闭合复位治疗发育性髋关节脱位发生股骨头缺血坏死的相关因素分析

Causative factors of avascular necrosis after closed reduction for developmental dysplasia of the hip

目的研究闭合复位术治疗发育性髋脱位（DDH）的长期随访结果，评估导致股骨头缺血坏死（AVN）的相关因素。方法对DDH闭合复位后81例（106髋）进行平均3．6年的随访，Kalamchi and MacEwen分级评定缺血坏死，总结临床记录和影像学资料，统计分析缺血坏死的相关因素。结果106髋中39髋发生缺血坏死（36．8%）。其中，股骨头骨化中心发育基本正常的59髋中，7髋发生缺血坏死（11．9％）；骨化中心发育偏小的40髋中，27髋发生缺血坏死（67．5％）；骨化中心延迟未出现的7髋中5髋发生缺血坏死（71．4%）。脱位程度越高发生缺血坏死的风险越大（P〈0．05）。其他因素：性别、复位年龄、石膏固定类型、内收肌合并髂腰肌切断与缺血坏死的发生均无显著统计学意义。结论闭合复位治疗发育性髋脱位，股骨头骨化中心发育延迟和高脱位与股骨头缺血坏死的发生相关。

Objective To reviewed the closed reduction for Developmental Dysplasia of the Hip （DDH）, and analyzed the causative factors of avascular necrosis （AVN）. Methods We reviewed the results of closed reduction for DDH in 81 children （106 hips） over 3.6 year period. AVN was diagnosed according to the criteria of Kalamchi and MacEwen. The possible causative factors from medical records and radiographs were analysized. Results 39 out of 106 hips （37%） developed AVN. When the ossific nucleus was normal in size, for the age, 11.9 % （7/59） developed AVN. When the nucleus was small for age as compared to the opposite side 67. 5% （27/40） developed AVN and 71.4% （5/7） of delayed nucleus formation developed AVN. The incidence of AVN increased with the grade of the dislocation. Other factors such as gender, age at reduction, plaster mode, adductor tenotomy were not statistically significant. Conclusions Delayed nucleus formation or nucleus developmental dysplasia and high dislocation are the risk factors of AVN in closed reduction for DDH.