Kitoh Hiroshi, Kitakoji Takahiko, Katoh Mitsuyasu, Ishiguro Naoki
Department of Orthopaedic Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
J Orthop Sci. 2006 Oct;11(5):473-7. doi: 10.1007/s00776-006-1049-2.
The prediction of acetabular development after reduction of developmental dysplasia of the hip (DDH) is important to ensure optimal timing of acetabuloplasty and to avoid unnecessary surgery. The objective of this study was to find early and reliable predictors of future acetabular dysplasia in the hips reduced by overhead traction (OHT).
We retrospectively reviewed 45 hips in 40 patients treated by OHT for DDH without additional procedures. The average age at the time of closed reduction was 9.3 months, and the average age at the latest examination was 17.3 years. Residual hip dysplasia at skeletal maturity was defined according to Severin's classification. The following variables were evaluated as possible predictors of the final outcome: age at reduction, severity of the dislocation, serial measurements of acetabular index (AI), center-edge angle of Wiberg (CE), and the center-head discrepancy distance (CHDD).
Sixty-two percent of the hips had satisfactory results in Severin I/II and 38% had unsatisfactory results in Severin III. Bilateral DDH showed significantly poorer outcome than unilateral DDH. The average AI of the unsatisfactory group was significantly greater than that of the satisfactory group at 4 years or more after reduction. Similarly, the average CE of the satisfactory group was greater than that of the unsatisfactory group at 5 years or more after reduction. In unilateral cases, the AI and the CE of the uninvolved hip at 1 year after reduction also correlated with the final outcome of the involved hip.
The AI of 4 years and the CE of 5 years after reduction were the earliest predictors of the final outcome. Careful consideration for the need of acetabuloplasty would be given at 4 or 5 years after reduction by OHT. Bilateral DDH and poor acetabular coverage of the uninvolved hip in unilateral DDH were the prognostic factors of unfavorable acetabular development of the dislocated hip.
预测发育性髋关节发育不良（DDH）复位后髋臼的发育情况对于确保髋臼成形术的最佳时机以及避免不必要的手术至关重要。本研究的目的是找出通过悬吊牵引（OHT）复位的髋关节未来髋臼发育不良的早期可靠预测因素。
我们回顾性分析了40例接受OHT治疗DDH且未进行额外手术的患者的45个髋关节。闭合复位时的平均年龄为9.3个月，最近一次检查时的平均年龄为17.3岁。骨骼成熟时的残余髋关节发育不良根据Severin分类进行定义。以下变量被评估为最终结果的可能预测因素：复位时的年龄、脱位的严重程度、髋臼指数（AI）的系列测量、Wiberg中心边缘角（CE）以及中心-头差异距离（CHDD）。
62%的髋关节在Severin I/II级中结果满意，38%在Severin III级中结果不满意。双侧DDH的结果明显比单侧DDH差。复位后4年或更长时间，不满意组的平均AI明显高于满意组。同样，复位后5年或更长时间，满意组的平均CE大于不满意组。在单侧病例中，复位后1年未受累髋关节的AI和CE也与受累髋关节的最终结果相关。
复位后4年的AI和5年的CE是最终结果的最早预测因素。通过OHT复位后4或5年时应仔细考虑是否需要进行髋臼成形术。双侧DDH以及单侧DDH中未受累髋关节的髋臼覆盖不良是脱位髋关节髋臼发育不良的预后因素。
