发育性髋脱位髋臼指数与闭合复位后结果的相关性研究

目的 观察发育性髋脱位患儿闭合复位成功后的转归,探讨髋臼指数与预后间的关系,研究行走年龄段(Walking age)发育性髋脱位治疗方法的选择.方法 随诊在1997年1月至2006年12月10年间治疗的闭合复位患儿,纳入研究范围者需具备下列条件:闭合复位时年龄介于1岁至2岁之间;复位成功且经过三期共9个月石膏治疗;随诊时间在2年以上.共计72例患儿97髋,按年龄段分为A组(1岁至1岁半)和B组(1岁半至2岁), 再按髋臼指数40°为界分成两个亚组,如A1组(<40°),A2组(≥40°).进行两个亚组间最终结果的比较.结果 评价以影像学Severin分级为标准,评为Severin Ⅰ、Ⅱ级者则计入优良组,统计学分析采用卡方检验, P值设为0.05.结果 A1组优良率56%(14/25髋),有4髋小现股骨头坏死,6髋进行手术矫正残留的发育不良,A2组优良率24%(7/29髋), 8髋出现股骨头坏死,10髋进行手术,B1组优良率62%(13/21髋),5髋出现股骨头坏死,3髋进行手术, B2组优良率仅18%(4/22髋);2髋股骨头坏死,10髋已行手术.A1与A2组、B1与B2组间优良率差异均有统计学意义, 尤其D2组优良率极低.结论 行走年龄段(Walking age)患儿如髋臼指数大于40°, 闭合复位后优良率低,不提倡强行闭合复位、石膏制动的治疗方式.

Acetabular index and the result of closed reduction in developmental dysplasia of the hip

Objective To establish the relationship between acetabular index and prognosis of closed reduction of DDH in toddlers. Methods Patients were recruited according to the following conditions: age between 1 to 2 years at the beginning of the treatment; in cast for 9 months after reduction, , more than 2 years of follow-up. There were 97 hips in 72 patients. They were categorized into to groups older and younger than 1.5 years of age (A and B).They were further divided into sub-groups according to acetabular index. Severin classification was adopted.χ~2 test was performed to analyze the results. Results The rate of excellence in A1 was 56%.In this group there were 4 avascular necrosis (AVN) cases and 6 patients underwent operations. The rate of excellence in A2 was 24%, 8 hips developed AVN and 10 hips were operated oa The rate of excellence in B1 was 62% and 5 hips were found to have AVN and 3 hips were operated on. The rate of excellence in B2 was only 18%.There were 2 AVN and 10 patients underwent operations. There was significant difference between the subgroups. The rate of excellence in group B2 was low. Conclusions Because of the poor results of closed reduction, we suggest avoiding closed reduction when AI exceed 40 in the toddlers.