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Background and purpose - Proximal femoral osteotomy (PFO) is commonly performed to treat children with developmental dysplasia of the hip (DDH). Implant-related femoral fractures after osteotomy are sometimes reported, but the potential risk factors for these fractures remain unclear. We investigated the association of implant-related fractures with PFO and potential risk factors for these fractures.Patients and methods - We retrospectively reviewed 1,385 children undergoing PFO for DDH in our institution from 2009 to 2016 after obtaining institutional review board (IRB) approval and identified 27 children (28 hips, fracture group) with implant-related femoral fractures after PFO. We selected 137 children (218 hips, control group) without fractures who matched the children in the fracture group by age, weight, surgeon, and surgical period. Relevant clinical data were collected and compared between the 2 groups. Multiple analyses of risk factors for implant-related fractures were conducted by logistic regression with the stepwise regression method.Results - The occurrence rate of implant-related fractures was 1.9% (27/1,385). Compared with the control group, the fracture group more commonly exhibited bilateral involvement (74% vs. 53%, p = 0.04), used a spica orthosis for immobilization after osteotomy (43% vs 21%, p = 0.01) and exhibited mild remodeling at the osteotomy site (46% vs. 19%, p = 0.003), and less commonly required capsulotomy during osteotomy (61% vs. 79%, p = 0.03). According to the multiple regression analysis, the only factor identified as an independent risk factor for implant-related fractures was mild remodeling at the osteotomy site (OR = 3.2, 95% CI 1.4-7.5). Remodeling at the osteotomy site was significantly associated with varus osteotomy (coefficient = 1.4, CI 1.03-1.8). The fracture occurred at a mean of 12 months (2.2-25) after osteotomy or 3.3 months (0-12) after implant removal. In children undergoing implant removal, the fractures mostly occurred at the osteotomy site (n = 13/15), while in those with the implant remaining, the fractures mostly occurred in the screw hole (n = 8/13).Interpretation - The type of PFO performed is not associated with implant-related fractures in children with DDH. Children with mild remodeling at the osteotomy site should be closely followed up, regardless of whether the hardware is removed, and high-intensity activity should not be permitted until moderate or extensive remodeling is confirmed. After PFO, the implants should be removed when solid union is achieved at the osteotomy site.

背景与目的 - 股骨近端截骨术（PFO）常用于治疗发育性髋关节发育不良（DDH）的儿童。虽然术后与植入物相关的股骨骨折时有报道，但这些骨折的潜在危险因素仍不清楚。我们研究了 PFO 与植入物相关骨折的关系，以及这些骨折的潜在危险因素。

患者与方法 - 我们在获得机构审查委员会（IRB）批准后，回顾性分析了 2009 年至 2016 年在我院接受 PFO 治疗的 1385 例 DDH 患儿的资料，共发现 27 例（28 髋，骨折组）术后发生与植入物相关的股骨骨折。我们选择了 137 例（218 髋，对照组）无骨折的患儿，这些患儿在年龄、体重、手术医生和手术期间与骨折组相匹配。收集并比较了两组患儿的相关临床资料。采用逐步回归法对与植入物相关骨折的危险因素进行多因素 logistic 回归分析。

结果 - 植入物相关骨折的发生率为 1.9%（27/1385）。与对照组相比，骨折组更常见双侧受累（74% vs. 53%，p=0.04），术后使用斯皮罗氏固定架固定（43% vs. 21%，p=0.01），且截骨部位轻度重塑（46% vs. 19%，p=0.003），截骨时行关节囊切开术的比例较低（61% vs. 79%，p=0.03）。根据多因素回归分析，唯一被确定为与植入物相关骨折相关的独立危险因素是截骨部位的轻度重塑（OR=3.2，95%CI 1.4-7.5）。截骨部位重塑与内翻截骨显著相关（系数=1.4，CI 1.03-1.8）。骨折发生在截骨术后 12 个月（2.2-25）或植入物取出后 3.3 个月（0-12）。在接受植入物取出的患儿中，骨折大多发生在截骨部位（n=13/15），而在保留植入物的患儿中，骨折大多发生在螺钉孔（n=8/13）。

结论 - 对于 DDH 患儿，PFO 的手术类型与植入物相关骨折无关。无论是否取出内固定物，对于截骨部位轻度重塑的患儿，都应密切随访，在确认中度或广泛重塑之前，避免高强度活动。在截骨部位达到骨愈合后，应取出 PFO 后的植入物。