Sllamniku Sabit, Beqo Besiana P, Krasniqi Islam, Tërshana Azem, Murtezani Ardiana, Quehenberger Franz, Haxhija Emir Q
Orthopedic Department, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo.
Department of Postgraduate Medical Education, Global Clinical Scholars Research Program, Harvard Medical School, Boston, MA, United States.
Front Pediatr. 2022 Apr 26;10:850605. doi: 10.3389/fped.2022.850605. eCollection 2022.
The aim of this study was to determine whether the use of analgesia and sedation (AS) as opposed to general anesthesia (GA) for closed reduction and spica casting of children with severe developmental dysplasia of the hip (DDH) influenced the long-term incidence of avascular necrosis (AVN). In a prospective, randomized, single-blinded clinical trial we investigated 100 pediatric patients with DDH type IIIa, IIIb, and IV (according to Graf classification), who were randomly assigned into the group receiving AS, and the group receiving GA. Baseline demographics, splint duration, and type of DDH were carefully assessed. The presence of AVN was assessed at the follow-up visits at 1 and 7 years after the end of treatment. The AS-group consisted of 50 patients (46 girls) with 76 hips affected ( = 11/Type-IIIa, = 32/Type-IIIb, and = 33/Type-IV). The GA-group consisted also of 50 patients (44 girls) with 78 hips involved ( = 15/Type-IIIa, = 34/Type-IIIb, and = 29/Type-IV). At 7-years follow-up, AVN was diagnosed in 9 of 154 hips (5.8%), 5 hips in the AS-group and 4 hips in the GA group. The logistic regression model showed no significant difference in AVN incidence between the AS and GA groups at 7-years follow-up ( = 0.27). The multivariate regression analysis showed that neither the type of DDH nor the age at diagnosis influenced the incidence of AVN ( = 0.48 and = 0.28, respectively). Splint duration was identified as the only significant factor for the long-term incidence of AVN in the treatment of severe DDH. For every month of longer splint duration, the odds of AVN at 7-years follow-up increased by a factor of 3.81 (95%: 1.35-13.73, = 0.02). Closed reduction and spica casting of children with severe DDH under AS can be considered a feasible alternative to management under GA. All efforts must be made to diagnose patients with DDH as early as possible and shorten the duration of splint treatment to prevent the development of AVN. Level of Evidence. Level II-1.
本研究的目的是确定在对患有严重发育性髋关节发育不良（DDH）的儿童进行闭合复位和髋人字石膏固定时，使用镇痛镇静（AS）而非全身麻醉（GA）是否会影响股骨头缺血性坏死（AVN）的长期发生率。在一项前瞻性、随机、单盲临床试验中，我们调查了100例IIIa、IIIb和IV型（根据Graf分类）的DDH儿科患者，他们被随机分为接受AS的组和接受GA的组。仔细评估了基线人口统计学、夹板使用时间和DDH类型。在治疗结束后1年和7年的随访中评估AVN的存在情况。AS组由50例患者（46名女孩）组成，76个髋关节受累（IIIa型=11个，IIIb型=32个，IV型=33个）。GA组也由50例患者（44名女孩）组成，78个髋关节受累（IIIa型=15个，IIIb型=34个，IV型=29个）。在7年随访时，154个髋关节中有9个（5.8%）被诊断为AVN，AS组5个髋关节，GA组4个髋关节。逻辑回归模型显示，在7年随访时，AS组和GA组之间的AVN发生率无显著差异（P=0.27）。多变量回归分析表明，DDH类型和诊断时的年龄均未影响AVN的发生率（分别为P=0.48和P=0.28）。夹板使用时间被确定为严重DDH治疗中AVN长期发生率的唯一显著因素。夹板使用时间每延长1个月，7年随访时AVN的发生几率增加3.81倍（95%置信区间：1.35 - 13.73，P=0.02）。在AS下对严重DDH儿童进行闭合复位和髋人字石膏固定可被视为GA下治疗的一种可行替代方案。必须尽一切努力尽早诊断DDH患者并缩短夹板治疗时间，以预防AVN的发生。证据级别。II - 1级。
