脱位程度对闭合复位治疗发育性髋关节脱位的临床疗效分析

Clinical efficacy of different degree of preoperative displacement in closed reduction for developmental dislocation of the hip

目的评估脱位程度对闭合复位治疗发育性髋关节脱位(DDH)疗效的影响。方法对闭合复位治疗DDH的39例(62髋)进行平均2.8年的随访,术前以Tonnis分级评估脱位程度,应用Severin放射线评价标准和Mckay临床评价标准评定疗效,Kalamchi和MacEwen分级评估股骨头缺血坏死(AVN),总结临床记录和影像学资料,统计分析脱位程度对治疗效果的关系。结果 62髋中30髋Severin放射线满意,满意率为46.9%,复位前Ⅰ度、Ⅱ度、Ⅲ度、Ⅳ度脱位的远期满意率分别为92.9%、50.0%、18.8%、25.0%。48髋Mckay优良,优良率为77.4%,复位前Ⅰ度、Ⅱ度、Ⅲ度、Ⅳ度脱位远期优良率为100.0%、83.3%、62.5%、50.0%。20髋发生AVN,发生率为32.3%,Ⅰ度、Ⅱ度、Ⅲ度、Ⅳ度脱位AVN发生率分别为0%、16.7%、56.3%、87.5%。统计分析显示:闭合复位时不同脱位程度的患儿术后AVN发生率、形态学满意度、功能学满意度差异均具有统计学意义(P<0.05)。结论复位时脱位程度是影响疗效的重要因素之一;脱位程度越低闭合复位治疗后形态学及功能学越好,AVN发生率越低。

Objective To evaluate the impact of severity of the dislocation on the therapeutic effect of closed reduction used to treat developmental dislocation of the hip（DDH）.Methods We reviewed the results of closed reduction for DDH in 39 children（62 hips） over 2.8 years period.The degree of dislocation was evaluated by Tonnis’classification in preoperative;Curative effect was evaluated by Severin-standard and Mckay-score;Avascular necrosis of the femoral head（AVN） was diagnosed according to the criteria of Kalamchi and MacEwen.Clinical and imageology data were summarized to analyze the difference among different severities of the dislocation.Results 46.9% of the patients（30 /62） had satisfactory X-ray expression according to Severin classification.Long-term satisfactory rates for Tonnis typeⅠ,typeⅡ,typeⅢ,typeⅣ respectively were 92.9%,50.0%,18.8% and 25.0%（P 0.05） 77.4% of the patients（48 /62） had satisfactory function according to Mckay Standard,The rates of excellent and well for Tonnis typeⅠ,typeⅡ,typeⅢ and typeⅣ respectively were 100.0%,83.3%,62.5% and 50.0%（P 0.05）.AVN of 32.3% of the patients（20 /62） was observed,and occurrence rates of AVN in different severity of the dislocation were respectively 0%,16.7%,56.3% and 87.5%（P 0.05）.Conclusion The severity of the dislocation is one of the important factors affecting therapeutic efficacy.The less the severity is,the better the therapeutic effect is,also with the lower occurrence rate of AVN.