Lucchesi Giovanni, Sacco Riccardo, Zhou Weizheng, Li YiQiang, Li Lianyong, Canavese Federico
Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
Department of Orthopedic and Traumatology, Orthopedic and Trauma Center, Turin, Italy.
Indian J Orthop. 2021 Sep 29;55(6):1503-1514. doi: 10.1007/s43465-021-00531-1. eCollection 2021 Dec.
The best treatment option in children with late detected DDH is still a subject of much controversy and only few studies have investigated the long-term outcome of treatment in such patients. We performed a systematic review to assess long-term outcome of late detected DDH hips treated after walking age.
Studies met inclusion criteria if they: (1) reported at least 30 hips treated; (2) included children aged between 9 months and 12 years; (3) treatment indication was late detected DDH after walking age; (4) presented a minimum follow-up of 10 years; (5) reported a clinical or radiological outcome. The Kaplan-Meier method was used to evaluate long-term survival according to clinical and radiological outcomes. The rate of total hip replacement (THR) was retrieved.
From a total of 6561 articles, 13 articles with grade IV level of evidence were included in our review. A total of 988 hips in 800 patients with a mean follow-up of 27.9 years (range 10-67) were included. The mean age at surgery was 3.3 years (range, 9 months-12 years). The rate of THR increased according to the length of final follow-up. In particular, all studies reported no case of THR at 23.5 years of follow-up, a rate of 10.2% of THR between 30 and 40 years of follow-up and a rate of 35.6% of THR in patients with follow-up more than 40 years.
In patients with late detected DDH, most THR became necessary more than 30 years after the index procedure and their number increased further after 40 years and more of follow-up. Late detected DDH diagnosed after walking age is a life-long disease.
对于晚发性发育性髋关节发育不良（DDH）患儿，最佳治疗方案仍存在诸多争议，仅有少数研究调查了此类患者治疗的长期结局。我们进行了一项系统评价，以评估行走年龄后治疗的晚发性DDH髋关节的长期结局。
若研究符合以下标准则纳入：（1）报告至少30例髋关节接受治疗；（2）纳入年龄在9个月至12岁之间的儿童；（3）治疗指征为行走年龄后晚发性DDH；（4）至少随访10年；（5）报告临床或放射学结局。采用Kaplan-Meier方法根据临床和放射学结局评估长期生存率。检索全髋关节置换（THR）率。
从总共6561篇文章中，我们的综述纳入了13篇证据等级为IV级的文章。共纳入800例患者的988个髋关节，平均随访27.9年（范围10 - 67年）。手术时的平均年龄为3.3岁（范围9个月至12岁）。THR率随最终随访时间延长而增加。特别是，所有研究报告在随访23.5年时无THR病例，随访30至40年时THR率为10.2%，随访超过40年的患者中THR率为35.6%。
在晚发性DDH患者中，大多数全髋关节置换在首次手术30多年后变得必要，40年及更长时间的随访后其数量进一步增加。行走年龄后诊断的晚发性DDH是一种终身疾病。
