Kaneko Hiroshi, Kitoh Hiroshi, Kitamura Akiko, Sawamura Kenta, Hattori Tadashi
Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.
J Child Orthop. 2021 Dec 1;15(6):554-563. doi: 10.1302/1863-2548.15.210143.
This study aimed to explore the docking of the femoral head into the acetabulum after gradual reduction (GR) using traction for developmental dysplasia of the hip (DDH) and the impact on subsequent acetabular development.
A total of 40 patients with DDH (42 hips) undergoing GR using overhead traction and spica casting were retrospectively reviewed. The presence of inverted labrum and the coronal and axial femoral-acetabular distances (FADs) were compared between MRI immediately and five weeks after spica casting. The change in the acetabular index on anteroposterior pelvic radiographs were compared between hips with inverted labrum (residual group) and with normally-shaped labrum (normalized group) on follow-up MRI.
The mean age at reduction was 13.1 months (7 to 33) and the mean follow-up duration was 7.7 years (4 to 11). The rate of inverted labrum and the FADs significantly decreased between the MRI scans (all p-values < 0.001), and previous Pavlik harness failure had no negative effect on these decreases. The acetabular indices at the ages of three and five years in the residual group were significantly larger than those in the normalized group (both p-values < 0.001). Residual acetabular dysplasia was seen in 84.2% of the residual group compared with 34.8% of the normalized group (p = 0.002).
The docking phenomenon can occur during spica casting following GR using traction in children with DDH between the ages of six months and three years. The remaining inverted labrum at the cast removal may negatively affect subsequent acetabular development.
III - retrospective comparative study.
本研究旨在探讨采用牵引进行逐步复位（GR）治疗发育性髋关节发育不良（DDH）后股骨头与髋臼的对接情况以及对后续髋臼发育的影响。
回顾性分析40例（42髋）采用头环牵引及髋人字石膏固定进行GR治疗的DDH患者。比较髋人字石膏固定即刻及固定后5周MRI上盂唇内翻的情况以及冠状面和轴位的股骨髋臼距离（FAD）。比较随访MRI上盂唇内翻的髋关节（残留组）和盂唇形态正常的髋关节（正常化组）前后位骨盆X线片上髋臼指数的变化。
复位时的平均年龄为13.1个月（7至33个月），平均随访时间为7.7年（4至11年）。MRI扫描之间盂唇内翻率和FAD显著降低（所有p值<0.001），既往使用 Pavlik 吊带失败对这些降低没有负面影响。残留组3岁和5岁时的髋臼指数显著大于正常化组（两个p值<0.001）。残留组84.2%出现残留髋臼发育不良，而正常化组为34.8%（p = 0.002）。
6个月至3岁的DDH患儿采用牵引进行GR后在髋人字石膏固定期间可发生对接现象。去除石膏时残留的盂唇内翻可能对后续髋臼发育产生负面影响。
III - 回顾性比较研究。
