Size of femoral head and its impact on the incidence of avascular necrosis in patients with developmental dysplasia of the hip after closed reduction

Q4 Medicine

中华小儿外科杂志 Pub Date : 2019-12-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2019.12.006

JianPing Wu, Yiqiang Li, Jingchun Li, Zhe Yuan, F. Xun, Yanhan Liu, Yuanzhong Liu

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引用次数: 1

Abstract

Objective To explore the size of femoral head and its influencing factors in children with developmental dysplasia of the hip (DDH) and to examine the effect of size of femoral head and ossific nucleus on the development of avascular necrosis of femoral head (AVN) after closed reduction (CR). Methods Retrospective reviews were conducted for a consecutive series of DDH children undergoing CR. A total of 124 hips (111 children; mean age: 15.6±3.6 months) were included. The diameter (including anteroposterior, transverse & axial) and height of femoral head and ossific nucleus were assessed by magnetic resonance imaging (MRI) on coronal plane. And AVN was evaluated by the criteria of Kalamchi-MacEwen. Results The anteroposterior diameter of femoral head (1.91±0.27) cm, transverse diameter of femoral head (1.82±0.26) cm, height of femoral head (1.08±0.18) cm, anteroposterior of ossific nucleus (0.59±0.35) cm, transverse of ossific nucleus (0.49±0.28) cm, height of ossific nucleus (0.36±0.20) cm at contralateral side including 124 hips were significantly less developed than those at dislocated side including 98 hips (2.21±0.30), (2.27±0.19), (1.33±0.16), (1.06±0.33), (1.01±0.28) and (0.68±0.18) cm (P<0.001). AVN occurred in 21/124 hips (16.9%). According to the age, we divided the children into three groups. Group A: 6 ~ 12 months (20 hips), Group B: 13 ~ 18 months (77 hips), Group C: 19 ~ 24 months (27 hips). The rate of AVN was 30.0% (6/20) at group A, 18.2% (14/77) at group B and 3.7% (1/27) at group C. And the rate of AVN between the three groups was statistically different (χ2=6.800, P=0.033). For hip with AVN after closed reduction, anteroposterior diameter of femoral head (1.79±0.24) cm, transverse diameter of femoral head (1.69±0.19) cm and the anteroposterior diameter of ossific nudes(0.44±0.33)cm were less developed than those without AVN (1.98±0.27) cm, (1.89±0.28) cm and (0.62±0.36)cm (P<0.05). Spearman's correlation analysis showed that diameter of femoral head, diameter/height of ossific nucleus significantly increased with age but not height of femoral head; age was negatively correlated with the incidence of AVN (r=-0.274, P=0.002). The diameter of femoral head has significantly negative association with AVN grade (P<0.005). No significant association was observed between AVN grade and height of femoral head, presence of ossific nucleus, diameter/height of ossific nucleus and ratio of ossific nucleus to femoral head. Conclusions The size of femoral head at dislocated side is significantly worse than at contralateral side. And diameter of femoral head and diameter/height of ossific nucleus increase with advancing age. A significantly negative association exists between rate of AVN and diameter of femoral head. And it is unrelated with height of femoral head or size of ossific nucleus. Key words: Femoral head; Hip Joint; Closed reduction; Avascular necrosis of femoral head

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股骨头大小及其对闭合复位后发育不良髋关节患者缺血性坏死发生率的影响

目的探讨发育性髋关节发育不良(DDH)患儿股骨头大小及其影响因素，探讨股骨头大小及骨化核对股骨头缺血性坏死(AVN)闭合复位术(CR)发生的影响。方法对连续接受CR的DDH儿童进行回顾性分析，共124髋(111例儿童;平均年龄:15.6±3.6个月)。采用冠状面磁共振成像(MRI)测量股骨头和骨核的直径(包括正、横、轴)和高度。采用Kalamchi-MacEwen标准评价AVN。结果对侧124只髋关节脱位后股骨头前后径(1.91±0.27)cm、股骨头横径(1.82±0.26)cm、股骨头高度(1.08±0.18)cm、骨核前后径(0.59±0.35)cm、骨核横径(0.49±0.28)cm、骨核高度(0.36±0.20)cm发育明显低于对侧98只髋关节脱位后股骨头(2.21±0.30)、(2.27±0.19)、(1.33±0.16)、(1.06±0.33);(1.01±0.28)cm和(0.68±0.18)cm (P<0.001)。AVN发生在21/124髋(16.9%)。根据年龄，我们把孩子们分成三组。A组:6 ~ 12个月(20髋)，B组:13 ~ 18个月(77髋)，C组:19 ~ 24个月(27髋)。A组AVN发生率为30.0% (6/20)，B组为18.2% (14/77)，c组为3.7%(1/27)，三组间AVN发生率差异有统计学意义(χ2=6.800, P=0.033)。闭式复位后，股骨头前径(1.79±0.24)cm、股骨头横径(1.69±0.19)cm、骨骺前径(0.44±0.33)cm发育较无AVN者(1.98±0.27)cm、(1.89±0.28)cm、(0.62±0.36)cm发育较差(P<0.05)。Spearman相关分析显示，股骨头直径、骨核直径/高度随年龄的增长而显著增加，股骨头高度不显著增加;年龄与AVN发生率呈负相关(r=-0.274, P=0.002)。股骨头直径与AVN分级呈显著负相关(P<0.005)。AVN分级与股骨头高度、有无骨核、骨核直径/高度、骨核与股骨头比例无显著相关性。结论脱位侧股骨头大小明显差于对侧股骨头大小。股骨头直径和骨核直径/高度随年龄增长而增加。AVN发生率与股骨头直径呈显著负相关。与股骨头高度和骨核大小无关。关键词:股骨头;髋关节;封闭的减少;股骨头缺血性坏死

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来源期刊

中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.40

自引率

0.00%

发文量

8707

期刊介绍： Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.