牵引在闭合复位治疗儿童发育性髋关节脱位中的作用的多中心回顾性研究

目的 探讨双下肢牵引在儿童发育性髋关节脱位(DDH)闭合复位中的作用.方法 回顾性分析我国南方7家医院2004年1月至2014年6月采用闭合复位治疗的DDH患儿的临床资料.共有302例(333髋)符合纳入标准,其中,男40例,女262例;单侧271例,双侧31例.平均年龄(16.5±5.1)个月,平均随访时间(38.0±18.0)个月.牵引组227例,非牵引组75例.比较两组患儿Tonnis分度、再脱位发生率、股骨头坏死(AVN)、末次随访髋臼指数(AI)、中心边缘角(CE角)和Severin影像学分级.结果 非牵引组平均住院时间(5.1±2.6)d,显著短于牵引组(16.2±7.5)d(P＜0.001).术前牵引组的平均Tonnis分度显著高于非牵引组(P=0.021).333髋中有23髋(6.9％)出现再脱位,牵引组的再脱位发生率为8.7％,非牵引组的再脱位发生率为1.3％,两者差异有统计学意义(P=0.022).在Tonnis Ⅱ度的患儿中,牵引组和非牵引组的再脱位发生率差异无统计学意义.在Tonnis Ⅲ～Ⅳ度的患儿中,牵引组的再脱位发生率显著高于非牵引组(P=0.027).牵引组AVN发生率为17.4％,非牵引组AVN发生率为26.3％,两者差异无统计学意义(P =0.083).同样,根据Tonnis分型分别比较牵引和非牵引组之间的AVN发生率,结果差异也无统计学意义.牵引和非牵引组之间AVN的分型差异也无统计学意义(P=0.076).牵引组和非牵引组之间的AI值和CE角差异均无统计学意义(P＞0.05).两组之间Severin影像学分级差异无统计学意义(P =0.559).结论 牵引不能降低DDH闭合复位术后再脱位的发生率,不能减少AVN的发生率,也不能改善DDH闭合复位的最终治疗效果.

Effect of traction on developmental dysplasia of the hip treated via closed reduction: a multi-center retrospective study

Objective To explore the effect of traction on developmental dysplasia of the hip (DDH) treated by closed reduction.Methods A multi-center retrospective study was performed at 7 participating hospitals in southern China.A total of 302 patients (333 hips) treated by closed reduction fulfilled the inclusion criteria There were 40 males and 262 females with a mean age of 16.5 ± 5.1 months.The dislocations were unilateral (n =271) and bilateral (n =31).The mean follow-up period was 38.3 ± 18.0 months.They received traction (n =227) or not (n =75) prior to closed reduction.Tormis grade,redislocation rate,avascular necrosis of femoral head (AVN),acetabular index (AI),center-edge angle of Wiberg (CE angle) and Severin grade were compared between two groups.Results The mean hospitalization duration was significantly shorter in non-traction group than that in traction group (5.1 ± 2.6 vs 16.2 ± 7.5 days).And 23 hips had redislocation.Significant inter-group difference existed in redislocation rate (8.7％ vs 1.3％,P =0.022).Among those with Tonnis grade Ⅱ dislocations,no significant difference existed in redislocation rate between traction and non-traction groups;redislocation rate was significantly higher in traction group than that of non-traction group among patients with Tonnis grade Ⅲ-Ⅳ dislocations.No significant inter-group difference existed in AVN rate (17.4％ vs 26.3％,P =0.083).No significant inter-group differences existed in AVN rates among those with Tonnis grade Ⅱ/Ⅲ-Ⅳ dislocations.Wilcoxon rank sum test of two independent samples indicated no inter-group difference in AVN grade (P =0.076).No intergroup difference existed in AI or CE angle (P＞0.05).And there was no inter-group difference in Severin radiographic grade (P =0.559).Conclusions Traction does not decrease the rates of redislocation and AVN in DDH children treated by closed reduction.And it fails to improve the final outcomes of DDH.