发育性髋关节脱位闭合复位术后残留髋臼发育不良手术指证及时机的回顾性多中心研究  

Reoperative timing and management of residual deformity in developmental dislocation of the hip in children： summary of Southern China Pediatric Orthopedic Study Group

作　　者：徐宏文 梅海波[2] 郭跃明[3] 唐盛平[4] 沈先涛[5] 邵景范[6] 李进[7] 李敬春 

机构地区：[1]广州市妇女儿童医疗中心骨科,510623 [2]湖南省儿童医院骨科 [3]佛山市中医院小儿骨科 [4]深圳市儿童医院骨一科 [5]武汉市妇女儿童医疗保健中心骨科 [6]华中科技大学同济医学院附属同济医院小儿外科 [7]华中科技大学同济医学院附属协和医院骨科

出　　处：《中华小儿外科杂志》2016年第12期883-887,共5页Chinese Journal of Pediatric Surgery

基　　金：广东省医学科研基金（A2015487）

摘　　要：目的分析发育性髋关节脱位（developmental dislocation of the hip，DDH）闭合复位后残留髋臼发育不良指数变化的特点，探讨DDH闭合复位的最佳干预时间及治疗方案。方法回顾性分析2004年3月至2014年7月间7家医院277例DDH闭合复位后残留髋臼发育不良患儿的临床资料，分析患儿髋臼指数（acetabularindex，AI）变化。结果277例患儿中，男34例，女243例。闭合复位后18个月残留AI异常（髋臼发育不良）相关风险因素为：闭合时年龄、闭合复位术前的AI。统计DDH患儿行闭合复位前、后不同时间点AI，其在逐渐减小，且在闭合复位1年内下降最快，2～4年后AI下降基本稳定。手术干预组（22例）术后1年AI为（18．8±1．1）度，与术前（30．6±0．9）度比较，差异有统计学意义（P=0．001）。保守治疗组（255例）复位后3年平均AI为（26．7±4．5）度与手术干预组干预后1年平均AI（18．2±1．6）度比较，差异有统计学意义（P=0．001）。保守治疗组复位后4年平均AI为（24．9±5．3）度与手术干预组干预后2年平均AI（14．8±2．3）度比较，差异有统计学意义（P=0．001）。结论闭合复位后残留髋臼发育不良的风险因素为闭合复位时的年龄、闭合复位术前的AI。手术干预的近期效果较保守治疗好。在DDH在闭合复位2～4年后，如仍存在髋臼发育不良，AI〉23度，应考虑进行手术干预治疗。Objective To explore the acetabular index changes of DDH and examine the indication, timing and treatment for residual deformity after closed reduction. Methods The clinical data of 277 DDH children with residual acetabular dysplasia after closed reduction at 7 medical center in South China were collected from March 2004 to July 2014. Acetabular index changes were analyzed. Results A total of 277 DDH cases with residual acetabular developmental dysplasia were recruited.There were 34 boys and 243 girls. The risk factors associated with abnormal acetabular index （acetabular dysplasia） were age and acetabular index changes after closed reduction. Acetabular index decreased to a plateau at 2 to 4 years thereafter. Compared with preoperative acetabular index （30. 6 ± 0. 9）, acetabular index of surgical intervention group after 1 year （18. 8 ±1. 1 ） was statistically significant （P = 0. 001）. Compared with average acetabular index （26. 7± 4. 5） of conservative treatment group after reduction at 3 years, the average acetabular index （18. 2 ± 1. 6） of surgical intervention group at I year was statistically significant （P = 0. 001 ）. Compared with average acetabular index （24. 9 ± 5.3） of conservative treatment group after reduction at 4 years, the average acetabular index （14. 8 ± 2. 3） of surgical intervention group at 2 years was statistically significant （P = 0. 001）. Conclusions The risk factors of residual acetabular dysplasia after closed reduction are age and acetabular index changes. The shortterm outcome of surgical intervention is better than that of conservative treatment. At 2 to 4 years after closed reduction, persistent acetabular dysplasia and acetabular index 〉23 degrees require surgical interventions.

关 键 词：髋关节脱位 闭合复位术 髋臼发育不良 

分 类 号：R726.8[医药卫生—儿科]