Department of Orthopaedic Surgery, Okayama University.
Department of Orthopaedic Surgery, Asahigawasou Rehabilitation and Medical Center, Kitaku, Okayama, Japan.
J Pediatr Orthop B. 2021 Nov 1;30(6):509-514. doi: 10.1097/BPB.0000000000000799.
Early prediction of future acetabular development is important to determine an additional surgery for developmental dysplasia of the hip (DDH). The purpose of this study was to investigate the predictive factors of acetabular development using MRI. We retrospectively investigated dislocated 40 hips and 34 normal hips in 37 pediatric patients (9 males and 28 females) with DDH who underwent open reduction after walking age. We evaluated the cartilaginous acetabulum and labrum of the patients using coronal MRI T2*-weighted images at 5 years of age. The mean age at the time of surgery was 22 months, and the mean age at the final survey was 19 years. We divided patients into two groups in accordance with the Severin classification at the final follow-up. Groups with good outcomes (affected 26 hips and unaffected 27 hips) and poor outcomes (14 hips and 7 hips) were compared using the MRI parameters on each side. Predictive factors of acetabular development were identified using univariate and multiple logistic regression analyses. Using multiple logistic regression analysis, labral acetabular roof depth and labral hip center distance at 5 years of age represented predictors after open reduction (odds ratio 0.27, P = 0.035; odds ratio 3.4, P = 0.028, respectively) on the affected side, and bony hip center distance represented a predictor on the unaffected side (odds ratio 2.6, P = 0.049). Acetabular development in the unaffected side could be predicted by bony assessment, while acetabular development in the affected side had to be assessed by labrum using MRI.
早期预测髋臼未来的发育情况对于确定发育性髋关节发育不良（DDH）是否需要额外手术非常重要。本研究旨在通过 MRI 探讨髋臼发育的预测因素。我们回顾性调查了 37 名 DDH 患儿（9 名男性和 28 名女性）中的 40 髋脱位和 34 髋正常髋关节，这些患儿在行走后接受了切开复位。我们使用冠状位 MRI T2*-加权图像评估了患儿的软骨髋臼和盂唇，评估年龄为 5 岁。手术时的平均年龄为 22 个月，最终随访时的平均年龄为 19 岁。我们根据最终随访时的 Severin 分类将患者分为两组。使用 MRI 各侧参数比较了良好结局（受累 26 髋和未受累 27 髋）和不良结局（14 髋和 7 髋）患者。使用单变量和多变量逻辑回归分析确定髋臼发育的预测因素。多变量逻辑回归分析显示，5 岁时髋臼唇髋臼顶深度和髋臼唇髋关节中心距离是切开复位后受累侧的预测因素（比值比 0.27，P = 0.035；比值比 3.4，P = 0.028），骨髋关节中心距离是未受累侧的预测因素（比值比 2.6，P = 0.049）。未受累侧的髋臼发育可以通过骨性评估来预测，而受累侧的髋臼发育则必须通过 MRI 评估髋臼唇。
