发育性髋关节发育不良患儿闭合复位后再脱位的危险因素。
Risk factors for re-dislocation after closed reduction in children with developmental dysplasia of the hip.
机构信息
1. Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China.
2. Division of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China.
出版信息
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2022 Aug 1;51(4):454-461. doi: 10.3724/zdxbyxb-2022-0147.
OBJECTIVE
To investigate the risk factors for re-dislocation after the closed reduction in children with developmental dysplasia of the hip (DDH).
METHODS
The clinical data of 88 children aged ≤ 18 months with DDH (103 hips) who were treated with adductor muscle relaxation + closed reduction + plaster fixation at the Children's Hospital, Zhejiang University School of Medicine from January 2015 to December 2017, were retrospectively analyzed. According to the diagnostic criteria of hip dislocation, patients were divided into two groups: reduction group and re-dislocation group. The univariate and multivariate logistic regression analysis were applied to identify the risk factors for the re-dislocation of children.
RESULTS
Eighty-six patients (99 hips) successively underwent the treatment. 69 hips were fixed at the first intention, 9 hips at the second intention, and a total of 78 hips with no re-dislocation occurred till the last follow-up with a rate of 78.8%. The univariate analysis showed that preoperative acetabular index (AI), International Hip Dysplasia Institute (IHDI) grade, intraoperative hip flexion angle, and intraoperative head-socket spacing were significantly related to the occurrence of re-dislocation after closed-reduction. The multivariate logistic regression analysis showed that preoperative AI > 40.5° ( =5.57, <0.01), flexion angle < 80.5° ( =4.93, <0.01) and head-socket distance > 6.95 mm ( =8.42, <0.01) were risk factors for the re-dislocation. The area under the receiver operator characteristic curve was 0.91 when preoperative AI > 40.5°, flexion angle < 80.5°, head-socket distance > 6.95 mm, and IHDI grade were used to predict the occurrence of re-dislocation, and the sensitivity and specificity were 0.72 and 0.87, respectively.
CONCLUSIONS
Preoperative AI > 40.5°, intraoperative hip flexion angle < 80.5°, and head-socket distance > 6.95 mm are risk factors for postoperative re-dislocation in children with DDH. These risk factors combining with the IHDI grade would be better to predict the occurrence of re-dislocation.
目的
探讨发育性髋关节发育不良（DDH）患儿闭合复位后再脱位的危险因素。
方法
回顾性分析 2015 年 1 月至 2017 年 12 月浙江大学医学院附属儿童医院收治的 88 例≤18 月龄 DDH 患儿（103 髋）的临床资料，采用内收肌松解+闭合复位+石膏固定治疗。根据髋关节脱位的诊断标准，将患儿分为复位组和再脱位组。采用单因素和多因素 logistic 回归分析确定影响患儿再脱位的危险因素。
结果
86 例（99 髋）患儿顺利完成治疗。其中 69 髋获得Ⅰ期复位固定，9 髋获得Ⅱ期复位固定，78 髋复位后无再脱位，末次随访时无再脱位率为 78.8%。单因素分析显示，术前髋臼指数（AI）、国际髋关节发育不良研究所（IHDI）分级、术中髋关节屈曲角度和术中股骨头-髋臼间隙与闭合复位后再脱位的发生显著相关。多因素 logistic 回归分析显示，术前 AI＞40.5°（ =5.57，＜0.01）、屈曲角度＜80.5°（ =4.93，＜0.01）和股骨头-髋臼间隙＞6.95 mm（ =8.42，＜0.01）是再脱位的危险因素。当术前 AI＞40.5°、屈曲角度＜80.5°、股骨头-髋臼间隙＞6.95 mm 和 IHDI 分级用于预测再脱位的发生时，受试者工作特征曲线下面积为 0.91，敏感性和特异性分别为 0.72 和 0.87。
结论
术前 AI＞40.5°、术中髋关节屈曲角度＜80.5°和股骨头-髋臼间隙＞6.95 mm 是 DDH 患儿术后再脱位的危险因素。这些危险因素结合 IHDI 分级可以更好地预测再脱位的发生。
Zotero 插件