骨坏死并发发育性髋关节发育不良会影响后续髋臼的重塑。
Osteonecrosis complicating developmental dysplasia of the hip compromises subsequent acetabular remodeling.
机构信息
Institute of Child Health, University College London, London, UK.
出版信息
Clin Orthop Relat Res. 2013 Jul;471(7):2318-26. doi: 10.1007/s11999-013-2804-2. Epub 2013 Jan 26.
BACKGROUND
Osteonecrosis of the femoral head secondary to treatment of developmental dysplasia of the hip (DDH) affects acetabular remodeling but the magnitude of this effect is unclear.
QUESTIONS/PURPOSES: Using four measures of acetabular development, we (1) determined whether acetabular remodeling differed in hips with and without osteonecrosis; and (2) determined the impact of severity of osteonecrosis contributing to acetabular remodeling.
METHODS
We retrospectively reviewed 95 patients (118 hips) treated for DDH by closed or open reduction with or without femoral osteotomy between 1992 and 2006. We evaluated serial radiographs from the time when a stable reduction had been achieved. In 902 radiographs taken over 19 years, we measured the acetabular index and three other indices of hip development. Patients were followed for a mean of 8 years (range, 1-19 years). At last followup, 86 of the 118 hips (73%) had osteonecrosis according to the criteria by Bucholz and Ogden.
RESULTS
The acetabular index improved with time in all hips but the magnitude of improvement was larger in hips without osteonecrosis. The adjusted mean acetabular index at 14 years was 17° for hips with osteonecrosis (95% CI, 15°-18°) and 10° for hips without osteonecrosis (95% CI, 7°-13°). The lateral centering ratio improved after reduction to a normal value less than 0.85 in both groups but the rate of change with 0.06 versus 0.05 was higher in hips with osteonecrosis. The superior centering ratio was worse at all times in hips with osteonecrosis with a mean difference of 0.04. If only radiographic changes of Grades II and greater were considered osteonecrosis, the mean adjusted acetabular index at 14 years was 17.7° (15.6°-19.7°) for hips with osteonecrosis and 12.4° (10.3°-14.4°) for hips without osteonecrosis.
CONCLUSIONS
Although radiographic indices improved consistently with time in hips without osteonecrosis, hips with osteonecrosis had abnormal indices of acetabular remodeling throughout followup. Osteonecrosis of the femoral head inhibited acetabular remodeling.
LEVEL OF EVIDENCE
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
发育性髋关节发育不良（DDH）治疗后继发股骨头坏死会影响髋臼重塑，但这种影响的程度尚不清楚。
问题/目的：我们使用四种髋臼发育测量方法，（1）确定有无股骨头坏死的髋关节髋臼重塑是否存在差异；（2）确定导致髋臼重塑的股骨头坏死严重程度的影响。
方法
我们回顾性分析了 1992 年至 2006 年间采用闭合或切开复位，联合或不联合股骨截骨术治疗的 95 例（118 髋）DDH 患者的资料。我们评估了从获得稳定复位时起的连续 X 线片。在 19 年的 902 张 X 线片中，我们测量了髋臼指数和另外三个髋关节发育指标。患者的平均随访时间为 8 年（1-19 年）。末次随访时，根据 Bucholz 和 Ogden 的标准，118 髋中有 86 髋（73%）存在股骨头坏死。
结果
所有髋关节的髋臼指数均随时间改善，但无股骨头坏死的髋关节改善幅度更大。有股骨头坏死的髋关节 14 年时的髋臼指数平均为 17°（95%CI，15°-18°），无股骨头坏死的髋关节为 10°（95%CI，7°-13°）。两组患者的外侧中心比例在复位至小于 0.85 的正常范围后均得到改善，但有股骨头坏死的髋关节的变化率为 0.06 而无股骨头坏死的髋关节为 0.05。有股骨头坏死的髋关节的上侧中心比例始终较差，平均差为 0.04。如果仅考虑Ⅱ级及以上的影像学改变为股骨头坏死，则有股骨头坏死的髋关节 14 年时的平均调整髋臼指数为 17.7°（15.6°-19.7°），无股骨头坏死的髋关节为 12.4°（10.3°-14.4°）。
结论
尽管无股骨头坏死的髋关节的 X 线指标随时间持续改善，但有股骨头坏死的髋关节在整个随访期间髋臼重塑的指标异常。股骨头坏死抑制了髋臼重塑。
证据水平
Ⅲ级，预后研究。有关证据水平的完整描述，请参见《作者指南》。
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