年龄因素与发育性髋关节脱位保守治疗并发股骨头缺血性坏死的相关性研究

背景：应用保守方法治疗发育性髋关节脱位（developmental dysplasia of the hip,DDH）并发股骨头缺血性坏死（avascularnecrosis of the femoral head,AVN）的风险较高,年龄因素是公认的危险因素。目前国内外均将18个月作为保守治疗与手术切开复位的分界线。目的：研究年龄因素对于应用保守方法治疗DDH并发AVN的影响,讨论DDH保守治疗的年龄选择标准。方法：2005年1月至2010年8月应用保守方法治疗DDH患儿53例（77髋）,分为3个年龄段：（1）12个月龄,25髋;（2）13～15个月龄,20髋;（3）16个月龄,32髋。前3个月每月复诊1次,之后每3个月复诊1次,应用Salter标准评判AVN。总结临床资料及影像学结果,统计分析不同年龄段保守治疗DDH并发AVN率的差异。结果：随访时间为1.1～2.2年,平均1.5年。53例（77髋）中30髋出现AVN（40.0%）,其中12个月以内患儿25髋中3髋发生AVN（12.0%）,13～15个月患儿20髋中12髋发生AVN（60.0%）,16个月以上患儿32髋中15髋发生AVN（46.9%）。结论：脱位程度、股骨头骨化核出现与否等均对保守治疗DDH并发AVN有一定的影响。12个月以上合并Ⅲ度以上脱位的DDH患儿保守治疗并发AVN的风险较高,应根据患儿本身条件制定个性化的治疗方案。

Correlation between age and expectant treatment for developmental dislocation of hip combined with avascular necrosis of femoral head in children

Background:There is a high risk of expectant treatment for developmental dislocation of hip(DDH)combined with avascular necrosis of the femoral head(AVN).Age is a well-known risk factor.At present,18 months of age is a dividing line of operation and expectant treatment.Objective:The aim of the paper is to study the age in the role of expectant treatment for DDH combined with AVN of the femoral head,and discuss the appropriate age for DDH expectant treatment.Methods:From January 2005 to August 2010,53 children(77 hips)underwent expectant treatment were divided into≤ 12-month group(25 hips),13-to-15-month group(20 hips)and≥16-month group(32 hips).Salter criterion was used to evaluate AVN.Clinical and imageology data were summarized.The difference between different age groups of DDH expect-ant treatment complicated with AVN was analyzed.Results:The duration of follow-up was 1.1 to 2.2 years.Of the patients,30 in 77 hips(40.0%)developed into AVN.There were 3 hips(12.0%)with AVN in the 12-month group,12 hips(60.0%)with AVN in 13-to-15-month group,and 15 hips(46.9%)with AVN in≥16-month group.Conclusions:Children,less than 12 months of age,withⅢdegree of dislocation and AVN are not suitable for DDH expectant treatment.Individual scheme should be made for the infant patients.