Jadhav Siddharth P, More Snehal R, Shenava Vinitha, Zhang Wei, Kan J Herman
E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030-2399, USA.
vRad, Eden Prairie, MN, USA.
Pediatr Radiol. 2018 Aug;48(8):1096-1100. doi: 10.1007/s00247-018-4143-7. Epub 2018 Apr 25.
Magnetic resonance imaging (MRI) of the hips is being increasingly used to confirm hip reduction after surgery and spica cast placement for developmental dysplasia of the hip (DDH).
To review a single institutional experience with post-spica MRI in children undergoing closed or open hip reduction and describe the utility of MRI in directing the need for re-intervention.
Seventy-four patients (52 female, 22 male) who underwent post-spica hip MRI over a 6-year period were retrospectively reviewed. One hundred and seven hips were included. Data reviewed included age at intervention, gender, type of intervention performed, MRI findings, the need for re-intervention and the interval between interventions. Gender was compared between the closed and open reduction groups via the Fisher exact test. Age at the first procedure was compared via the Wilcoxon rank test. Rates of re-intervention after closed and open reduction were calculated and the reasons for re-intervention were reviewed.
The mean age at the time of the first intervention was 16.4 months (range: 4 to 63 months). Mean age for the closed reduction group was 10.5 months (range: 4-24 months) and for the open reduction group was 23.7 months (range: 5-63 months), which was significant (P-value <0.0001). Of the 52 hips that underwent closed reduction, 16 (31%) needed re-intervention. Of the 55 hips that underwent open reduction, MRI was useful in deciding re-intervention in only 1 (2%). This patient had prior multiple failed closed and open reductions at an outside institute.
Post intervention hip spica MRI is useful in determining the need for re-intervention after closed hip reduction, but its role after open reduction is questionable.
髋关节磁共振成像（MRI）越来越多地用于确认髋关节发育不良（DDH）手术后及人字石膏固定后的髋关节复位情况。
回顾单一机构对接受闭合或开放髋关节复位的儿童进行人字石膏固定后MRI检查的经验，并描述MRI在指导再次干预需求方面的作用。
回顾性分析了6年间接受人字石膏固定后髋关节MRI检查的74例患者（52例女性，22例男性）。共纳入107个髋关节。所回顾的数据包括干预时的年龄、性别、所进行的干预类型、MRI检查结果、再次干预的需求以及两次干预之间的间隔时间。通过Fisher精确检验比较闭合复位组和开放复位组的性别。通过Wilcoxon秩和检验比较首次手术时的年龄。计算闭合复位和开放复位后再次干预的发生率，并对再次干预的原因进行分析。
首次干预时的平均年龄为16.4个月（范围：4至63个月）。闭合复位组的平均年龄为10.5个月（范围：4至24个月），开放复位组的平均年龄为23.7个月（范围：5至63个月），差异有统计学意义（P值<0.0001）。在接受闭合复位的52个髋关节中，16个（31%）需要再次干预。在接受开放复位的55个髋关节中，MRI仅对1个（2%）髋关节的再次干预决策有帮助。该患者此前在外院多次进行闭合和开放复位均失败。
干预后人字石膏固定髋关节MRI有助于确定闭合髋关节复位后再次干预的需求，但其在开放复位后的作用尚存在疑问。
