发育性髋关节发育不良术后髋关节运动功能指标观测研究

Observational Study of Hip Motor Function Indexes After Developmental Dysplasia of the Hip Surgery

目的观察并分析发育性髋关节发育不良(DDH)患儿术后髋关节运动功能恢复情况,进一步探讨其对日常生活活动的影响。方法收集2019年8月至2021年2月就诊于我院小儿外科并确诊为单侧DDH且行手术治疗患儿30例,术后随访时现场测量患儿髋关节活动度,并将测量结果和日常生活活动中髋关节活动度需求进行对比,明确日常生活活动受限情况。采用Severin评估标准对影像学进行评估,并对髋关节疼痛、再脱位、股骨头坏死等并发症进行记录。结果术后平均随访时间(1.04±0.12)年。患儿术侧髋关节屈曲[(106.93±23.37)°vs.(125.67±10.57)°]及内旋活动度[(47.17±18.37)°vs.(56.77±14.40)°]较非术侧小,差异有统计学意义(P<0.05);而术侧髋关节外展及外旋活动度与非术侧相比,差异无统计学意义(P>0.05)。56.7%的患儿主要表现为下蹲活动的受限,20%~30%会伴有捡东西、穿裤子等日常生活活动障碍。影像学评估Severin Ⅰ级6例,Ⅱ级20例,总体优良率为86.7%。髋关节疼痛、再脱位、股骨头坏死发生率分别为6.7%、6.7%、13.3%。结论DDH术后早期可获得较为满意的影像学结局,但髋关节运动功能并未完全恢复,主要表现为髋屈曲和内旋活动范围不足,进一步会影响下蹲、穿裤子、捡东西等日常生活活动,这对确立此类患儿康复目标与精准康复干预具有重要意义。

Objective To observe and analyze postoperative recovery of hip motor function in children with developmental dysplasia of the hip(DDH),and to further explore its impact on activities of daily living.Methods From August 2019 to February 2021,30 children diagnosed with Unilateral DDH and received surgical treatment were retrospective collected.During postoperative follow-up,pediatric specialist musculoskeletal physical therapist used a protractor to assess the range of motion of the hip in children.And measurement results were compared with range of motion requirements of hip joint in activities of daily living to clarify limitation of activities of daily living.In addition,imaging was evaluated according to Severin evaluation criteria.And complications such as hip pain,redislocation,and femoral head necrosis were also recorded.Results The average follow-up time after operation was(1.04±0.12)years.The hip flexion[(106.93±23.37)°vs.(125.67±10.57)°,P<0.05]and internal rotation[(47.17±18.37)°vs.(56.77±14.40)°,P<0.05]of operated side were smaller than those of non-operated side with statistically significant difference.While there was no significant difference in the range of abduction and external rotation(P>0.05).In addition,56.7%of patients showed limitation of squatting,and 20%~30%of patients had activities of daily living disorders such as picking up something and putting on pants.Imaging evaluation was performed in 6 patients with Severin grade Ⅰ,20 patients with grade Ⅱ,and overall excellent and good rate was 86.7%.The incidences of pain,redislocation and femoral head necrosis were 6.7%,6.7%and 13.3%,respectively.Conclusion Satisfactory imaging outcomes could be obtained in the early postoperative period of DDH,but the motor function of the hip joint would be not fully recovered,mainly manifested as insufficient hip flexion and internal rotation range of motion,which further affects activities of daily living such as squatting,putting on pants,picking up something.There would be of great significance for establishing rehabilitation goals and precise rehabilitation interventions for such children.