关节造影对发育性髋关节脱位闭合复位治疗的影响

The role of arthrography-guided closed reduction for treatment of developmental dysplasia of the hip

目的探讨髋关节造影指导发育性髋关节脱位(DDH)患儿复位治疗的效果。方法回顾性分析2015年1月至2018年4月厦门大学附属福州第二医院小儿骨科诊治的DDH患儿的病例资料。纳入标准:①年龄<18个月的DDH患儿;②Pavlik吊带治疗失败或未经过治疗者;③随访时间≥2年;④术前、术后及术中髋关节造影资料完整。排除标准:神经肌肉性、创伤性、畸形性髋关节脱位。共57例患者(61髋)纳入研究,其中对照组27例(28髋)采用单纯闭合复位,造影组30例(33髋)采用闭合复位联合髋关节造影。比较两组髋臼指数(AI)、中心边缘角(CE)、髋关节再脱位率、切开复位率及股骨头坏死发生率。结果造影组随访24~30个月,平均(26.2±4.2)个月,对照组随访24~37个月,平均(33.6±7.9)个月。造影组CE角为12.14°±5.03°,小于对照组(17.84°±7.44°)(P=0.001)。造影组AI为26.09°±4.62°,与对照组(26.62°±4.41°)无差异(P=0.592)。造影组14髋(42.4%)出现坏死(Ⅰ型5髋,Ⅱ型9髋),对照组12髋(42.9%)坏死(Ⅰ型6髋,Ⅱ型6髋),两组差异无统计学意义(P=0.973)。造影组7髋(21.2%)出现再脱位,对照组3髋(10.7%)出现再脱位,两组差异无统计学意义(P=0.449)。造影组6髋切开复位,对照组则无,两组差异有统计学意义(P=0.027)。结论小于18个月的DDH患儿,闭合复位时行髋关节造影有助于了解髋关节脱位的真实情况。

Objective To investigate the role of hip arthrography-guided closed reduction in the treatment of developmental dysplasia of the hip(DDH).Methods A total of 162 patients(173 hips)diagnosed as DDH between January 2015 and April 2018 were retrospectively analyzed.Inclusion criteria are:①children with DDH under 18 months old;②children without Pavlik harness treatment or treatment failure;③follow-up time≥2 years;④complete preoperative,postoperative and intraoperative data.Exclusion criteria are patients suffering neuromuscular,traumatic or deformed hip dislocation.A total of 57 patients(61 hips)were finally included.Among them,27 patients(28 hips)undergoing simple closed reduction were considered as the control group,and the other 30 patients(33 hips)receiving closed reduction guided with hip arthrography were allocated into the arthrography group.The two groups were compared in terms of acetabular index(AI)angle,central-edge(CE)angle,the rate of hip re-dislocation,the rate of open reduction,and the incidence of femoral head necrosis.Results The arthrography group was followed up for 24 to 30 months,with an average of 26.2±4.2 months.The control group was followed up for 24 to 37 months with an average of 33.6±7.9 months.The mean CE angle in the arthrography group(12.14°±5.03°)was less than that in the control group(17.84°±7.44°),with statistically significant difference(P=0.001).The AI angle of the arthrography group(26.09°±4.62°)was less than that of the control group(26.62°±4.41°),but the difference was not statistically significant(P=0.592).Necrosis was observed in 14 hips(42.4%)in the arthrography group(typeⅠ5 hips,typeⅡ9 hips),and 12 hips(42.9%)in the control group(typeⅠ6 hips,typeⅡ6 hips).There was no statistically significant difference between the two groups(P=0.973).In the arthrography group,7 hips among 33 hips(21.2%)were found re-dislocated,and 3 hips in the control group re-dislocated(10.7%).There was no significant difference between the two groups(P=0.449).Six hips in the arthrography group but none in the control group received open reduction.The difference between the two groups was statistically significant(P=0.027).Conclusion Arthrography can help to understand the true situation of hip joint in DDH patients aged under 18 months.