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

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25...

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

Objective 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).T?nnis 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 T?nnis II hips was significantly shorter than T?nnis III/IV hip[(32.8±15.7)vs.(40.2/40.7)months,P<0.05].Conclusions The cumulative probability of achieving normal pelvis radiographs rises linearly during the first 5.5 years post-CR and then it tends to plateau.Age above 24 months,bilateral dislocation,preoperative AI>40°and AVN are risk factors for a lower probability of achieving normal radiographic parameters in DDH children undergoing CR.And age above 24 months and T?nnis grade III/IV are associated with a longer time of achieving normal radiographic parameters.