The Medical School of Chinese People's Liberation Army (PLA); Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China (mainland).
Med Sci Monit. 2020 Oct 25;26:e926239. doi: 10.12659/MSM.926239.
BACKGROUND Indications for subtrochanteric shortening osteotomy (SSOT) during Crowe type IV developmental dysplasia of the hip (DDH) are unclear. The aim of this retrospective study was to create a model to predict the need for performing SSOT. MATERIAL AND METHODS One hundred forty-nine patients (186 hips) with Crowe Type IV DDH who underwent total hip arthroplasty (THA) with S-ROM implants from January 2010 to November 2018 were included in the study. The acetabular components were placed at the true acetabulum and the trial femoral component was inserted. Reduction then was attempted and if it could not be achieved, SSOT was performed. Using multivariable Cox regression analysis, a model was constructed that included age, sex, surgical history, use of a cone- or triangle-shaped sleeve, secondary acetabulum formation, and percentage of dislocation as predictive factors for SSOT. RESULTS SSOTs were performed on 140 of 186 hips. Secondary acetabulum formation was present in 27 hips (58.70%) in which SSOT was not performed 7 (5.00%) in which it was performed. Cone-shaped sleeves were used in 17 hips (36.96%) in which SSOT was not performed versus 15 (10.71%) hips in which it was performed. Dislocation occurred in 31.30±5.80% hips in which SSOT was performed versus 24.05±4.39% of those in which it was not performed. Percentage of dislocation was associated with an increased likelihood of SSOT (odds ratio [OR] 1.24, 95% confidence interval 1.11-1.38), whereas secondary acetabulum formation (OR 0.10, 0.03-0.33) and use of a cone-shaped sleeve (0.18, 0.06-0.53) were associated with decreased likelihood of SSOT. We established a model for prediction of SSOT with a nanogram and the discriminative ability (C statistic) of it was 0.918 (0.79-0.92). CONCLUSIONS Factors that significantly affect likelihood of performing an SSOT were identified and a model with significant ability to predict the need for SSOT in patients with Crowe Type IV DDH was created.
在 Crowe Ⅳ型发育性髋关节发育不良（DDH）中，股骨转子下缩短截骨术（SSOT）的适应证尚不清楚。本回顾性研究的目的是建立一个预测 SSOT 需求的模型。
纳入了 2010 年 1 月至 2018 年 11 月期间因 Crowe Ⅳ型 DDH 接受 S-ROM 假体全髋关节置换术（THA）的 149 例患者（186 髋）。髋臼组件置于真髋臼，试用股骨组件插入。如果不能复位，则尝试进行 SSOT。使用多变量 Cox 回归分析，建立一个包括年龄、性别、手术史、使用锥形或三角形袖套、二期髋臼形成以及脱位百分比的模型，作为 SSOT 的预测因素。
186 髋中，140 髋进行了 SSOT。未行 SSOT 的 27 髋中存在二期髋臼形成（58.70%），而行 SSOT 的仅 7 髋（5.00%）存在二期髋臼形成。未行 SSOT 的 17 髋使用了锥形袖套（36.96%），而行 SSOT 的 15 髋（10.71%）使用了锥形袖套。行 SSOT 的 31.30±5.80%髋发生脱位，而未行 SSOT 的 24.05±4.39%髋发生脱位。脱位百分比与 SSOT 的可能性增加相关（比值比[OR] 1.24，95%置信区间 1.11-1.38），而二期髋臼形成（OR 0.10，0.03-0.33）和锥形袖套的使用（OR 0.18，0.06-0.53）与 SSOT 可能性降低相关。我们建立了一个预测 SSOT 的纳米模型，其判别能力（C 统计量）为 0.918（0.79-0.92）。
确定了显著影响 SSOT 实施可能性的因素，并为 Crowe Ⅳ型 DDH 患者建立了一个具有显著预测 SSOT 需求能力的模型。
