Texas Scottish Rite Hospital for Children, Dallas, Texas.
University of Texas Southwestern Medical Center, Dallas, Texas.
J Bone Joint Surg Am. 2021 Feb 3;103(3):235-242. doi: 10.2106/JBJS.20.00562.
Outcomes studies following successful closed reduction of late-detected developmental dysplasia of the hip (DDH) reveal high rates of secondary reconstructive surgery with limited comparative data demonstrating lower rates of residual dysplasia with open reduction. The purpose of this study was to compare long-term outcomes, with regard to radiographic evidence of residual dysplasia and secondary reconstructive procedures, between late closed and late open reduction for DDH in patients 6 to 24 months of age at reduction.
We identified all patients between 6 and 24 months of age who underwent closed or open reduction for DDH between 1980 and 2008 and were followed until at least 10 years of age. Outcomes included radiographic measurement of acetabular dysplasia after triradiate cartilage closure, development of osteonecrosis, and the need for secondary procedures for residual dysplasia.
One hundred and four hips underwent index closed reduction and 54 hips underwent index open reduction. There was no significant difference in the age at reduction (p = 0.07). Among the 116 hips for which initial anteroposterior pelvic radiographs were available, most closed reductions (55%) were performed in International Hip Dysplasia Institute (IHDI) grade-III hips whereas most open reductions (71%) were performed in IHDI grade-IV hips. Analysis of the hips that did not undergo a secondary procedure showed that those with an index open reduction had a greater lateral center-edge angle (mean and standard deviation, 27.2° ± 10.0° versus 22.4° ± 6.8° in the closed reduction cohort; p = 0.02), lower femoral head extrusion index (22.2% ± 8.9% versus 26.0% ± 6.2%; p = 0.04), and lower Sharp angle (43.3° ± 6.0° versus 46.6° ± 3.1°; p = 0.002) at triradiate closure. There was no difference in the prevalence of osteonecrosis (Bucholz-Ogden grades II, III, and IV) between the closed and open reduction cohorts (22% versus 19%, respectively; p = 0.60). Secondary procedures were performed more frequently after closed reduction than after open reduction (47% versus 30%, respectively; p = 0.03).
In patients with late reduction of DDH, closed reduction was associated with increased residual dysplasia and it was associated with a higher rate of secondary surgery in those >12 months old despite a decreased severity of displacement based on the IHDI classification. Additional, prospective studies with assessment of functional outcomes are needed to validate these findings.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
对迟发性发育性髋关节发育不良（DDH）成功闭合复位后的结果研究显示，二次重建手术的发生率较高，而开放性复位的残余发育不良率较低的比较数据有限。本研究的目的是比较 6 至 24 个月龄儿童迟发性闭合和迟发性开放性复位治疗 DDH 的长期结果，以评估复位后残余发育不良的放射学证据和二次重建手术。
我们确定了 1980 年至 2008 年间接受闭合或开放性复位治疗的 6 至 24 个月龄 DDH 患者，并随访至至少 10 岁。结果包括闭合复位后闭孔软骨闭合时髋臼发育不良的放射学测量、股骨头坏死的发生以及残余发育不良需要二次手术。
104 髋行指数闭合复位，54 髋行指数开放复位。复位年龄无显著差异（p = 0.07）。在初始前后骨盆 X 线片可评估的 116 髋中，大多数闭合复位（55%）在国际髋关节发育不良研究所（IHDI）分级-III 髋中进行，而大多数开放复位（71%）在 IHDI 分级-IV 髋中进行。对未行二次手术的髋关节进行分析显示，行指数开放性复位的髋关节外侧中心边缘角更大（平均值和标准差，27.2°±10.0°与闭合复位组的 22.4°±6.8°；p = 0.02），股骨头外展指数更低（22.2%±8.9%与 26.0%±6.2%；p = 0.04），Sharp 角更小（43.3°±6.0°与 46.6°±3.1°；p = 0.002）。闭合复位和开放复位组的股骨头坏死（Bucholz-Ogden 分级 II、III 和 IV）发生率无差异（分别为 22%和 19%；p = 0.60）。闭合复位后行二次手术的频率高于开放复位（分别为 47%和 30%；p = 0.03）。
在迟发性 DDH 患者中，闭合复位与残余发育不良的发生率增加有关，尽管基于 IHDI 分类，其脱位严重程度较低，但与开放性复位相比，12 个月以上的患者行二次手术的比例更高。需要进一步的前瞻性研究来评估功能结果，以验证这些发现。
治疗 III 级。请参阅作者说明以获取完整的证据水平描述。
