Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri.
Texas Children's Hospital, Houston, Texas.
J Pediatr Orthop B. 2024 Jul 1;33(4):322-327. doi: 10.1097/BPB.0000000000001122. Epub 2023 Sep 5.
The objective of this study was to analyze a multicenter cohort of children with developmental dysplasia of the hip (DDH) who underwent treatment with closed reduction. We sought to report the effects that severity of hip dysplasia and age have on the development of femoral head avascular necrosis (AVN) and the need for additional procedures. All patients with DDH and minimum 2 years of follow-up who underwent closed reduction were identified. The following variables were recorded: sex, laterality of hip involvement, age, acetabular index (AI), and International Hip Dysplasia Institute (IHDI) grade. The effects of patient age and pre-procedure IHDI grade on the rate of AVN and need for additional procedures after the closed reduction were analyzed using an alpha of 0.05. Seventy-eight total hips were included in the final analysis. The average patient age was 12 months. AVN of the femoral head was reported in 24 hips (30.8%) and 32 hips (41.0%) required additional surgery. Higher pre-op IHDI grade was associated with higher risk of developing Bucholz-Ogden grades II-IV AVN of the femoral head ( P = 0.025) and requiring additional surgery ( P = 0.033) regardless of patient age. There were no statistically significant differences for the effect of age on the measured outcomes ( P > 0.05). These findings suggest that severity of dislocation (IHDI grade) is a significant risk factor for the development of AVN and need for additional procedure.
本研究的目的是分析一组接受闭合复位治疗的发育性髋关节发育不良（DDH）儿童的多中心队列。我们旨在报告髋关节发育不良的严重程度和年龄对股骨头缺血性坏死（AVN）的发展和额外手术需求的影响。所有接受 DDH 治疗且随访至少 2 年的患者均接受闭合复位。记录了以下变量：性别、髋关节受累的侧别、年龄、髋臼指数（AI）和国际髋关节发育不良研究所（IHDI）分级。使用 0.05 的显著性水平分析患者年龄和术前 IHDI 分级对闭合复位后 AVN 发生率和额外手术需求的影响。最终分析纳入 78 个髋关节。患者平均年龄为 12 个月。24 个髋关节（30.8%）报告出现股骨头 AVN，32 个髋关节（41.0%）需要额外手术。较高的术前 IHDI 分级与较高的 Bucholz-Ogden Ⅱ-IV 级股骨头 AVN 发展风险（P=0.025）和额外手术需求相关（P=0.033），而与患者年龄无关。年龄对测量结果的影响无统计学意义（P＞0.05）。这些发现表明，脱位严重程度（IHDI 分级）是 AVN 发展和额外手术需求的重要危险因素。
