Yong Ming, Xu Mengqiu, Lou Yue, Lin Gang
Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, China.
Front Pediatr. 2023 Mar 6;11:1089341. doi: 10.3389/fped.2023.1089341. eCollection 2023.
To investigate factors associated with postoperative avascular necrosis of the femoral head (ANFH) in developmental dysplasia of the hip (DDH) patients, and if or how the associations varied among different subpopulations of age, sex and surgical method.
Patients with DDH were enrolled between October 31, 2016 and July 15, 2020 in this retrospective cohort study. The average follow-up time was 21.42 ± 10.02 months. The outcome was postoperative ANFH. The main study variables were the DDH classification, Tonnis grade, International Hip Dysplasia Institute (IHDI) classification, and preoperative traction. Multivariate logistic regression was employed to assess the associations between main study variables and postoperative ANFH. Subgroup analysis was carried out based on age at reduction, sex and surgical method. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated.
A total of 427 children with DDH were included, with 92 (21.55%) in the ANFH group, and 335 (78.45%) in the non-ANFH group. DDH classification was positively correlated with the risk of postoperative ANFH (OR = 4.14, 95% CI, 1.08-15.77, = 0.038). Children with preoperative traction had a significantly decreased risk of postoperative ANFH in contrast to those without preoperative traction (OR = 0.37, 95% CI, 0.22-0.61, < 0.001). Children aged 1-3 years who received preoperative traction has a significantly reduced risk of postoperative ANFH than those who did not receive preoperative traction (OR = 0.28, 95% CI, 0.15-0.51, < 0.001). For children aged >3 years, positive association was found between DDH classification and the risk of postoperative ANFH (OR = 3.75, 95% CI, 1.51-9.31, = 0.004). Girls with a more severe DDH type had a significantly higher risk of postoperative ANFH (OR = 3.80, 95% CI, 1.80-8.02, < 0.001). Receiving preoperative traction was associated with a significantly decreased risk of postoperative ANFH in girls (OR = 0.37, 95% CI, 0.22-0.61, < 0.001). For children undergoing open reduction, DDH classification was positively associated with the risk of postoperative ANFH (OR = 3.01, 95% CI, 1.65-5.50, < 0.001), and those with preoperative traction had a lower risk of postoperative ANFH compared with those without preoperative traction (OR = 0.35, 95% CI, 0.20-0.61, < 0.001).
DDH classification and preoperative traction were associated with the risk of postoperative ANFH, and these associations varied across DDH patients with different ages, sexes and surgical methods.
探讨发育性髋关节发育不良（DDH）患者术后股骨头缺血性坏死（ANFH）的相关因素，以及这些关联在不同年龄、性别和手术方法亚组中是否存在差异及如何变化。
本回顾性队列研究纳入了2016年10月31日至2020年7月15日期间的DDH患者。平均随访时间为21.42±10.02个月。观察指标为术后ANFH。主要研究变量包括DDH分类、托尼斯分级、国际髋关节发育不良协会（IHDI）分类和术前牵引。采用多因素logistic回归分析评估主要研究变量与术后ANFH之间的关联。根据复位时年龄、性别和手术方法进行亚组分析。计算比值比（OR）和95%置信区间（CI）。
共纳入427例DDH患儿，其中ANFH组92例（21.55%），非ANFH组335例（78.45%）。DDH分类与术后ANFH风险呈正相关（OR = 4.14，95%CI，1.08 - 15.77，P = 0.038）。与未进行术前牵引的患儿相比，术前进行牵引的患儿术后ANFH风险显著降低（OR = 0.37，95%CI，0.22 - 0.61，P < 0.001）。1 - 3岁接受术前牵引的患儿术后ANFH风险比未接受术前牵引的患儿显著降低（OR = 0.28，95%CI，0.15 - 0.51，P < 0.001）。对于年龄>3岁的患儿，DDH分类与术后ANFH风险呈正相关（OR = 3.75，95%CI，1.51 - 9.31，P = 0.004）。DDH类型较严重的女孩术后ANFH风险显著更高（OR = 3.80，95%CI，1.80 - 8.02，P < 0.001）。术前牵引与女孩术后ANFH风险显著降低相关（OR = 0.37，95%CI，0.22 - 0.61，P < 0.001）。对于接受切开复位的患儿，DDH分类与术后ANFH风险呈正相关（OR = 3.01，95%CI，1.65 - 5.50，P < 0.001），与未进行术前牵引的患儿相比，进行术前牵引的患儿术后ANFH风险更低（OR = 0.35，95%CI，0.20 - 0.61，P < 0.001）。
DDH分类和术前牵引与术后ANFH风险相关，且这些关联在不同年龄、性别和手术方法的DDH患者中存在差异。
