Castañeda P, Moscona L, Masrouha K
NYU Langone Orthopedic Hospital. Department of Pediatric Orthopaedic Surgery, New York, USA.
McMaster University Medical Center. Division of Orthopaedic Surgery, Hamilton, Ontario, Canada.
J Child Orthop. 2019 Aug 1;13(4):371-376. doi: 10.1302/1863-2548.13.190029.
The optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is controversial. High tension forces after hip reduction increase the pressure on the femoral head, potentially causing avascular necrosis. Femoral shortening (FS) is commonly used as a means to decrease the pressure on the femoral head. We examined the effect of FS on the outcomes of patients with late-presenting DDH.
A total of 645 hips of a late-presenting DDH cohort treated with open reduction and iliac osteotomies were retrospectively reviewed; 328 hips had a FS performed (FS+) and 317 (FS-) had not. The mean age was 3.9 years (sd 1.55). We classified the hips with the Tönnis and International Hip Dysplasia Institute (IHDI) methods; and the Pediatric Outcomes Data Collection Instrument (PODCI), Iowa Hip Score (IHS) and Severin classification as outcome measurements.
The FS- group had higher scores in PODCI (median 95 points; interquartile range (IQR) 78 to 91) and IHS (median 91 points; IQR 64 to 88) than the FS+ group (PODCI: median 94 points; IQR 69 to 89 points; IHS: median 89 points; IQR 62 to 87). The mean Severin scores were similar (FS- 2.65; FS+ 2.5; p = 0.93) but the FS- group had higher rates of good and excellent outcomes (FS- 56%; FS+ 41%; p < 0.00001) and lesser dislocation rates (FS- 6%; FS+ 14%; p = 0.16).
Although FS should be used when a hip cannot be reduced without undue tension, our results indicate that this procedure is not necessarily related to a better outcome.
Therapeutic, Level III.
晚期发育性髋关节发育不良（DDH）的最佳治疗方法存在争议。髋关节复位后的高张力会增加股骨头的压力，有可能导致缺血性坏死。股骨缩短（FS）通常被用作降低股骨头压力的一种手段。我们研究了股骨缩短对晚期DDH患者治疗结果的影响。
回顾性分析645例接受切开复位和髂骨截骨术治疗的晚期DDH队列中的髋关节；328例髋关节进行了股骨缩短（FS+），317例（FS-）未进行。平均年龄为3.9岁（标准差1.55）。我们采用Tönnis和国际髋关节发育不良协会（IHDI）方法对髋关节进行分类；并将儿童结局数据收集工具（PODCI）、爱荷华髋关节评分（IHS）和Severin分类作为结局指标。
FS-组在PODCI（中位数95分；四分位间距（IQR）78至91）和IHS（中位数91分；IQR 64至88）方面的得分高于FS+组（PODCI：中位数94分；IQR 69至89分；IHS：中位数89分；IQR 62至87）。平均Severin评分相似（FS- 2.65；FS+ 2.5；p = 0.93），但FS-组的优良结局率更高（FS- 56%；FS+ 41%；p < 0.00001），脱位率更低（FS- 6%；FS+ 14%；p = 0.16）。
虽然在髋关节无法在不过度张力的情况下复位时应使用股骨缩短术，但我们的结果表明，该手术不一定与更好的结局相关。
治疗性，III级。
