Liu Lei, Xiong Qing-Guang, Dai Zhen-Zhen, Ding Jing, Wu Zhen-Kai, Dai Yun
Department of Orthopedics, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China.
Department of Orthopedics, Maoming People's Hospital, Maoming, Guangdong, China.
Orthop Surg. 2025 Jun;17(6):1702-1709. doi: 10.1111/os.70043. Epub 2025 Apr 22.
For children aged 18 months and above with developmental dysplasia of the hip (DDH), treatment typically involves open reduction and hip reconstruction surgery. However, there is limited literature evaluating the efficacy of closed reduction in this patient population. The purpose of this study was to investigate the clinical efficacy of closed reduction and spica cast immobilization treatment for children aged 18 months and above with DDH, as well as the incidence of avascular necrosis of the femoral head (ANFH) and their associated risk factors.
We retrospectively reviewed all children aged 18 months and above undergoing closed reduction and spica cast immobilization for DDH in our institution from January 2014 to December 2020. We found 51 hips suffered from closed reduction failure and identified 51 hips with successful closed reduction that matched the hips in the failure group in terms of age (difference < 1 month), weight (difference < 2 kg), and same gender. For patients with bilateral DDH, we prioritized self-matching, pairing the failed side with the successfully treated side. Relevant clinical data were collected and compared between the two groups. Multiple analyses of risk factors for closed reduction failure and ANFH were conducted by logistic regression.
In all, 61 patients (102 hips) were included in our study, 2 boys and 59 girls. Compared with the success group, the failure group more commonly had a higher International Hip Dysplasia Institute (IHDI) classification (Type III: 23.53% vs. 15.69%; Type IV: 60.78% vs. 23.53%, p < 0.001), a higher preoperative acetabular index (AI) index (39.42 ± 5.50 vs. 34.03 ± 6.15, p < 0.001), and a higher preoperative migration percentage (MP) (0.81 ± 0.27 vs. 0.54 ± 0.36, p < 0.001). Adjusting for other factors, the IHDI classification Types III-IV was the independent factor associated with closed reduction failure. Compared with the IHDI classification Type I, the failure risk of Type III and Type IV was increased 16.87 and 52.13 times, respectively (p < 0.05). ANFH was observed in three patients (4 hips, 4/102, 3.92%). All cases of ANFH occurred in the closed reduction failure group. The higher preoperative MP was related to the ANFH occurrence significantly through the unilateral factor analysis (0.98 ± 0.05 vs. 0.66 ± 0.34, p < 0.001). Adjusting for other factors, we did not find any independent factor regarding the ANFH occurrence (p > 0.05).
For patients aged 18 months and above with DDH, an IHDI classification assessment is necessary before closed reduction and spica cast immobilization. For patients classified as IHDI classification Types III and IV, active consideration of open reduction is advisable.
对于18个月及以上患有发育性髋关节发育不良（DDH）的儿童，治疗通常包括切开复位和髋关节重建手术。然而，评估该患者群体中闭合复位疗效的文献有限。本研究的目的是探讨闭合复位及髋人字石膏固定治疗18个月及以上DDH患儿的临床疗效，以及股骨头缺血性坏死（ANFH）的发生率及其相关危险因素。
我们回顾性分析了2014年1月至2020年12月在我院接受DDH闭合复位及髋人字石膏固定的所有18个月及以上儿童。我们发现51例髋关节闭合复位失败，并确定了51例闭合复位成功的髋关节，这些髋关节在年龄（差异<1个月）、体重（差异<2 kg）和性别相同方面与失败组的髋关节相匹配。对于双侧DDH患者，我们优先进行自身匹配，将失败侧与成功治疗侧配对。收集两组的相关临床数据并进行比较。通过逻辑回归对闭合复位失败和ANFH的危险因素进行多因素分析。
本研究共纳入61例患者（102个髋关节），其中男孩2例，女孩59例。与成功组相比，失败组更常见的是国际髋关节发育不良协会（IHDI）分类更高（III型：23.53%对15.69%；IV型：60.78%对23.53%，p<0.001），术前髋臼指数（AI）更高（39.42±5.50对34.03±6.15，p<0.001），术前移位百分比（MP）更高（0.81±0.27对0.54±0.36，p<0.001）。在调整其他因素后，IHDI分类III-IV型是与闭合复位失败相关的独立因素。与IHDI分类I型相比，III型和IV型的失败风险分别增加了16.87倍和52.13倍（p<0.05）。3例患者（4个髋关节，4/102，3.92%）出现ANFH。所有ANFH病例均发生在闭合复位失败组。通过单因素分析，术前较高的MP与ANFH的发生显著相关（0.98±0.05对0.66±0.34，p<0.001）。在调整其他因素后，我们未发现与ANFH发生相关的任何独立因素（p>0.05）。
对于18个月及以上的DDH患者，在进行闭合复位及髋人字石膏固定前，有必要进行IHDI分类评估。对于分类为IHDI分类III型和IV型的患者，建议积极考虑切开复位。
