髋关节发育不良中闭合复位与切开复位：对髋臼重塑的短期影响
Closed vs open reduction in developmental dysplasia of the hip: The short-term effect on acetabular remodeling.
作者信息
Abousamra Oussama, Deliberato David, Singh Satbir, Klingele Kevin E
机构信息
Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Orthopedic Surgery, Doctor's Hospital, Columbus, OH, USA.
出版信息
J Clin Orthop Trauma. 2020 Mar-Apr;11(2):213-216. doi: 10.1016/j.jcot.2019.09.010. Epub 2019 Sep 12.
BACKGROUND
This study aims to assess acetabular remodeling following closed vs, open hip reduction in children younger than 2 years of age.
METHODS
Records of children with DDH, who underwent closed or open reduction, were reviewed. Acetabular index (AI) was measured on radiographs taken prior to reduction and on outcome radiographs taken at age 4 years. Radiographic outcomes were analyzed and residual dysplasia (outcome AI ≥ 30) degrees recorded.
RESULTS
42 hips had closed reduction; and 26 hips had open reduction. A higher percentage of hips treated with successful closed reduction, had outcome AI ≥ 30° (29% vs. 19% p = 0.387). Residual dysplasia was more common in IHDI-IV hips than IHDI-III hips for both groups. A higher incidence of AVN was seen in the open reduction group (13% vs. 7%; p = 0.43).
CONCLUSION
In children with DDH under the age of two, open reduction with capsulorrhaphy may benefit acetabular remodeling more so than closed reduction despite maintenance of reduction. Although AVN remains a risk, higher remodeling might be expected with open reduction.
背景
本研究旨在评估2岁以下儿童行闭合性与开放性髋关节复位术后髋臼重塑情况。
方法
回顾性分析接受闭合性或开放性复位的发育性髋关节发育不良（DDH）患儿的病历资料。在复位前及4岁时拍摄的X线片上测量髋臼指数（AI）。分析X线片结果并记录残余发育不良（结果AI≥30°）的程度。
结果
42例髋关节接受了闭合性复位；26例髋关节接受了开放性复位。闭合性复位成功治疗的髋关节中，结果AI≥30°的比例更高（29%对19%，p = 0.387）。两组中，与IHDI-III级髋关节相比，IHDI-IV级髋关节残余发育不良更为常见。开放性复位组股骨头缺血性坏死（AVN）的发生率更高（13%对7%；p = 0.43）。
结论
在2岁以下的DDH患儿中，尽管闭合性复位能维持复位效果，但开放性复位加关节囊缝合术可能比闭合性复位更有利于髋臼重塑。虽然AVN仍然是一种风险，但开放性复位可能会有更高的重塑效果。
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