Department of Pediatric Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Orthop. 2024 Mar 1;44(3):e211-e217. doi: 10.1097/BPO.0000000000002597. Epub 2023 Dec 25.
Developmental dysplasia of the hip is prevalent and is associated with dysplasia of both the femoral head and acetabulum. There is a paucity of literature describing femoral head remodeling after surgical reduction of developmentally dislocated hips. The purpose of this study was to describe and quantify changes in femoral head sphericity after closed or open reduction for developmental dysplasia of the hip.
A retrospective cohort study was performed including patients with typical developmental hip dislocations who underwent closed or open reduction from 2009 to 2022 at a single institution and had immediate postoperative and average 3-week follow-up magnetic resonance imaging (MRI) scans. A subset of patients also had 3-year follow-up MRI scans. Patients with insufficient imaging or bony procedures at the time of reduction were excluded. We developed a technique to quantify femoral head "sphericity" by comparing differences in measured radii of the femoral head on axial and coronal plane MRI slices. We then calculated the variance of the radii for each plane and averaged these to calculate a combined variance. The variance was used to represent "sphericity," with a larger variance indicating a wider distribution of radii and thus a less spherical shape.
A total of 74 patients (69 females) with 96 hips were included in this series. The median age of the child at the time of reduction was 8.7 months [interquartile range (IQR): 2.2]. Over half (58.3%) of the hips had a closed reduction, whereas the remaining were open reduced (41.7%). Immediately postoperatively, at the 3-week time point, and at the 3-year time point the median combined variance was 1.1 (IQR: 3.93), 0.51 (IQR: 1.32), and 0.31 (IQR: 0.50), respectively, indicating improved sphericity over time.
Sphericity of the femoral head in developmental hip dislocations improves in both the immediate postoperative period, as well as the first few years after reduction. Further research is needed to evaluate the mechanism of remodeling, the ideal timing of reduction, and the relationship between femoral head and acetabular remodeling.
Level IV-case series, therapeutic study.
发育性髋关节发育不良较为常见，与股骨头和髋臼均发育不良有关。目前，文献中很少描述发育性髋关节脱位手术后股骨头的重塑情况。本研究旨在描述和量化闭合或切开复位治疗发育性髋关节发育不良后股骨头球形度的变化。
这是一项回顾性队列研究，纳入了 2009 年至 2022 年在一家单机构接受闭合或切开复位治疗的具有典型发育性髋关节脱位的患者，并在术后即刻和平均 3 周的随访磁共振成像（MRI）检查中进行了研究。部分患者还进行了 3 年的随访 MRI 检查。排除了影像学资料不充分或在复位时存在骨手术的患者。我们开发了一种技术，通过比较股骨头在轴位和冠状位 MRI 切片上的测量半径差异来量化股骨头的“球形度”。然后，我们计算了每个平面的半径方差，并对这些方差进行平均，以计算出综合方差。方差用于表示“球形度”，方差越大，半径分布越广，形状越不规则。
本研究共纳入 74 例（69 例女性）96 髋。患儿的平均年龄为 8.7 个月[四分位间距（IQR）：2.2]。58.3%的髋关节行闭合复位，其余行切开复位（41.7%）。术后即刻、3 周和 3 年时，中位数综合方差分别为 1.1（IQR：3.93）、0.51（IQR：1.32）和 0.31（IQR：0.50），表明随着时间的推移球形度逐渐改善。
发育性髋关节脱位的股骨头球形度在术后即刻以及复位后数年逐渐改善。需要进一步研究以评估重塑机制、最佳复位时机以及股骨头与髋臼重塑之间的关系。
IV 级-病例系列，治疗性研究。
