髋关节发育不良关节复位后造影中内卷缘的临床意义

The Clinical Significance of Infolded Limbus on Postreduction Arthrogram in Developmental Dysplasia of the Hip.

机构信息

Scottish Rite for Children.

Southwestern Medical Center, University of Texas, Dallas, TX.

出版信息

J Pediatr Orthop. 2022 Apr 1;42(4):e309-e314. doi: 10.1097/BPO.0000000000002070.

DOI:10.1097/BPO.0000000000002070

PMID:35132011

Abstract

BACKGROUND

The purpose of this study was to investigate whether presence of an infolded limbus on hip arthrogram at index closed reduction was associated with increased residual dysplasia or secondary surgery.

METHODS

We retrospectively reviewed all patients who underwent closed reduction for dysplasia of the hip with a minimum 2-year follow-up between 1980 and 2016. Demographic data was obtained including the age at reduction and severity of dislocation based on the International Hip Dysplasia Institute (IHDI) classification. Arthrograms performed at time of closed reduction were separately reviewed by 3 fellowship-trained pediatric orthopaedic surgeons to evaluate for an infolded limbus. The primary radiographic outcome was acetabular indices at 2 and 4 years postreduction. We also assessed the presence of avascular necrosis and rate of secondary reconstructive surgery for residual dysplasia.

RESULTS

A total of 182 hips in 165 patients underwent closed reduction at a mean age of 9.8±4.5 mo and were followed a mean of 9.0±4.9 y. An infolded limbus was identified in 20.3% (37/182) hips with substantial agreement among the 3 graders (Fleiss κ=0.75). The frequency of labral infolding increased with the severity of dislocation (8.8%% of IHDI II, 26.7% IHDI III, and 25.0% of IHDI IV hips; P=0.03). Hips with infolded limbus were older at reduction (12.4±5.3 vs. 9.2±5.8 mo, P=0.001). The mean acetabular index was higher in hips with infolded limbus than hips without at 2 years postreduction (34.8±4.8 vs. 32.6±5.8 degrees, respectively; P=0.04). However, multivariate analysis revealed that only the severity of dislocation predicted dysplasia at 2 years postreduction. No significant difference in acetabular index was seen at 4 years postreduction (27.2±7.4 vs. 25.4±6.5 degrees, P=0.24). There was no difference in avascular necrosis between groups (P=0.74). There was no difference in rate of secondary surgery between hips with labral infolding and those without (35% vs. 30%, respectively; P=0.52).

CONCLUSIONS

An infolded limbus was more common in older patients with more severe dislocations. However, it is not associated with increased residual dysplasia or secondary surgery and may have limited utility in decision-making during closed reduction.

LEVEL OF EVIDENCE

Level II-prognostic study.

摘要

背景

本研究旨在探讨髋关节造影术中闭孔复位时是否存在内卷边与残余发育不良或二次手术的关系。

方法

我们回顾性分析了 1980 年至 2016 年间接受髋关节发育不良闭合复位治疗且至少随访 2 年的所有患者。收集了包括复位时年龄和脱位严重程度在内的人口统计学数据，脱位严重程度根据国际髋关节发育不良研究所（IHDI）分类进行评估。由 3 名接受过小儿矫形外科专业培训的医生分别对髋关节造影术进行单独评估，以评估是否存在内卷边。主要的放射学结果是复位后 2 年和 4 年的髋臼指数。我们还评估了存在股骨头骨骺缺血性坏死和残余发育不良的二次重建手术的情况。

结果

共 165 例患者的 182 髋接受了闭合复位，平均年龄为 9.8±4.5 个月，平均随访 9.0±4.9 年。在 3 名评分者中，存在内卷边的髋关节比例为 20.3%（37/182），具有很高的一致性（Fleiss κ=0.75）。唇状突内卷的发生率随脱位的严重程度而增加（IHDI II 型为 8.8%，IHDI III 型为 26.7%，IHDI IV 型为 25.0%；P=0.03）。存在内卷边的髋关节在复位时年龄较大（12.4±5.3 岁 vs. 9.2±5.8 个月；P=0.001）。复位后 2 年，存在内卷边的髋关节髋臼指数高于无内卷边的髋关节（分别为 34.8±4.8 度和 32.6±5.8 度；P=0.04）。然而，多变量分析显示，只有脱位的严重程度是预测复位后 2 年发育不良的因素。复位后 4 年，髋臼指数无显著差异（分别为 27.2±7.4 度和 25.4±6.5 度；P=0.24）。两组股骨头骨骺缺血性坏死发生率无差异（P=0.74）。存在唇状突内卷的髋关节与无内卷边的髋关节之间的二次手术率无差异（分别为 35%和 30%；P=0.52）。