Segal L S, Boal D K, Borthwick L, Clark M W, Localio A R, Schwentker E P
Department of Orthopaedics and Rehabilitation, The Milton S. Hershey Medical Center and The Pennsylvania State University College of Medicine, Hershey 17033, USA.
J Pediatr Orthop. 1999 Mar-Apr;19(2):177-84. doi: 10.1097/00004694-199903000-00008.
We retrospectively reviewed the results of open or closed reduction for developmental dysplasia of the hip (DDH) in 49 children younger than 12 months old, who had 57 hip dislocations. Group A (18 hips) developed partial or complete avascular necrosis (AVN), and group B (39 hips) did not develop AVN. Thirty-eight hips were treated by closed reduction, and 17 had open reduction. One patient with bilateral hip dislocation initially had closed reductions followed by bilateral open reduction 3 months later. With the numbers available for study, there was no significant difference in the occurrence of AVN with respect to variables such as preliminary traction, closed versus open reduction, Pavlik harness use, and age at the time of operative intervention. However, the presence of the ossific nucleus before reduction, detected either by radiographs (p < 0.001) or ultrasonography (p = 0.033) was statistically significant in predicting AVN. Only one (4%) of 25 hips with an ossific nucleus developed AVN, whereas 17 (53%) of 32 hips without an ossific nucleus before reduction developed AVN. Our results suggest that the presence of the ossific nucleus before closed or open reduction for DDH may decrease the risk of AVN.
我们回顾性分析了49例12个月以下患有57处髋关节脱位的发育性髋关节发育不良（DDH）患儿行切开或闭合复位的结果。A组（18髋）发生了部分或完全性股骨头缺血性坏死（AVN），B组（39髋）未发生AVN。38髋行闭合复位，17髋行切开复位。1例双侧髋关节脱位患儿最初行闭合复位，3个月后双侧切开复位。就现有可用于研究的数据而言，在诸如初步牵引、闭合复位与切开复位、使用 Pavlik 支具以及手术干预时的年龄等变量方面，AVN的发生率没有显著差异。然而，复位前通过X线片（p < 0.001）或超声检查（p = 0.033）检测到的骨化核的存在，在预测AVN方面具有统计学意义。25处有骨化核的髋关节中只有1处（4%）发生了AVN，而32处复位前没有骨化核的髋关节中有17处（53%）发生了AVN。我们的结果表明，DDH行闭合或切开复位前骨化核的存在可能会降低AVN的风险。
