The First Affiliated Hospital of Jinan University, Jinan University.
Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou.
J Pediatr Orthop B. 2024 Jul 1;33(4):340-347. doi: 10.1097/BPB.0000000000001117. Epub 2023 Aug 15.
To investigate the factors influencing outcome of pelvic osteotomy (PO) for residual acetabular dysplasia (RAD) following closed reduction (CR) in patients with developmental dysplasia of the hip (DDH). We retrospectively reviewed 91 patients (95 hips) with DDH who underwent PO for RAD. Tönnis grade, Acetabular index, Center Edge Angle, Reimer's Index (RI), and avascular necrosis of the femoral head (AVN) were assessed. Hips were divided into satisfactory (Severin I/II) and unsatisfactory group (Severin III/IV). Finally, 87 hips (91.5%) had satisfactory and 8 (8.5%) unsatisfactory outcomes. The RI before PO was significantly higher in unsatisfactory (49.6 ± 9%) than in satisfactory group (30.6%±11.8%). All patients without AVN had satisfactory outcome, while it was 78.9% of patients with AVN. Logistic regression analysis showed that higher AVN grade and RI before PO were risk factors for unsatisfactory outcome. Satisfactory outcome was obtained in all hips with RI < 33% before PO, while it was 79.5% if RI > 33% before PO (79.5%). There was no difference in the satisfactory rate between patients undergoing open reduction (66.7%) and those not undergoing (83.3%). The rate of satisfactory outcome in patients undergoing femoral osteotomy (63.6%) was lower than those without it (100%). In patients with RAD following CR, good outcome can be expected after PO alone. AVN and preoperative RI > 33% are risk factors for poor outcome. Additional open reduction and femoral osteotomy do not significantly improve outcome of PO in patients with preoperative RI > 33%.
探讨闭合复位（CR）后残余髋臼发育不良（RAD）行骨盆截骨术（PO）的影响因素。我们回顾性分析了 91 例（95 髋）DDH 患者，均行 PO 治疗 RAD。评估 Tönnis 分级、髋臼指数、CE 角、Reimer 指数（RI）和股骨头缺血性坏死（AVN）。将髋关节分为满意（Severin I/II）和不满意组（Severin III/IV）。最终 87 髋（91.5%）获得满意，8 髋（8.5%）不满意。术前 RI 不满意组（49.6±9%）显著高于满意组（30.6%±11.8%）。无 AVN 患者均获得满意结果，而 AVN 患者为 78.9%。Logistic 回归分析显示，较高的 AVN 分级和术前 RI 是不满意结果的危险因素。术前 RI<33%的所有髋关节均获得满意结果，而 RI>33%的仅为 79.5%（79.5%）。RI<33%和 RI>33%的患者，行开放复位的满意比例分别为 66.7%和 83.3%，差异无统计学意义。行股骨截骨术的患者（63.6%）满意比例低于未行该术式者（100%）。CR 后 RAD 患者，单独行 PO 可获得良好的结果。AVN 和术前 RI>33%是预后不良的危险因素。术前 RI>33%的患者，附加开放复位和股骨截骨术不能显著改善 PO 效果。
