Tolk Jaap J, Merchant Rajiv, Eastwood Deborah M, Buddhdev Pranai, Hashemi-Nejad Aresh
Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK.
Department of Orthopaedic Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
Indian J Orthop. 2021 Aug 30;55(6):1568-1575. doi: 10.1007/s43465-021-00492-5. eCollection 2021 Dec.
INTRODUCTION: Leg-length difference (LLD) is common in patients with developmental dysplasia of the hip (DDH). LLD of > 1 cm at skeletal maturity is reported in > 40% of patients, with the majority related to ipsilateral overgrowth. A longer DDH leg might lead to excessive mechanical loading at the acetabular margin, resulting in compromised acetabular development. We hypothesised that the LLD would negatively influence acetabular development. If so, it would be advantageous to identify such patients early in the course of follow-up, and address this if necessary. METHODS: A retrospective study was conducted on a consecutive series of DDH patients managed surgically at the Royal National Orthopaedic Hospital, Stanmore, United Kingdom. We included patients with adequate long-leg radiographs at the age of 4-8 years (early-FU) and skeletal maturity (final-FU). Bilateral cases and those who underwent surgical procedures for hip dysplasia during the follow-up period were excluded. Measurements including leg length and centre-edge-angle (CE-angle) were obtained at the 2 time points. RESULTS: Twenty-seven patients were included, mean age at early-FU 5.7 (± 0.9) years, and 13.9 (± 1.0) years at final-FU. Mean LLD at early-FU was 9.5 (± 7.6) mm and 10.9 (± 9.4) mm at final-FU, = 0.337. Correlation between early- and final-FU LLD was 0.68 ( < 0.001). The mean CE-angle at early follow-up was 14.6° (± 9.8), this improved to 23.2° (± 8.2) at skeletal maturity ( = 0.003, paired samples -test). Linear regression analysis showed a non-significant trend towards less CE-angle improvement in patients with more initial residual dysplasia and more initial LLD. CONCLUSION: Most leg-length differences can be identified early in the follow-up period, nevertheless, considerable individual changes in LLD are observed on continued follow-up. Furthermore, a trend was observed towards impaired acetabular improvement in patients with more LLD. These findings justify careful clinical and radiological monitoring of LLD from an early stage in the follow-up period. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-021-00492-5.
引言：腿长差异（LLD）在发育性髋关节发育不良（DDH）患者中很常见。据报道，超过40%的患者在骨骼成熟时腿长差异>1cm，大多数与同侧过度生长有关。DDH侧腿较长可能导致髋臼边缘承受过大的机械负荷，从而影响髋臼发育。我们假设LLD会对髋臼发育产生负面影响。如果是这样，在随访过程中尽早识别此类患者并在必要时加以处理将是有益的。 方法：对英国斯坦莫尔皇家国立骨科医院连续接受手术治疗的一系列DDH患者进行回顾性研究。我们纳入了在4至8岁（早期随访）和骨骼成熟时（最终随访）有足够长腿X线片的患者。排除双侧病例以及在随访期间因髋关节发育不良接受手术的患者。在两个时间点进行包括腿长和中心边缘角（CE角）在内的测量。 结果：纳入27例患者，早期随访时平均年龄5.7（±0.9）岁，最终随访时平均年龄13.9（±1.0）岁。早期随访时平均LLD为9.5（±7.6）mm，最终随访时为10.9（±9.4）mm，P = 0.337。早期和最终随访时LLD的相关性为0.68（P<0.001）。早期随访时平均CE角为14.6°（±9.8），骨骼成熟时改善至23.2°（±(8.2)）（P = 0.003，配对样本t检验）。线性回归分析显示，初始残余发育不良和初始LLD较多的患者，CE角改善程度有不显著的降低趋势。 结论：大多数腿长差异可在随访早期识别，但在持续随访中观察到LLD有相当大的个体变化。此外，观察到LLD较多的患者髋臼改善有受损趋势。这些发现证明在随访期早期对LLD进行仔细的临床和影像学监测是合理的。 补充信息：在线版本包含可在10.1007/s43465-021-00492-5获取的补充材料。
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