骨化核对发育性髋关节脱位术后股骨头缺血性坏死的影响研究  

Effect of ossification on avascular necrosis of femoral head after operation for developmental dysplasia of the hip

作　　者：鲁婵 唐兹诞 康晓鹏[1] 周游[1] Lu Chan;Tang Zidan;Kang Xiaopeng;Zhou You(Department of Orthopedics,Municipal Children's Hospital,Kunming 650000,China)

机构地区：[1]昆明市儿童医院骨科,昆明650000

出　　处：《临床小儿外科杂志》2024年第3期216-222,共7页Journal of Clinical Pediatric Surgery

基　　金：云南省杨军林专家工作站(202205AF150062)

摘　　要：目的探讨股骨头骨化核对6~24月龄发育性髋关节脱位(developmental dysplasia of the hip,DDH)患儿治疗后发生股骨头缺血性坏死(avascular necrosis of femoral head,AVN)的影响。方法回顾性分析2018年1月至2022年1月期间在昆明市儿童医院接受石膏固定术治疗的6~24月龄DDH患儿的髋关节临床资料。依据末次随访时患髋股骨头是否坏死分为:AVN(+)组(Kalamchi-MacEwen分型Ⅰ~Ⅳ型)、AVN(-)组(Kalamchi-MacEwen分型未见坏死);根据股骨头是否出现临床坏死分为临床AVN(+)组(Kalamchi-MacEwen分型Ⅱ~Ⅳ型)、临床AVN(-)组(Kalamchi-MacEwen分型Ⅰ型或未见坏死);根据手术年龄分为6~12月龄组、12~18月龄组和18~24月龄组。比较AVN(+)组与AVN(-)组患儿性别、患髋骨化核状态、侧别、手术年龄、手术方式、术前国际髋关节发育不良协会(International Hip Dysplasia Institute,IHDI)分型、术前髋臼指数(acetabular index,AI)值、外展角度,采用二元Logistic回归分析评估DDH术后发生AVN的独立影响因素,基于独立影响因素绘制受试者操作特征(receiver operating characteristic,ROC)曲线评估其对DDH术后发生AVN的诊断效能。对比临床AVN(+)组与临床AVN(-)组患髋的骨化核状态,分析骨化核状态对临床AVN的影响。对比6~12月龄组、12~18月龄组、18~24月龄组患髋AVN发生率、临床AVN发生率、再脱位发生率、残余髋臼发育不良(residual acetabular dysplasia,RAD)发生率。结果本研究共纳入221髋。AVN(+)组54髋,AVN(-)组167髋。患髋中有骨化核者AVN发生率为18.1%(27/149),无骨化核者ANV发生率为37.5%(27/72),有骨化核者AVN发生率显著低于无骨化核者(P=0.002)。多因素Logistic回归分析发现,骨化核状态(OR=3.064,95%CI:1.486~6.319)、外展角度(OR=1.184,95%CI:1.110~1.264)、术前IHDI分型(OR=3.821,95%CI:1.465~9.968)是DDH术后发生AVN的独立影响因素(P<0.05)。ROC曲线分析显示外展角度预测DDH术后发生AVN的最佳截断值为63.5°,曲�Objective To explore the effect of ossified nuclei on avascular necrosis of femoral head(AVN)in children aged 6-24 month with developmental dysplasia of the hip(DDH)and examine whether or not DDH therapy should be deferred until the emergence of ossified nuclei.Methods The clinical data of hip joint in children with DDH aged 6 to 24 months who received plaster fixation in Kunming Children's Hospital from January 2018 to January 2022 were retrospectively analyzed.According to the necrosis of the hip head at the last follow-up,it was divided into:AVN(+)group(Kalamchi-MacEwen typeⅠ~Ⅳ),AVN(-)group(Kalamchi-MacEwen type no necrosis),The femoral head was divided into clinical AVN(+)group(Kalamchi-MacEwen typeⅡtoⅣ)and clinical AVN(-)group(Kalamchi-MacEwen type I or no necrosis)according to whether clinical necrosis occurred,and were divided into 6 to 12 months of age group,12 to 18 months of age group and 18 to 24 months of age group according to operative age.The ossified nucleus status,gender,side,age,mode of operation,preoperative IHDI classification,preoperative AI value,and abduction Angle of the affected hip were compared between the AVN(+)group and the AVN(-)group,and the independent influencing factors of postoperative AVN were evaluated by multivariate Logistic regression analysis.receiver operating characteristic curve(ROC)was drawn based on independent influencing factors to evaluate its diagnostic efficacy for postoperative AVN after DDH.The status of ossified nucleus of hip in clinical AVN(+)group and clinical AVN(-)group were compared to analyze the influence of ossified nucleus status on clinical AVN.The incidence of AVN,clinical AVN,redislocation and residual acetabular dysplasia(RAD)of the affected hip in the 6-12 months age group,the 12-18 months age group and the 18-24 months age group were analyzed.Results A total of 221 hips were included in the study.The AVN(+)group had 54 hips and the AVN(-)group had 167 hips.In all affected hips,the incidence of AVN with ossified nucleus was 18.1%,and the

关 键 词：发育性髋关节脱位 股骨头缺血性坏死 外科手术 儿童 

分 类 号：R726.8[医药卫生—儿科]