动态石膏固定促进发育性髋关节发育不良闭合复位术后早期髋臼发育

目的比较发育性髋关节发育不良(DDH)闭合复位术后人位石膏与动态石膏固定方式对患儿髋关节发育的影响。方法回顾分析2015年1月至2016年12月广州市妇女儿童医疗中心收治的行闭合复位石膏固定的DDH患儿49例(53髋)的病历资料。平均年龄14.9个月,男4例,女45例。根据石膏固定方式分为人位石膏固定组(32例,34髋)和动态石膏固定组(17例,19髋)。在MRI影像图像上测量闭合复位后髋关节间隙(HJD),明确有无盂唇内翻。在骨盆正位X线片上测量术前、术后3个月的髋臼指数(AI)和髋臼深度比(ADR),以及末次随访时的AI和中心边缘角(CEA)。评价末次随访时是否存在半脱位和股骨头缺血性坏死(AVN)。结果 2组患者的性别、侧别、中位年龄、T?nnis分级、AI、ADR比较差异均无统计学意义(均P>0.05)。术后6周更换石膏时,2组患者盂唇内翻以及HJD的改善情况差异均无统计学意义(均P>0.05)。术后3个月拆除石膏时,动态石膏固定组AI为27.9°±5.2°,显著低于人位石膏固定组的31.0°±4.9°(P<0.05)。末次随访时,人位石膏固定组和动态石膏固定组AVN发生率、再脱位和半脱位发生率差异均无统计学意义(11.8%比21.1%,14.7%比21.1%,均P<0.05)。末次随访时,动态石膏固定组AI为22.5°±5.7°,显著低于人位石膏固定组的26.9°±4.1°(P<0.05)。结论动态石膏可以更好地促进DDH闭合复位术后早期髋臼发育,且不会增加DDH闭合复位后再脱位和AVN的发生风险。

Dynamic cast immobilization promote hip development in children with early developmental dysplasia of the hip after closed reduction

Objective To compare the effects of cast immobilization (human position cast and dynamic cast) on hip development in children with developmental dysplasia of the hip (DDH) after closed reduction. MethodsA retrospective study of 49 children (53 hips) with DDH who underwent closed reduction and cast immobilization in Department of Orthopaedics, Guangzhou Women and Children Medical Center between January 2015 and December 2016 were enrolled, with an average age of 14.9 months, 4 males and 45 females. All patients were divided into 2 groups according to the method of cast immobilization, 32 cases (34 hips) with the human position cast immobilization, and 17 cases (19 hips) with the dynamic cast immobilization. Hip joint distance (HJD) after closed reduction was measured on MRI, and inverted labrum was determined on MRI as well. Acetabular index (AI) and acetabular depth radio (ADR) were measured before closed reduction and 3 months later dependently on the anteroposterior X-ray, the central edge angle (CEA) and AI were measured on the last follow-up of anteroposterior X-ray. The presence of subluxation and avascular necrosis (AVN) at the last follow-up was evaluated. ResultsThere was no significant difference in gender, side, age, Tonnis degree, AI, and ADR before the reduction between 2 groups(all P >0.05). There was no significant difference in inverted labrum and HJD improvement between the 2 groups 6 weeks after closed reduction(all P > 0.05). The AI of the dynamic cast immobilization group were significantly lower than those of the human position cast immobilization group when cast was removed 3 months after closed reduction(27.9°±5.2° vs . 31.0°±4.9°, all P <0.05). At the last follow-up, the incidence of AVN and the incidence of dislocation and subluxation were significantly different between the 2 groups (11.8% vs .21.1%,14.7% vs .21.1%). At the last follow-up, the AI in the dynamic cast immobilization group was significantly lower than the human position cast immobilization group (22.5°± 5.7° vs .26.9°± 4.1°, P < 0.05 ). ConclusionDynamic cast can better promote early hip development of DDH after closed reduction , and does not increase the risk of dislocation and AVN.