Department of Orthopaedic Surgery, Royal Manchester Children's Hospital, Manchester University Trust, Manchester, UK.
Department of Orthopaedic Surgery, Sophia's Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Bone Joint J. 2021 May;103-B(5):999-1004. doi: 10.1302/0301-620X.103B5.BJJ-2020-1485.R1.
The most important complication of treatment of developmental dysplasia of the hip (DDH) is avascular necrosis (AVN) of the femoral head, which can result in proximal femoral growth disturbances leading to pain, dysfunction, and eventually to early onset osteoarthritis. In this study, we aimed to identify morphological variants in hip joint development that are predictive of a poor outcome.
We retrospectively reviewed all patients who developed AVN after DDH treatment, either by closed and/or open reduction, at a single institution between 1984 and 2007 with a minimal follow-up of eight years. Standard pelvis radiographs obtained at ages one, two, three, five, and eight years, and at latest follow-up were retrieved. The Bucholz-Ogden classification was used to determine the type of AVN on all radiographs. Poor outcome was defined by Severin classification grade 3 or above on the latest follow-up radiographs and/or the need for secondary surgery. With statistical shape modelling, we identified the different shape variants of the hip at each age. Logistic regression analysis was used to associate the different modes or shape variants with poor outcome.
In all, 135 patients with AVN were identified, with a minimum of eight years of follow-up. Mean age at time of surgery was 7.0 months (SD 0.45), and mean follow-up was 13.3 years (SD 3.7). Overall, 46% had AVN type 1 while 54% type 2 or higher. More than half of the patients (52.6%) had a poor outcome. We found 11 shape variants that were significantly associated with a poor outcome. These shape variants were predominantly linked to AVN type 2 or higher.
Specific morphological characteristics on pelvis radiographs of AVN hips were predictive for poor outcome, at a very young age. There was an overall stronger association to Bucholz-Ogden types 2-3-4 with the exception of two modes at age two and five years, linked to AVN type 1. Cite this article: 2021;103-B(5):999-1004.
发育性髋关节发育不良（DDH）治疗中最重要的并发症是股骨头缺血性坏死（AVN），这可能导致股骨近端生长障碍，导致疼痛、功能障碍，最终导致早发性骨关节炎。本研究旨在确定髋关节发育的形态变异与不良预后相关。
我们回顾性分析了 1984 年至 2007 年期间在一家医院接受 DDH 治疗后发生 AVN 的所有患者，治疗方法包括闭合和/或切开复位，随访时间至少为 8 年。获取了患者 1 岁、2 岁、3 岁、5 岁和 8 岁时以及随访时的标准骨盆 X 线片。使用 Bucholz-Ogden 分类法确定所有 X 线片上的 AVN 类型。不良预后定义为末次随访 X 线片上 Severin 分级 3 级或以上和/或需要二次手术。使用统计形状建模，我们确定了每个年龄的不同髋关节形态变异。使用逻辑回归分析将不同的模式或形状变异与不良预后相关联。
共发现 135 例 AVN 患者，随访时间至少为 8 年。手术时的平均年龄为 7.0 个月（标准差 0.45），平均随访时间为 13.3 年（标准差 3.7）。总体而言，46%的患者为 AVN 1 型，54%的患者为 2 型或更高型。超过一半的患者（52.6%）预后不良。我们发现了 11 种与不良预后显著相关的形态变异。这些形态变异主要与 2 型或更高型的 AVN 相关。
在非常年幼时，AVN 髋关节的骨盆 X 线片上的特定形态特征与不良预后相关。除了 2 岁和 5 岁时与 AVN 1 型相关的两种模式外，总体上与 Bucholz-Ogden 2-3-4 型的相关性更强。
Dijkstra, PD, Luitse, JS, Ring, D, et al. (2021). Morphological hip variants as a predictor of poor outcome in avascular necrosis of the femoral head after treatment of developmental dysplasia of the hip. Bone Joint J, 103-B(5), 999-1004.
