Li Chenyang, Zhou Weizheng, Chen Yufan, Canavese Federico, Li Lianyong
Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Pediatric Orthopedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, Lille, France.
Front Pediatr. 2023 Jan 10;10:1072831. doi: 10.3389/fped.2022.1072831. eCollection 2022.
Closed reduction is a common treatment method for developmental dysplasia of the hip (DDH) in children aged 6-18 months. Residual acetabular dysplasia (RAD) is the most common complication associated with closed reduction. Residual limbus inversion (RLI) is a common condition following DDH closed reduction. Previously, we confirmed that when limbus inversion exceeds 32.2% of the acetabular depth after closed reduction, RLI persists and leads to RAD; however, this was based on a small cohort with a short-term follow-up period. The long-term fate of RLI and the correlation between RLI and RAD have yet to be verified. Therefore, this multicenter clinical study protocol was designed in three parts to investigate the effect of RLI on acetabular development after closed reduction of DDH (a multicenter retrospective cohort study), effect of RLI clearance on acetabular development (a multicenter retrospective and prospective randomized controlled study), and influence of inverted limbus clearance on acetabular development during DDH reduction (a multicenter prospective cohort study). Statistical analysis was performed by assessing the basic measures of acetabular development including the acetabular index and central-edge angle using frontal pelvic radiographs; the magnitude of limbus inversion, cartilaginous acetabular index, and T1ρ mapping values were measured using magnetic resonance imaging. The multicenter retrospective cohort studies required 5 years of follow-up period at minimum, and the prospective randomized controlled studies required reviews of frontal pelvic radiographs every 6 months as well as data pooling every 2 years to compare the short- and mid-term outcomes of hip joint morphological development between the two groups of pediatric patients. This research program is expected to verify that RLI following closed reduction of DDH can affect acetabular development and that limbus excision during DDH reduction can improve postoperative RAD. Therefore, the indication and timing of surgical intervention for RLI after closed reduction of DDH provide a basis for revising the acceptable criteria for utilizing closed reduction of DDH to reduce the incidence of osteoarthritis caused by RAD following DDH treatment. http://www.chictr.org.cn/showproj.aspx?proj=35045 (ChiCTR1900020996).
闭合复位是6 - 18个月儿童发育性髋关节发育不良（DDH）的常见治疗方法。残余髋臼发育不良（RAD）是与闭合复位相关的最常见并发症。残余髋臼盂唇内翻（RLI）是DDH闭合复位后的常见情况。此前，我们证实，闭合复位后髋臼盂唇内翻超过髋臼深度的32.2%时，RLI持续存在并导致RAD；然而，这是基于一个小队列且随访期较短得出的结论。RLI的长期转归以及RLI与RAD之间的相关性尚未得到验证。因此，本多中心临床研究方案分为三个部分，以研究RLI对DDH闭合复位后髋臼发育的影响（一项多中心回顾性队列研究）、RLI清除对髋臼发育的影响（一项多中心回顾性和前瞻性随机对照研究）以及DDH复位过程中髋臼盂唇内翻清除对髋臼发育的影响（一项多中心前瞻性队列研究）。通过使用骨盆正位X线片评估髋臼发育的基本指标，包括髋臼指数和中心边缘角进行统计分析；使用磁共振成像测量髋臼盂唇内翻程度、软骨髋臼指数和T1ρ映射值。多中心回顾性队列研究至少需要5年的随访期，前瞻性随机对照研究需要每6个月复查骨盆正位X线片，并每2年汇总数据，以比较两组儿科患者髋关节形态发育的短期和中期结果。本研究计划有望验证DDH闭合复位后的RLI会影响髋臼发育，并且DDH复位过程中的髋臼盂唇切除可改善术后RAD。因此，DDH闭合复位后RLI手术干预的指征和时机为修订DDH闭合复位的可接受标准提供了依据，以降低DDH治疗后由RAD引起的骨关节炎发生率。 http://www.chictr.org.cn/showproj.aspx?proj=35045 (ChiCTR1900020996)
