切开复位和 Salter 髂骨截骨术联合股骨截骨术治疗发育性髋关节发育不良：4 岁前后结果比较。
Open reduction and Salter innominate osteotomy combined with femoral osteotomy in the treatment of developmental dysplasia of the hip: Comparison of results before and after the age of 4 years.
机构信息
Department of Orthopedics and Traumatology, Mersin University, School of Medicine, Mersin, Turkey.
Clinic of Orthopedics and Traumatology, Ardahan State Hospital, Ardahan, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2021 Jan;55(1):28-32. doi: 10.5152/j.aott.2021.17385.
OBJECTIVE
This study aimed to compare the clinical and radiological findings of radical reduction (open reduction and Salter innominate osteotomy combined with femoral osteotomy) for children of walking age, younger and older than 4 years in the treatment of with developmental dysplasia of the hip (DDH).
METHODS
In this retrospective study, children of walking age with DDH who underwent radical reduction between 2008 and 2014 were identified. They were then divided into 2 groups according to the age at which the surgery was performed: before and after the age of 4 years. Improvement in the acetabular index was examined on follow-up radiographs. The presence of avascular necrosis (AVN) was determined and classified on the basis of the Kalamchi-MacEwen classification on final follow-up radiographs. Clinical assessment was performed with the modified McKay criteria at the final follow-up appointment.
RESULTS
A total of 19 children (14 girls, 5 boys; mean age=37.5±21 months) (25 hips) were included. Their mean age was 27.9±4.9 and 63.3±19.7 months in children operated before and after the age of 4 years, respectively. The mean follow-up time was 29.9±19 and 19.6±5 months in children operated before and after the age of 4 years, respectively. No significant difference was observed in improvements in the acetabular index between children younger than 4 years (24±6.9°) and those older than 4 years (20.7±6.7°) (p=0.25). According to the modified McKay criteria, all the children younger than 4 years exhibited excellent or good clinical results compared with those operated after the age of 4 years (67%) (p=0.013). At the final follow-up, 64% of all patients demonstrated no radiographical sign of AVN. The rates of AVN were significantly higher in children operated after the age of 4 years (33%) than in those operated before the age of 4 years (19%) (p=0.049).
CONCLUSION
Better clinical and radiographical results can be expected from radical reduction in children undergoing surgery before the age of 4 years.
LEVEL OF EVIDENCE
level III, Therapeutic Study.
目的
本研究旨在比较手术年龄在行走期的儿童中，4 岁以下和 4 岁以上接受根治性复位（切开复位和 Salter 骨盆截骨术联合股骨截骨术）治疗发育性髋关节发育不良（DDH）的临床和影像学结果。
方法
在这项回顾性研究中，确定了 2008 年至 2014 年期间接受根治性复位的行走期儿童患者。然后根据手术年龄将其分为两组：4 岁前和 4 岁后。通过随访 X 线片检查髋臼指数的改善情况。根据 Kalamchi-MacEwen 分类，在最终随访 X 线片上确定并分类有无缺血性坏死（AVN）。在最终随访时，采用改良 McKay 标准进行临床评估。
结果
共纳入 19 名儿童（14 名女孩，5 名男孩；平均年龄=37.5±21 个月）（25 髋）。4 岁前手术的儿童平均年龄为 27.9±4.9 岁，4 岁后手术的儿童平均年龄为 63.3±19.7 岁。4 岁前手术的儿童平均随访时间为 29.9±19 个月，4 岁后手术的儿童平均随访时间为 19.6±5 个月。4 岁以下儿童（24±6.9°）与 4 岁以上儿童（20.7±6.7°）髋臼指数改善程度无显著差异（p=0.25）。根据改良 McKay 标准，所有 4 岁以下儿童的临床结果均优于 4 岁后手术的儿童（67%）（p=0.013）。最终随访时，所有患者中 64%无影像学 AVN 征象。4 岁后手术的儿童（33%）的 AVN 发生率明显高于 4 岁前手术的儿童（19%）（p=0.049）。
结论
4 岁以下儿童接受根治性复位术可获得更好的临床和影像学结果。
证据水平
III 级，治疗性研究。
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