd手术治疗新生儿肠旋转不良效果比较[J].临床小儿外科杂志,2011,10(02):128.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):128.
[11]黄乙勇,符凯,洪聪,等.血清骨桥蛋白与瘦素联合临床特征对发育性髋关节脱位闭合复位后股骨头坏死的预测价值[J].临床小儿外科杂志,2024,(03):210.[doi:10.3760/cma.j.cn101785-202210020-002]
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,2024,(05):210.[doi:10.3760/cma.j.cn101785-202210020-002]
[12]鲁婵,唐兹诞,康晓鹏,等.骨化核对发育性髋关节脱位术后股骨头缺血性坏死的影响研究[J].临床小儿外科杂志,2024,(03):216.[doi:10.3760/cma.j.cn101785-202310025-003]
Lu Chan,Tang Zidan,Kang Xiaopeng,et al.Effect of ossification on avascular necrosis of femoral head after operation for developmental dysplasia of the hip[J].Journal of Clinical Pediatric Surgery,2024,(05):216.[doi:10.3760/cma.j.cn101785-202310025-003]
[13]王亚琴,陈培章,张凯,等.超声引导下髋关节囊周神经阻滞在小儿髋关节手术中的应用[J].临床小儿外科杂志,2024,(03):223.[doi:10.3760/cma.j.cn101785-202211036-004]
Wang Yaqin,Chen Peizhang,Zhang Kai,et al.Ultrasound-guided pericapsular nerve group block for pediatric hip surgery:a comparative study with caudal block[J].Journal of Clinical Pediatric Surgery,2024,(05):223.[doi:10.3760/cma.j.cn101785-202211036-004]
备注/Memo
收稿日期:2023-05-29。
基金项目:云南省杨军林专家工作站(202205AF150062)
通讯作者:康晓鹏,Email: shedk@163.com