儿童发育性髋关节脱位闭合复位术后髋关节恢复正常X线表现影响因素的多中心回顾性研究  

Factors influencing the probability to achieve normal pelvic radiographs in children with developmental dysplasia of the hip undergoing closed reduction:a multi-center retrospective study

作　　者：黎艺强 刘行[2] 郭跃明[3] 陈顺有[4] 沈先涛[5] 梅海波[6] 邵景范[7] 唐盛平[8] 徐宏文 Li Yiqiang;Liu Hang;Guo Yueming;Chen Shunyou;Shen Xiantao;Mei Haibo;Shao Jingfan;Tang Shengping;Xu Hongwen(Department of Pediatric Orthopedics,Guangzhou Women&Children's Medical Center,Guangzhou 510623,China;Department of Pediatric Orthopedics,Affiliated Children's Hospital,Chongqing Medical University,Chongqing 400014,China;Department of Pediatric Orthopedics,Foshan Hospital of TCM,Foshan 528000,China;Department of Pediatric Orthopedics,Second Municipal Hospital,Fuzhou 350007,China;Department of Pediatric Orthopedics,Wuhan Children's Hospital,Tongji Medical College of HUST,Wuhan 430016,China;Department of Pediatric Orthopedics,Hunan Children's Hospital,Changsha 410007,China;Department of Pediatric Orthopedics,Tongji Medical College of HUST,Wuhan 430022,China;Department of Pediatric Orthopedics,Municipal Children's Hospital,Shenzhen 518026,China)

机构地区：[1]广州市妇女儿童医疗中心儿童骨科,510623 [2]重庆医科大学附属儿童医院骨科,400014 [3]佛山市中医院小儿骨科,528000 [4]厦门大学附属福州市第二医院儿童骨科,350007 [5]华中科技大学同济医学院附属武汉儿童医院骨科,430016 [6]湖南省儿童医院骨科,长沙410007 [7]华中科技大学同济医学院附属同济医院儿童骨科,武汉430022 [8]深圳市儿童医院骨科,518026

出　　处：《中华小儿外科杂志》2021年第2期118-125,共8页Chinese Journal of Pediatric Surgery

基　　金：广州市妇女儿童医疗中心/儿科研究所临床研究基金(GWCMC2020-6-005)。

摘　　要：目的探讨发育性髋关节脱位(developmental dislocation of the hip,DDH)闭合复位术后髋关节恢复正常影像学表现的概率及其影响因素。方法回顾性分析2004年1月至2015年12月采用闭合复位石膏固定治疗的507例(586髋)DDH患儿的病历资料。其中,男50例,女457例;左侧259髋,右侧164髋,双侧163髋。通过X线片评估Tönnis脱位程度分级、股骨头坏死(avascular necrosis of the femoral head,AVN)(Bucholz/Ogden分型)、髋臼指数(acetabular index,AI)和中心边缘角(center-edge angle,CEA)。尝试建立髋关节恢复正常X线的参考标准,并按该参考标准将患儿分为恢复组(200髋)和未恢复组(386髋),对比分析两组患儿的年龄、性别、侧别、Tönnis分级、骨化核出现、术前和末次随访的AI和CEA、AVN和Severin分级。采用Cox回归分析、t检验、卡方检验、方差分析研究影响DDH闭合复位术后髋关节恢复正常影像学的概率以及影响因素。结果末次随访时,200髋(34.1%)恢复正常髋关节X线,78髋(13.4%)出现了Ⅱ型及以上AVN。年龄≥24个月患儿恢复率为8.8%(3/34),显著低于<12个月患儿的44.3%(47/106)、12~18个月患儿的35.5%(98/276)和18~24个月患儿的30.6%(52/170),组间差异有统计学意义(P=0.001)。恢复组双侧髋关节脱位患儿的恢复率为27.0%(44/163),明显小于左侧髋关节脱位患儿的39.0%(101/259)和右侧髋关节脱位患儿的33.5%(55/164),差异有统计学意义(P=0.04)。恢复组术前AI(34.8°±4.2°)显著小于未恢复组(36.0°±4.6°),组间差异有统计学意义(P<0.01)。Cox回归分析显示,术后5.5年前累积恢复概率大致呈线性增长至56%,此后累积恢复概率的增速明显降低(年增长<5%)。复位年龄大于24个月、双侧脱位、术前AI≥40°和Bucholz/OgdenⅡ型以上AVN患儿的累积恢复概率明显降低,差异有统计学意义(P<0.05)。200髋的平均恢复时间为(36.5±14.9)个月,其中93%(186/200)的髋关节在术后5年内恢复。恢复组年龄≥2Objective To explore the probability of achieving normal pelvic radiographs and to examine the influencing factors in children with developmental dislocation of the hip(DDH)undergoing closed reduction(CR).Methods Retrospective reviews were conducted for 507 DDH children undergoing CR from January 2004 to December 2015.There were 457 girls and 50 boys.The involved side was left(n=259),right(n=164)and bilateral(n=163).Tönnis grade,AVN(Bucholz/Ogden classification),acetabular index(AI)and center-edge angle(CEA)were evaluated on X-ray.Criteria of rating pelvis radiographs as normal were established.Cox regression,t-test,Chi-square test and one-way analysis of variance(ANOVA)were used for evaluating the influencing factors of the probability and time to achieve normal.Results At the final follow-up,78 hips(13.4%)had AVN and 200 hips(34.1%)achieved normal radiographic parameters during follow-ups.The recovery rate of children aged above 24 months(8.8%)was significantly lower than other age groups[<12M:44.3%(47/106);12-18M:35.5%(98/276);18-24M:30.6%(52/170)](P=0.001).The recovery rate of bilateral DDH(44/163)was significantly lower than that of unilateral DDH[left 39%(101/259);right 33.5%(55/164)](P=0.04).The preoperative AI in recovered children was significantly lower than those unrecovered counterparts[(34.8°±4.2°)vs.(36.0°±4.6°),P<0.01].Cox regression analysis indicated that the overall cumulative probability of recovery increased by 56%at 5.5 years post-CR and then it tapered off to plateau with an annual increase<5%.Age>24 months,bilateral dislocation,preoperative AI>40°and AVN were risk factors for a lower probability of achieving normal radiographic parameters.Among 200 hips achieving normal hip radiography,the mean recover time was(36.5±14.9)months.And 93%of hips recovered within 5 years post-CR.The recovery time(55.2±28.0 months)of hips with an age>24 months at reduction was significantly longer than other age groups(<12M:32.2±18.0M;12-18M:36.9±11.9M;18-24M:38.6±15.1M)(P<0.05).The recovery time of

关 键 词：髋关节 闭合复位术 股骨头缺血性坏死 

分 类 号：R726.8[医药卫生—儿科]