Lu Xiaokun,Wang Jiansi,Zeng Huiyi,et al.Short-term follow-ups of traumatic hip dislocation in children:a single-center retrospective study[J].Journal of Clinical Pediatric Surgery,2026,(09):811-815.[doi:10.3760/cma.j.cn101785-20260106-00008]
儿童创伤性髋关节脱位的短期随访：一项单中心回顾性研究
- Title:
- Short-term follow-ups of traumatic hip dislocation in children:a single-center retrospective study
- Keywords:
- Traumatic Hip Dislocation; Hip Fracture; Surgical Procedures; Operative; Child
- 摘要:
- 目的 分析儿童创伤性髋关节脱位的临床特征，并总结治疗后短期随访结果。方法 本研究为回顾性病例系列研究，收集福建省泉州市正骨医院小儿骨科2016年1月至2023年3月收治的20例儿童创伤性髋关节脱位患者资料，统计患者性别、年龄、患侧、骨折分型、合并骨折、损伤机制、复位方式、复位时机、复位后治疗方案，同时记录并发症及合并损伤。末次随访采用股骨头缺血性坏死（avascular necrosis,AVN）评估、Barquet分型及Harris髋关节评分评价临床疗效。结果 剔除3例合并脑瘫、1例合并先天性髋关节发育不良、2例失访病例，最终纳入14例；平均随访2.6年，（随访时间范围1.5~5.4年）。男9例，女5例；平均年龄9.5岁（年龄范围1.3~13.8岁）；右侧脱位6例，左侧脱位8例。 14例中，伤后6h内复位11例，无一例AVN发生（发生率0%）；伤后超过6 h复位3例，2例发生AVN（发生率66.7%）；两组AVN发生率对比差异有统计学意义（P=0.033）。高能量损伤（高处坠落、车祸伤）6例，年龄13.3(10.8,13.5)岁；低能量损伤8例，年龄6.1(4.4,13.0)岁；两组年龄比较差异无统计学意义（Z=-1.617，P=0.106）。14例均为髋关节后脱位；其中单纯脱位（无合并损伤）6例，年龄4.7(3.3,5.8)岁；合并损伤8例，平均年龄13.3(13.0,13.7)岁；两组年龄比较差异有统计学意义（Z=-3.105，P= 0.002）。14例中，9例行闭合复位（其中1例闭合复位后联合关节镜探查清理），5例行切开复位。14例复位后均采用髋人字石膏或支具固定4~6周。伤后6 h内复位11例，超过6 h复位3例，两组AVN发生率分别为0%、66.7%，差异有统计学意义（P=0.033）；性别、年龄、患侧、复位方式、损伤机制对AVN发生率无显著影响（P>0.05）。末次随访Barquet分型：Ⅰ型11例，Ⅱ型1例，Ⅲ型0例，Ⅳ型0例，Ⅴ型2例；共2例发生股骨头缺血性坏死，均为高能量损伤、切开复位且复位时间超过6 h的患者。末次随访Harris髋关节评分：优12例，良1例，差1例。结论 儿童及青少年创伤性髋关节脱位发病率低，以后脱位为主。伤后复位时间超过6 h会显著升高股骨头缺血性坏死发生风险，临床需尽早完成复位以改善预后。青少年患者易合并股骨头、髋臼骨折等损伤；实现解剖中心复位且未发生股骨头缺血性坏死的患者，短期随访疗效满意。
- Abstract:
- Objective To explore the clinical characteristics of traumatic hip dislocation (THD) in children and summarize the short-term follow-up results after treatment.Methods A retrospective review of clinical data was performed for 20 children with traumatic hip dislocation hospitalized at the Department of Pediatric Orthopedics,Quanzhou Orthopedic-traumatological Hospital from January 2016 to March 2023.Gender,age,affected side,fracture type,concurrent fractures,injury mechanism,reduction mode,reduction timing,treatment protocols after reduction and complications were recorded.At the final follow-up,clinical efficacy was evaluated by avascular necrosis of femoral head (AVN),Barquet classification and Harris hip score.Results After excluding cerebral palsy (n=3),congenital hip dysplasia (n=1) and lost to follow-up (n=2).The reminders (n=14) were finally recruited.The average follow-up period was 2.6(1.5-5.4) year.There were 9 boys and 5 girls with an average age of 9.5(1.3-13.8) year.The affected side was left (n=8) and right (n=6). Among the 14 cases,11 cases were reset within 6 hours after injury, and no AVN occurred (incidence rate 0%); Three cases were reduced after more than 6 hours of injury,and two cases developed AVN (incidence rate 66.7%); There was a statistically significant difference in the incidence of AVN between the two groups (P=0.033). There were 6 cases of high-energy injuries (falls from heights & automobile accidents) with an average age of 13.3(10.8,13.5) year and 8 cases of low-energy injury with an average age of 6.1 (4.4,13.0) years.No statistically significant inter-group difference existed in age (Z=-1.617,P=0.106).All of them belonged to posterior dislocation of hip joint.Among them,there were 6 cases of simple dislocation (without concomitant injury) with an average age of 4.7(3.3,5.8) year and an age range of (1.3-6.8) year.Eight cases of concurrent injuries were reported with an average age of 13.3(13.0,13.7) year and an age range of (12.9-14.0) year.The inter-group age difference was statistically significant (Z=-3.105,P= 0.002).Closed reduction was performed (n=9) and 1/9 underwent joint arthroscopic exploration and cleaning after closed reduction.Another 5 were treated with routine open reduction.Fixing with hip herringbone plaster or brace was implemented for 4-6 weeks after reduction.Reset occurred within 6 hours after injury (n=11) and after 6 hours (n=3).The incidence of AVN was 0% and 66.7% in two groups and there was statistically significant difference (P=0.033).Gender,age,affected side,reduction mode and injury mechanism had no significant effect on the incidence of AVN (P>0.05).At the last follow-up,Barquet classification was type Ⅰ (n=11),type Ⅱ (n=1),type Ⅲ/Ⅳ (n=0) and type Ⅴ (n=2).Ischemic necrosis of femoral head occurred (n=2).Both were caused by high-energy injury.After open reduction,reduction time lasted over 6 hours.At the last follow-up,Harris hip joint score was excellent (n=12),decent (n=1) and poor (n=1).Conclusions The incidence of THD is low in children and adolescents.It is predominantly posterior dislocation.Reduction time after injury >6 hours may significantly elevate the risk of ischemic necrosis of femoral head.And early reduction is essential for achieving a better prognosis.Adolescents are prone to such complications as femoral head and acetabular fractures.Patients who achieved anatomical center reduction without experiencing ischemic necrosis of femoral head have satisfactory short-term follow-up outcomes.
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备注/Memo
收稿日期:2026-1-6。
通讯作者:李炳钻,Email:1423037870@qq.com