De Salvo Sara, Lu Yunan, Shi Liwei, Wang Wentao, Sammartino Fabio, Dimeglio Alain, Pavone Vito, Chen Shunyou, Li Lianyong, Canavese Federico
Department of Pediatric Orthopedic Surgery, Faculty of Medicine, Lille University Hospital, Av. Eugene Avinée, Lille, 59000, France.
Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy.
Arch Orthop Trauma Surg. 2025 Mar 17;145(1):194. doi: 10.1007/s00402-025-05802-2.
Current understanding of the outcomes of post-traumatic hip dislocation (PHD) in pediatric patients is limited. The purpose of this study is to evaluate the radiologic, clinical, and functional outcomes of patients with PHD, whether isolated or associated with acetabular (ACF) or proximal femoral fractures (PFF), and to identify potential risk factors for adverse outcomes.
This is a retrospective study of pediatric patients with PHD who were consecutively enrolled at three different institutions between 01/2016 and 06/2023. Patients were divided into three groups: PHD (PHD group), PHD with ACF (ACF group), and PHD with PFF (PFF group). Standard radiographs were used to classify each PHD and to identify the presence of other associated bone lesions. Clinical and functional outcomes were assessed using the Harris Hip Score (HHS). Avascular necrosis (AVN) was determined according to the Ratliff criteria. The association between outcome and associated injuries, age at trauma (≤ 10 versus > 11 years), traumatic mechanism (low versus high energy), reduction type (open versus closed), and direction of dislocation (posterior versus anterior) was evaluated.
Sixty-six cases of unilateral PHD (63 posterior and 3 anterior) were analyzed, consisting of 43 males and 23 females with a mean age of 10.7 years (1-18). Of these, 24 patients were ≤ 10 years old (36.4%), 16 of whom (66.7%) had low-energy trauma. Meanwhile, 42 patients were > 11 years old (63.6%), of which 26 had high-energy trauma (61.9%; p < 0.05). It was observed that patients in the PHD group were significantly younger than those in the ACF and PFF groups (p < 0.05). ACF group had 2/25 patients with misdiagnosed ACF > 3 weeks after injury (8%) and 3/25 with concomitant ACF and PFF (12%), and PFF group had 4/12 patients with AVN (33.3%). Most patients had a favorable mean HHS score, being 97.3 for the PHD group, 93.8 for the ACF group, and 93.6 for the PFF group.
The outcome of PHD is worse in patients with AVN secondary to PFF, simultaneous ACF and PFF, misdiagnosed ACF, high-energy trauma, and older age at the time of injury. Advanced imaging, such as CT scan or MRI is necessary to rule out ACF in isolated dislocations. Timely diagnosis and treatment of these lesions usually result in a favorable outcome.
III.
目前对于小儿创伤后髋关节脱位（PHD）预后的了解有限。本研究的目的是评估PHD患者（无论单纯性还是合并髋臼骨折（ACF）或股骨近端骨折（PFF））的放射学、临床和功能预后，并确定不良预后的潜在危险因素。
这是一项对2016年1月至2023年6月期间在三个不同机构连续入组的小儿PHD患者的回顾性研究。患者分为三组：PHD（PHD组）、合并ACF的PHD（ACF组）和合并PFF的PHD（PFF组）。使用标准X线片对每个PHD进行分类，并确定是否存在其他相关骨损伤。使用Harris髋关节评分（HHS）评估临床和功能预后。根据Ratliff标准确定有无缺血性坏死（AVN）。评估预后与相关损伤、创伤时年龄（≤10岁与>11岁）、创伤机制（低能量与高能量）、复位类型（开放与闭合）以及脱位方向（后脱位与前脱位）之间的关联。
分析了66例单侧PHD病例（63例后脱位和3例前脱位），其中男性43例，女性23例，平均年龄10.7岁（1 - 18岁）。其中，24例患者≤10岁（36.4%），其中16例（66.7%）为低能量创伤。同时，42例患者>11岁（63.6%），其中26例有高能量创伤（61.9%；p<0.05）。观察到PHD组患者明显比ACF组和PFF组患者年轻（p<0.05）。ACF组有2/25例患者在受伤3周后ACF误诊>3周（8%），3/25例患者合并ACF和PFF（12%），PFF组有4/12例患者发生AVN（33.3%）。大多数患者的平均HHS评分良好，PHD组为97.3，ACF组为93.8，PFF组为93.6。
继发于PFF的AVN、同时合并ACF和PFF、ACF误诊、高能量创伤以及受伤时年龄较大的PHD患者预后较差。对于单纯性脱位，需要进行CT扫描或MRI等高级影像学检查以排除ACF。及时诊断和治疗这些损伤通常会取得良好的预后。
III级。
