12至18个月大及18个月以上发育性髋关节发育不良（DDH）患者闭合复位后残余髋关节发育不良的预测因素及一项残余髋关节发育不良标准的可靠性：一项回顾性队列研究
Predictors of residual hip dysplasia in 12-18-month-old over 18-month-old DDH patients after closed reduction and the reliability of one residual hip dysplasia criterion: a retrospective cohort study.
作者信息
Dai Lixia, Huang Peng, Pei Xinhong
机构信息
Department of Orthopaedics, Xiamen Children's Hospital, Xiamen, China.
Department of Orthopaedics, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
出版信息
Transl Pediatr. 2023 May 30;12(5):861-870. doi: 10.21037/tp-22-299. Epub 2023 Apr 27.
BACKGROUND
The diagnostic and prediction criteria of residual hip dysplasia (RHD) remains controversial. There were no studies that focused on the risk factors of RHD after closed reduction (CR) in children with developmental dislocation of the hips (DDH) over 12 months of age. In this study, we assessed the percentage of RHD in DDH patients aged 12 to 18 months that in DDH patients aged over 18 months after CR and determine the predictors of RHD. Meanwhile, we tested the reliability of our RHD criteria compared with Harcke standard.
METHODS
Patients over 12 months of age who underwent successful CR from October 2011 to November 2017 and followed up for at least 2 years were enrolled. Gender, affected side, age at CR and follow-up time were recorded. Acetabular index (AI), horizontal acetabular width (AWh), center-to-edge angle (CEA), and femoral head coverage (FHC) were measured. The cases were divided into two groups according to whether older than 18 months. RHD was determined according to our criteria.
RESULTS
A total of 82 patients (107 hips) were included, including 69 females (84.1%), 13 males (15.9%), 25 patients (30.5%) with bilateral DDH, 33 patients (40.2%) with left side, 24 patients (29.3%) with right side, 40 patients (49 hips) with age 12-18 months, and 42 patients (58 hips) with age >18 months. At a mean follow-up of 47.8 [24-92] months, the percentage of RHD was higher in patients >18 months of age (58.6%) than patients 12-18 months of age (40.8%), but the difference was not statistically significant. Binary logistic regression analysis showed that pre-AI, pre-AWh, and improvement in AI and AWh (P=0.025, 0.016, 0.001, 0.003, respectively) had significant difference. The sensitivity and specialty of our RHD criteria were 81.82% and 82.69%, respectively.
CONCLUSIONS
For patients with DDH over 18 months, CR is still a choice. We documented four predictors of RHD, suggesting that we should focus on the developmental potential of an individual's acetabulum. Our RHD criteria may be one of the reliable and useful tools in clinical practice to help determine whether to perform continuous observation or surgery, but further research is needed due to limited sample size and follow-up time.
背景
残余髋关节发育不良（RHD）的诊断和预测标准仍存在争议。目前尚无研究聚焦于12个月以上发育性髋关节脱位（DDH）患儿闭合复位（CR）后RHD的危险因素。在本研究中，我们评估了12至18个月DDH患者及18个月以上DDH患者CR后RHD的发生率，并确定RHD的预测因素。同时，我们将我们的RHD标准与Harcke标准相比较，测试其可靠性。
方法
纳入2011年10月至2017年11月期间成功接受CR且随访至少2年的12个月以上患者。记录性别、患侧、CR时年龄及随访时间。测量髋臼指数（AI）、髋臼水平宽度（AWh）、中心边缘角（CEA）和股骨头覆盖率（FHC）。根据年龄是否大于18个月将病例分为两组。根据我们的标准确定RHD。
结果
共纳入82例患者（107髋），其中女性69例（84.1%），男性13例（15.9%）；双侧DDH患者25例（30.5%），左侧33例（40.2%），右侧24例（29.3%）；年龄12 - 18个月患者40例（49髋），年龄>18个月患者42例（58髋）。平均随访47.8 [24 - 92]个月，年龄>18个月患者的RHD发生率（58.6%）高于12 - 18个月患者（40.8%），但差异无统计学意义。二元逻辑回归分析显示，术前AI、术前AWh以及AI和AWh的改善（P分别为0.025、0.016、0.001、0.003）有显著差异。我们的RHD标准的敏感性和特异性分别为81.82%和82.69%。
结论
对于18个月以上的DDH患者，CR仍是一种选择。我们记录了RHD的四个预测因素，提示我们应关注个体髋臼的发育潜力。我们的RHD标准可能是临床实践中帮助确定是否进行持续观察或手术的可靠且有用的工具之一，但由于样本量和随访时间有限，仍需进一步研究。
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