发育性髋关节发育不良的手术复位：16年的流行病学研究

Operative Reduction for Developmental Dysplasia of the Hip: Epidemiology Over 16 Years.

作者信息

Nelson Susan E, DeFrancesco Christopher J, Sankar Wudbhav N

机构信息

Department of Orthopaedics, University of Rochester, Rochester, NY.

Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA.

出版信息

J Pediatr Orthop. 2019 Apr;39(4):e272-e277. doi: 10.1097/BPO.0000000000001292.

DOI:10.1097/BPO.0000000000001292

PMID:30451811

Abstract

BACKGROUND

The burden of surgical treatment for infantile developmental dysplasia of the hip (DDH) is unknown. We aimed to investigate the epidemiology of operative DDH reductions in the United States and identify potential at-risk populations.

METHODS

The Healthcare Utilization Project Kids' Inpatient Database (1997 to 2012) were analyzed. International Classification of Diseases (ICD-9) codes identified inpatient hospitalizations for DDH reductions excluding neuromuscular cases. Hospital variables and patient demographics were captured. Weighted population-level counts were calculated to allow for national estimates.

RESULTS

An estimated 5525 (95% confidence interval, 4907.8-6142.2) operative reductions were performed. In total, 73.3% were open with a mean age at the reduction of 2.3 years (95% confidence interval, 2.1-2.5). In total, 70.0% were female and 42.3% were white. Regional distribution varied: 36.4% of reductions occurred in the West, 22.8% in the South, 21.9% in the Midwest, and 18.9% in the Northeast. Operative reductions decreased over time; open reductions decreased by 5.6% and closed by 53.4%. Mean age at treatment increased from 1.6 to 3.7 years (P<0.001). On multivariate analysis, age (P<0.001) and geographic location (P<0.05) were associated with open reduction. Patients in the West had increased odds of being Hispanic or Asian/Pacific Islander [odds ratio (OR), 4.9, P<0.001 and OR, 2.8; P=0.008]. In the South and Midwest, the highest income quartile was protective (OR, 0.4; P=0.001 and OR, 0.5; P=0.018).

CONCLUSIONS

The frequency of closed reductions decreased more over time compared with open reductions. However, the mean age of children undergoing reductions increased suggesting a possible delay in diagnosis. The data suggests that there is room for improvement in screening. Targeted research in identified populations may reduce the burden of surgical disease in infantile DDH.

LEVEL OF EVIDENCE

Level III.

摘要

背景

婴儿发育性髋关节发育不良（DDH）手术治疗的负担尚不清楚。我们旨在调查美国DDH手术复位的流行病学情况，并确定潜在的高危人群。

方法

分析了医疗保健利用项目儿童住院数据库（1997年至2012年）。国际疾病分类（ICD-9）编码确定了排除神经肌肉病例的DDH复位住院情况。记录了医院变量和患者人口统计学数据。计算加权人口水平计数以进行全国估计。

结果

估计进行了5525例（95%置信区间，4907.8 - 6142.2）手术复位。总体而言，73.3%为切开复位，复位时平均年龄为2.3岁（95%置信区间，2.1 - 2.5）。总体而言，70.0%为女性，42.3%为白人。区域分布各不相同：36.4%的复位发生在西部，22.8%在南部，21.9%在中西部，18.9%在东北部。手术复位随时间减少；切开复位减少了5.6%，闭合复位减少了53.4%。治疗时的平均年龄从1.6岁增加到3.7岁（P<0.001）。多因素分析显示，年龄（P<0.001）和地理位置（P<0.05）与切开复位相关。西部的患者为西班牙裔或亚裔/太平洋岛民的几率增加[优势比（OR），4.9，P<0.001和OR，2.8；P = 0.008]。在南部和中西部，最高收入四分位数具有保护作用（OR，0.4；P = 0.001和OR，0.5；P = 0.018）。