出生时接受髋关节发育不良治疗且1岁时髋臼指数正常的儿童：5岁时有多少人存在残余发育不良？
Children treated for developmental dysplasia of the hip at birth and with normal acetabular index at 1 year: How many had residual dysplasia at 5 years?
作者信息
Håberg Øyvind, Bremnes Thomas, Foss Olav A, Angenete Oskar, Lian Øystein B, Holen Ketil J
机构信息
Department of Orthopedic Surgery, Kristiansund Hospital, Kristiansund, Norway.
Institute of Neuromedicine and Movement Science, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway.
出版信息
J Child Orthop. 2022 Jun;16(3):183-190. doi: 10.1177/18632521221106376. Epub 2022 Jun 30.
PURPOSE
The purpose of the study was to assess the effect of further follow-up for children treated for developmental dysplasia of the hip, with normal clinical and radiological findings at 1-year time point. The effect was quantified by the number of hips with a pathologic deterioration up to 5 years.
METHODS
Among 47,289 children born in Sør-Trøndelag county in Norway between 2003 and 2015, 265 children had developmental dysplasia of the hip. Of these, 164 children (239 hips) treated for developmental dysplasia of the hip with normal clinical findings and normal acetabular index at the 1-year time point were included in the study. The number of hips with pathologic acetabular index at the 5-year time point were reported. The diagnostic uncertainty related to radiological measurements was quantified together with the effect of introducing a second radiographic measurement, the center edge angle.
RESULTS
A total of 239 treated hips were normal at the 1-year time point. At 5-year time point, 10 (4.2%) hips had a pathologic acetabular index measurement and none classified to have developmental dysplasia of the hip caused by measurement inaccuracy. Eight (3.3%) hips had pathologic center edge angle measurement. Four hips had both pathologic acetabular index and center edge angle measurements, with three later treated with surgery. The intra- and interobserver repeatability coefficients were within 3.1°-6.6°.
CONCLUSION
The repeatability coefficient of the acetabular index measurements was high and no hips could be classified to have developmental dysplasia of the hip at the 5-year time point when taking this repeatability into account. Hips classified as pathologic combining acetabular index and center edge angle measurements were likely to be treated with surgery for residual dysplasia. We recommend further follow-up for these children.
LEVEL OF EVIDENCE
level II.
目的
本研究旨在评估对髋关节发育不良患儿进行进一步随访的效果，这些患儿在1年时间点时临床和放射学检查结果正常。通过5年内出现病理恶化的髋关节数量来量化该效果。
方法
在2003年至2015年期间于挪威南特伦德拉格郡出生的47289名儿童中，有265名儿童患有髋关节发育不良。其中，164名（239个髋关节）在1年时间点时接受了髋关节发育不良治疗且临床检查结果正常、髋臼指数正常的儿童被纳入研究。报告了5年时间点时髋臼指数异常的髋关节数量。对与放射学测量相关的诊断不确定性以及引入第二项放射学测量指标——中心边缘角的效果进行了量化。
结果
共有239个接受治疗的髋关节在1年时间点时正常。在5年时间点时，10个（4.2%）髋关节的髋臼指数测量结果异常，且没有因测量不准确而被归类为患有髋关节发育不良的情况。8个（3.3%）髋关节的中心边缘角测量结果异常。4个髋关节的髋臼指数和中心边缘角测量结果均异常，其中3个后来接受了手术治疗。观察者内和观察者间的重复性系数在3.1°至6.6°之间。
结论
髋臼指数测量的重复性系数较高，考虑到这一重复性，在5年时间点时没有髋关节可被归类为患有髋关节发育不良。髋臼指数和中心边缘角测量结果均异常的髋关节可能因残留发育不良而接受手术治疗。我们建议对这些儿童进行进一步随访。
证据水平
二级。
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