发育性髋关节发育不良闭合复位后股骨头的对接：真的会发生吗？
Docking of the Femoral Head Following Closed Reduction for DDH: Does it Really Occur?
作者信息
Talathi Nakul S, Chauvin Nancy A, Sankar Wudbhav N
机构信息
Division of Orthopaedic Surgery.
Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA.
出版信息
J Pediatr Orthop. 2018 Sep;38(8):e440-e445. doi: 10.1097/BPO.0000000000001199.
BACKGROUND
It has been suggested that the femoral head can "dock" deeper into the acetabulum after initial closed reduction (CR) for developmental dysplasia of the hip (DDH). The purpose of this study was to quantify the interval change in femoral head position between immediate postoperative magnetic resonance imaging (MRI) and follow-up imaging at ~3 weeks.
METHODS
A retrospective review of 29 patients (30 hips) who underwent CR and spica casting for DDH was conducted. Immediate postoperative and average 3-week follow-up MRI scans in spica were performed on all patients. On both scans, 2 blinded reviewers measured the following indices: the distance between the femoral head and the acetabulum on midcoronal and midaxial images, the displacement of the center of femoral head from Hilgenreiner's line in the coronal and axial plane, and the left-right displacement of the center of femoral head from Perkins line. Measurements were averaged between the 2 reviewers and the interval change in femoral head position between the immediate postoperative and follow-up scans were compared.
RESULTS
There were 26 female individuals and 3 male individuals in our series with a mean age of 7.6 months (range, 4 to 13 mo). Follow-up MRI scans were performed at an average of 23.8 days (range, 13 to 46 d). On the basis of the averaged measurements from both readers, the distance between the femoral head and the acetabulum decreased significantly on coronal measurement and on all 3 axial measurements between initial and follow-up MRI. In addition, the position of the femoral head became significantly more medial, more anterior, and more cranial relative to the acetabulum. The interrater correlation coefficient between both readers across all measurements was 0.731.
CONCLUSIONS
These findings provide evidence that femoral head position within the acetabulum improves even over a short time period following initial CR for DDH, suggesting that the "docking" phenomenon may in fact occur.
LEVEL OF EVIDENCE
Level IV-therapeutic study.
背景
有人提出，对于发育性髋关节发育不良（DDH），在初次闭合复位（CR）后，股骨头可更深入地“对接”至髋臼内。本研究的目的是量化术后即刻磁共振成像（MRI）与约3周后的随访成像之间股骨头位置的间隔变化。
方法
对29例（30髋）因DDH接受CR及髋人字石膏固定的患者进行回顾性研究。对所有患者进行术后即刻及平均3周随访时的髋人字石膏固定状态下的MRI扫描。在两次扫描中，2名盲法阅片者测量以下指标：在冠状面和矢状面图像上股骨头与髋臼之间的距离、股骨头中心在冠状面和轴平面上相对于Hilgenreiner线的位移，以及股骨头中心相对于Perkins线的左右位移。测量结果在2名阅片者之间进行平均，并比较术后即刻与随访扫描之间股骨头位置的间隔变化。
结果
本系列中有26名女性和3名男性，平均年龄7.6个月（范围4至13个月）。随访MRI扫描平均在23.8天（范围13至46天）进行。根据两位阅片者的平均测量结果，在初次与随访MRI之间，冠状面测量以及所有3个矢状面测量中，股骨头与髋臼之间的距离均显著减小。此外，相对于髋臼，股骨头的位置在更内侧、更前方和更高位变得显著。两位阅片者在所有测量中的组内相关系数为0.731。
结论
这些发现提供了证据，表明对于DDH，在初次CR后的短时间内，髋臼内的股骨头位置即有改善，提示“对接”现象可能确实存在。
证据水平
IV级治疗性研究。
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