Department of Orthopedics, National Children's Medical Center & Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
Department of Orthopedics, Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China.
BMC Musculoskelet Disord. 2020 Sep 14;21(1):613. doi: 10.1186/s12891-020-03635-1.
It remains controversial whether the older age to perform closed reduction (CR) procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among different age groups, and to analyze and identify risk factors for the failure of this procedure.
Clinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC).
A total of 107 patients (156 hips) undergoing CR procedure were evaluated with a median age at initial reduction of 13.0 ± 5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7 ± 0.8 years (range, 3-8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p = 0.033), age ≥ 18 months (p = 0.012), and pre-op IHDI IV (p = 0.004) and walking (p = 0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age).
Severe DDH patients older than 18 months with CR procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR procedure.
对于发育性髋关节发育不良（DDH），行闭合复位（CR）的年龄越大，并发症的发生率越高，这一观点仍存在争议。本研究旨在评估不同年龄段行 CR 治疗 DDH 的中期结果，并分析和确定该手术失败的风险因素。
回顾性分析 107 例接受 CR 治疗的 DDH 患者的临床资料。根据初始治疗年龄将数据分为三组（I 组：<12 个月；II 组：12 个月至<18 个月；III 组：>18 个月）。观察有无股骨头缺血性坏死（AVN）、残余髋臼发育不良（RAD）、再脱位和进一步手术（FS）。使用单变量逻辑回归模型确定上述结局的风险因素。对于确定的风险因素年龄、术前髋臼指数（AI）和术后 AI，通过受试者工作特征曲线（ROC）评估其对 CR 失败的预测能力。
共 107 例（156 髋）患者接受 CR 治疗，初次复位时的中位年龄为 13.0±5.4 个月（4-28 个月）。本研究的平均随访时间为 6.7±0.8 年（3-8 年）。AVN、RAD 和再脱位的发生率分别为 15.4%（24/156）、17.3%（27/156）和 14.7%（23/156）。对于 AVN、RAD 和再脱位，显著的风险因素分别为术前髋臼指数头包容指数（IHDI）IV 型（p=0.033）、年龄≥18 个月（p=0.012）和术前 IHDI IV 型（p=0.004）和行走（p=0.011）。每种类型失败的 ROC 曲线下面积分别为 0.841（术后 AI）、0.688（术前 AI）和 0.650（年龄）。
对于行 CR 治疗的年龄较大的重度 DDH 患者，可能会导致 RAD 并发症的高风险。再脱位与术前 IHDI IV 型和行走显著相关。年龄大于 12.5 个月或术前 AI 为 38.7°或术后 AI 为 26.4°的患者，也更有可能出现 CR 治疗失败。
