发育性髋关节发育不良闭合复位失败的发生率及危险因素：一项系统评价和荟萃分析

Rates and risk factors for failure of reduction in closed reduction in developmental dysplasia of the hip: a systematic review and meta-analysis.

作者信息

Domos Gyula, Váncsa Szilárd, Szeverényi Csenge, Agócs Gergely, Hegyi Péter, Perge Anna, Békési Krisztina, Varga Csaba, Szőke György

机构信息

Department of Orthopaedics, Semmelweis University, Budapest, Hungary.

Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.

出版信息

EFORT Open Rev. 2024 Sep 2;9(9):908-922. doi: 10.1530/EOR-24-0007.

DOI:10.1530/EOR-24-0007

PMID:39222331

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11457818/

Abstract

OBJECTIVE

In developmental dysplasia of the hip (DDH), concentric reduction of dislocated hips cannot be achieved by closed reduction in many cases, and open reduction is required ('failure of reduction'). The incidence of cases requiring open reduction and the significance of risk factors for unsuccessful reduction remain unclear. We investigated the overall rate and the risk factors for failed closed reduction in DDH.

METHODS

We followed the Cochrane recommendations in our systematic review and meta-analysis. We performed a systematic search in three medical databases to identify all studies reporting on pediatric patients with hip dislocation in DDH on 2 July 2022. Eligible studies reported on the rate of failure in children younger than 36 months. We calculated odds ratios (ORs) with 95% CIs from two-by-two tables (event rate in risk group, event rate in non-risk group).

RESULTS

We identified 13 316 studies and included 62 studies (5281 hips) for failure rate and 34 studies (3810 hips) for risk factor analysis. The overall rate of failure in closed reduction was 20%. The risk of failure of reduction increased with the grade of dislocation and was significantly higher for high dislocations (group 0-24: IHDI 4 vs IHDI 2 OR: 17.45, CI: 9.26-32.92; Tönnis 4 vs Tönnis 2 OR: 14.67, CI: 1.21-177.37; Graf IV vs Graf III OR: 3.4, CI: 2.27-5.09). Male gender was also a significant risk factor (OR: 2.27, CI: 1.13-4.56) in group 0-36.

CONCLUSION

Higher grade dislocations and male gender are significant risk factors for failure of reduction in closed reduction in hip dislocation in DDH.

摘要

目的

在发育性髋关节发育不良（DDH）中，许多情况下闭合复位无法实现脱位髋关节的同心复位，需要切开复位（“复位失败”）。需要切开复位的病例发生率以及复位失败的危险因素的意义仍不明确。我们调查了DDH中闭合复位失败的总体发生率和危险因素。

方法

我们在系统评价和荟萃分析中遵循Cochrane推荐意见。我们于2022年7月2日在三个医学数据库中进行了系统检索，以识别所有报告DDH中髋关节脱位儿科患者的研究。符合条件的研究报告了36个月以下儿童的失败率。我们从二乘二表（风险组事件发生率、非风险组事件发生率）计算95%可信区间的比值比（OR）。

结果

我们识别出13316项研究，纳入62项研究（5281例髋关节）进行失败率分析，34项研究（3810例髋关节）进行危险因素分析。闭合复位失败的总体发生率为20%。复位失败的风险随着脱位程度增加而升高，高位脱位时显著更高（0 - 24组：国际髋关节发育不良指数（IHDI）4级对比IHDI 2级，OR：17.45，可信区间：9.26 - 32.92；托尼斯（Tönnis）4级对比托尼斯2级，OR：14.67，可信区间：1.21 - 177.37；格拉夫（Graf）IV级对比格拉夫III级，OR：3.4，可信区间：2.27 - 5.09）。在0 - 36组中，男性也是一个显著的危险因素（OR：2.27，可信区间：1.13 - 4.56）。