发育性髋脱位早期保守治疗后残余半脱位的长期随访  

Residual subluxation after early close reduction for developmental dislocation of the hip： a long-termfollow-up

作　　者：付喆[1] 杨建平[1] 曾裴[1] 张中礼[1] 

机构地区：[1]天津医院小儿骨科,300211

出　　处：《中华骨科杂志》2013年第5期473-479,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨发育性髋脱位（developmental dislocation of the hip，DDH）早期手术干预的时机与指证。方法纳入2000年1月之前出生，经保守治疗后1年内出现残余半脱位畸形，至生长发育停止（髋臼“Y”形软骨闭合）系列骨盆正位X线片完整的DDH患儿共36例48髋。测量髋臼指数（acetabularindex，AI）、Reimers指数和CE角，并观察髋臼眉弓形态。采用Severin标准，对末次随访X线片分级，SeverinI、Ⅱ级为优良，SeverinⅢ、Ⅳ级为中差，分析两组患儿在随访过程中系列X线片各指标的改变。结果闭合复位时平均年龄1．6岁，末次随访时平均年龄13．8岁，最终18髋（37％，18／48）为SeverinI、Ⅱ级，30髋（63％，30，48）为SeverinⅢ、Ⅳ级。两组患儿3-4岁时Reimers指数（34.4％±4．5％和43．0％±4．6％）的差异有统计学意义，4～5岁时Reimers指数（29.3％±7.2％和40．0％±6．2％）及CE角（21．0°±5．5°和10．6°±5．2°）的差异均有统计学意义。3-4岁时Reimers指数〉38％（18／18，100％）、4-5岁时Reimers指数〉33％（26／30，87％）的患儿最终为SeverinⅢ、Ⅳ级；4-5岁时Reimers指数〉33％且眉弓向上倾斜（26／26，100％）的患儿最终为SeverinⅢ、Ⅳ级。结论患儿3-4岁时Reimers指数〉38％、4-5岁时Reimers指数〉33％、眉弓向上倾斜，明显提示远期Seveing分级为Ⅲ、Ⅳ级，应考虑手术矫正，以避免和预防成年后早发性骨关节炎的发生。Objective To analyze the natural development of the residual subluxation after earlyclose reduction for developmental dislocation of the hip, and to seek the early surgical timing and indication. Methods The research included 36 patients （48 hips） born before January 2000 who showed residual subluxation after close reduction in one year. All of patients had serial X-ray radiographs at every follow-up point. The radiographs were assessed using acetabular index （AI）, Reimers index, center edge （CE） angle and the orientation of the sourcil of the acetabulum. The last follow-up results were evaluated according to the Severin classification, and Severin grade I and II were defined as satisfactory group and Severin grade III and IV as unsatisfactory group. Then we compared and analyzed the serial radiological parameters between satisfactory and unsatisfactory groups. Results The mean age at close reduction was 1.6 years. At the last follow-up, the mean age was 13.8 years. The satisfactory group comprised 18 hips （37%）, whereas the unsatisfactory group comprised 30 hips （63%）. At the age of three to four years, there was a significant differ- ence between the two groups in the Reimers index （34.4%±4.5% vs. 43.0%±4.6%, P 〈 0.05）. And at four to five years old, there were significant differences for both Reimers index and CE angle （29.3%±7.2% vs. 40.0%±6.2%, P 〈 0.05; 21.0°±5.5° vs. 10.6°±5.2°, P 〈 0.05）. When the Reimers index 〉38% at the age of three to four years, 18 of 18 hips fell into the unsatisfactory group. And when Reimers index 〉33% at the age of four to five years, 26 of 30 hips had unsatisfactory result, and in addition to that the sourcil orienta- tion was upward, 26 of 26 hips fell into the unsatisfactory group. Conclusion To avoid early osteoarthritis, surgical correction for residual subluxation was recommended if the Reimees index 〉38% at the age of three to four years or the Reimers index 〉33% with the sourcil upward at the age of four to five years.

关 键 词：髋脱位 先天性 预后 随访研究 

分 类 号：R726.8[医药卫生—儿科]