Sankar Wudbhav N, Tang Edward Y, Moseley Colin F
Shriners Hospitals for Children, Los Angeles, CA 90020, USA.
J Pediatr Orthop. 2009 Dec;29(8):868-71. doi: 10.1097/BPO.0b013e3181c29cb2.
It is well accepted that femoral shortening osteotomy can reduce the risk of complications after open reduction of developmental dislocation of the hip (DDH), especially in older children and "high" dislocations. It remains unclear, however, at what age a child needs a femoral shortening osteotomy and what exactly constitutes a "high" dislocation. The purpose of our study was to evaluate age and femoral displacement as predictors of the need for a femoral shortening osteotomy during the open treatment of DDH.
A retrospective study was performed on all hips that underwent open treatment for DDH between 2005 and 2008. In our algorithm, femoral shortening osteotomy was performed only if it was necessary to ease femoral head reduction (independent of patient age and radiographic displacement). Preoperative anteroposterior radiographs of the pelvis were used to measure the normalized superior and lateral displacement of the proximal femoral metaphysis relative to Hilgenreiner's line and the lateral edge of the triradiate cartilage, respectively. Operative reports were reviewed to determine age at the time of surgery and whether or not a femoral shortening osteotomy was performed.
Our series consisted of 72 consecutive hips; mean patient age was 35.6 months (range: 16.4 to 76.0 mo). Overall, 25 of 72 hips (35%) underwent a femoral shortening osteotomy. When the proximal femur was vertically displaced greater than 30% of the pelvic width, the child was significantly more likely to need a femoral shortening osteotomy (P<0.0001, relative risk 3.6). Children older than 36 months of age were also more likely to require a shortening compared with younger children (P=0.001, relative risk 3.2). When both factors were present, the relative risk of needing a femoral shortening was 3.8 (P<0.00002).
As expected, older patients (>36 mo of age) and high dislocations (superior displacement of the proximal femur >30% of pelvic width) were more likely to require a femoral shortening osteotomy. Our results may help frame expectations for both the family and the surgeon when anticipating surgical treatment for DDH.
3 (case-control study).
人们普遍认为，股骨缩短截骨术可降低发育性髋关节脱位（DDH）切开复位术后的并发症风险，尤其是对于大龄儿童和“高位”脱位患者。然而，目前尚不清楚儿童在什么年龄需要进行股骨缩短截骨术，以及“高位”脱位的确切定义是什么。我们研究的目的是评估年龄和股骨移位情况，作为DDH切开治疗期间股骨缩短截骨术需求的预测因素。
对2005年至2008年间所有接受DDH切开治疗的髋关节进行回顾性研究。在我们的算法中，仅在有必要便于股骨头复位时才进行股骨缩短截骨术（与患者年龄和影像学移位无关）。术前骨盆前后位X线片用于分别测量股骨近端干骺端相对于希尔根赖纳线和三叶软骨外侧缘的标准化上移和侧方移位。查阅手术报告以确定手术时的年龄以及是否进行了股骨缩短截骨术。
我们的系列研究包括连续72例髋关节；患者平均年龄为35.6个月（范围：16.4至76.0个月）。总体而言，72例髋关节中有25例（35%）进行了股骨缩短截骨术。当股骨近端垂直移位大于骨盆宽度的30%时，患儿更有可能需要进行股骨缩短截骨术（P<0.0001，相对风险3.6）。与年幼患儿相比，36个月以上的患儿也更有可能需要进行缩短截骨术（P=0.001，相对风险3.2）。当两个因素都存在时，需要进行股骨缩短的相对风险为3.8（P<0.00002）。
正如预期的那样，大龄患者（>36个月）和高位脱位（股骨近端上移>骨盆宽度的30%）更有可能需要进行股骨缩短截骨术。我们的结果可能有助于在预期DDH手术治疗时，为患儿家庭和外科医生设定合理预期。
3（病例对照研究）
