儿童发育性髋关节发育不良采用闭合复位和石膏固定治疗复位失败的危险因素

Q4 Medicine

中华小儿外科杂志 Pub Date : 2019-12-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2019.12.004

Zhe Yuan, Yiqiang Li, Min Ye, Yuanzhong Liu, Jingchun Li, F. Xun, Yanhan Liu

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引用次数: 0

摘要

目的探讨儿童发育性髋关节发育不良(DDH)闭合复位失败的危险因素。方法回顾性分析2015年7月至2018年11月DDH患儿行闭合复位铸造固定的临床和影像学资料。收集患者的相关临床资料，包括年龄、性别、侧边度、骨盆治疗前复位、骨骺骨化中心外观、国际髋关节发育不良研究所(IHDI)分级、髋臼指数(AI)、安全变焦、髋缘倒置、髋关节内侧池距(MPD)、髋关节外展角。采用Logistic回归、t检验、卡方检验和fisher精确概率对降低失败的危险因素进行评价。结果16髋(9.2%)首次复位失败，7髋(43.8%)通过第二次闭合复位和改良石膏固定获得稳定复位。因此闭合复位失败修正率为5.2%(9/173)。单因素Logistic回归分析显示闭合复位失败与性别、年龄、人工智能、倒缘和MPD有关。多因素Logistic回归分析显示，MPD和AI是危险因素。受试者工作特征曲线(ROC)显示MPD >6 mm是DDH闭合复位失败的危险因素。关节边缘不清(83.3%，5/6)和内侧关节池(36.8%，7/19)的儿童闭合复位失败率明显高于关节边缘明显(6.5%，11/167)和内侧关节池(5.8%，9/154)的儿童(术中P6 mm)，明显增加DDH闭合复位失败的风险。关节造影术中不清楚髋关节边缘和内侧池提示DDH闭合复位失败。关键词:髋关节;关闭减少;风险因素;髋关节发育不良

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The risk factors of failure of reduction in children with developmental dysplasia of the hip treated by closed reduction and cast immobilization

Objective To explore the risk factors of failed reduction after closed reduction in children with developmental dysplasia of the hip (DDH). Methods Retrospective reviews were conducted for the clinical and radiographic data of DDH children undergoing closed reduction and cast immobilization from July 2015 to November 2018. The relevant clinical data were collected, including age, gender, sideness, pavlic treatment pre-reduction, appearance of epiphyseal ossification center, International Hip Dysplasia Institute (IHDI) grade, acetabular index (AI), safe zoom, inverted limbus, medial pool distance of hip (MPD) and abduction angle of hip. The risk factors of failed reduction were evaluated by Logistic regression, t test and Chi-square test and fisher exact probability. Results Sixteen hips (9.2%) failed to achieve initial stable reduction and yet 7 hips (43.8%) obtained stable reduction through a second closed reduction and modified cast immobilization. Thus the modified rate of failed closed reduction was 5.2%(9/173). Single factor Logistic regression indicated that the failure of closed reduction was associated with gender, age, AI, inverted limbus and MPD. Multiple factor Logistic regression showed that MPD and AI are the risk factors. Receiver operating characteristic curve (ROC) showed MPD >6 mm were the risk factors of failure of closed reduction for DDH. The failure rate of closed reduction in children with indistinct limbus (83.3%, 5/6) and medial pool (36.8%, 7/19) on arthrography were significantly higher than those with distinct limbus (6.5%, 11/167) and medial pool (5.8%, 9/154) on arthrography (P<0.001). According to the outcome of closed reduction, they were divided into two groups of successful closed reduction (n=157) and failed closed reduction (n=16). The difference of AI of both groups (36.8°±4.5 and 34.4°±3.7° respectively) are statistically significant (P<0.05). Conclusions AI and MPD are the risk factors of failure closed reduction. Patients with MPD >6 mm during operation significantly increase the risk of failure of closed reduction for DDH.Unclearness of limbus and medial pool of hip during arthrography hint the failure of closed reduction for DDH. Key words: Hip joint; Close reduction; Risk factor; Developmental dysplasia of the hip

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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.