Terjesen Terje, Horn Joachim, Gunderson Ragnhild B
Department of Orthopaedic Surgery (T.T. and J.H.) and Department of Radiology (R.B.G.), Oslo University Hospital, Rikshospitalet, NO-0027 Oslo, Norway. E-mail address for T. Terjesen:
J Bone Joint Surg Am. 2014 Feb 19;96(4):e28. doi: 10.2106/JBJS.M.00397.
There is little knowledge concerning outcomes for middle-aged adults who were treated for late-detected developmental dislocation of the hip. The aims of this retrospective study were to evaluate the fifty-year clinical and radiographic results after closed reduction and to identify prognostic factors.
Seventy-one patients (ninety hips) with late-detected hip dislocation treated between 1958 and 1962 were assessed clinically and radiographically. The primary treatment was skin traction to obtain a gradual closed reduction. The mean age of the patients at the time of the long-term radiographic examination was 51.6 years (range, forty-four to fifty-five years).
A stable reduction was achieved in eighty-three hips. The mean age at reduction was 1.7 years (range, 0.3 to 5.4 years). Traction failed in six patients (seven hips [8%]), for whom an open reduction was necessary. Twenty-six patients (thirty hips) underwent late surgical procedures because of residual hip dysplasia. A good long-term clinical outcome (a Harris hip score of ≥85 points) after closed reduction was assessed for fifty-two (63%) of the hips. A satisfactory radiographic outcome (no osteoarthritis) was found for fifty-six (67%) of the hips. Osteoarthritis had developed in twenty-seven (33%) of the hips, of which nineteen had undergone total hip replacement, performed at a mean patient age of 43.7 years (range, thirty-one to fifty-four years). Risk factors for osteoarthritis were an older age at the time of reduction, osteonecrosis of the femoral head, residual subluxation, a high acetabular index during childhood, and a classification of Severin grades III or IV at skeletal maturity. A survival analysis showed a reduction in "surviving" hips (no total hip replacement) from 99% at a patient age of thirty years to 74% at the age of fifty-two years.
With a mean follow-up of fifty years, the clinical and radiographic outcomes after gradual closed reduction by skin traction were satisfactory in approximately two-thirds of eighty-three hips. The most important independent risk factors for a poor long-term outcome were an age of eighteen months or older at the time of reduction, residual subluxation, and osteonecrosis.
对于接受治疗的髋关节发育性脱位发现较晚的中年成年人的预后情况，人们了解甚少。这项回顾性研究的目的是评估闭合复位术后五十年的临床及影像学结果，并确定预后因素。
对1958年至1962年间接受治疗的71例（90髋）髋关节发育性脱位发现较晚的患者进行了临床及影像学评估。主要治疗方法是皮肤牵引以实现逐渐闭合复位。长期影像学检查时患者的平均年龄为51.6岁（范围44至55岁）。
83髋实现了稳定复位。复位时的平均年龄为1.7岁（范围0.3至5.4岁）。6例患者（7髋[8%]）牵引失败，需要进行切开复位。26例患者（30髋）因残留髋关节发育不良接受了二期手术。83髋中有52髋（63%）在闭合复位后获得了良好的长期临床结果（Harris髋关节评分≥85分）。56髋（67%）获得了满意的影像学结果（无骨关节炎）。27髋（33%）出现了骨关节炎，其中19髋接受了全髋关节置换，患者平均年龄为43.7岁（范围31至54岁）。骨关节炎的危险因素包括复位时年龄较大、股骨头坏死、残留半脱位、儿童期髋臼指数较高以及骨骼成熟时Severin分级为III或IV级。生存分析显示，“存活”髋关节（未行全髋关节置换）的比例从患者30岁时的99%降至52岁时的74%。
平均随访五十年，83髋中约三分之二经皮肤牵引逐渐闭合复位后的临床及影像学结果令人满意。长期预后不良的最重要独立危险因素是复位时年龄在18个月或以上、残留半脱位和股骨头坏死。
