蛙式石膏联合牵引对发育性髋关节发育不良婴幼儿远期遗留畸形率的影响

Effect of frog cast combined with traction on the rate of long-term residua deformity in infants and children with developmental hip dysplasia

目的研究蛙式石膏联合牵引治疗发育性髋关节发育不良婴幼儿的效果。方法回顾性纳入2020年4月—2023年9月杭州市儿童医院收治的82例发育性髋关节发育不良婴幼儿进行观察,将其中41例接受蛙式石膏联合牵引治疗的患儿纳入研究组,另41例采取牵引治疗的患儿纳入对照组。比较两组临床资料(性别、月龄、体质量、患侧、分型)、影像学指标[髋臼指数(AI)、中心边缘角(CE)、髋臼Sharp角]、髋关节活动度、髋关节功能(McKay)、Severin X射线评分、远期遗留畸形率(再脱位、髋臼发育不良、股骨头缺血坏死等)。结果两组临床资料比较,差异均无统计学意义(均P>0.05)。治疗前,两组影像学指标比较,差异无统计学意义(P>0.05),治疗后,研究组AI(22.84±3.53)°、髋臼Sharp角(38.46±4.05)°低于对照组(30.19±4.12)°、(42.37±5.18)°,但CE(24.25±3.06)°高于对照组(20.97±2.55)°,差异均有统计学意义(均P<0.05)。治疗前,两组髋关节活动度比较,差异无统计学意义(P>0.05),治疗后,研究组外展(43.06±5.25)°、外旋(50.19±6.20)°、屈曲(121.09±25.30)°、内旋活动度(55.30±6.94)°均高于对照组(40.23±5.01)°、(47.36±5.88)°、(116.24±23.20)°、(51.25±6.02)°,差异均有统计学意义(均P<0.05)。研究组治疗后的McKay、Severin X射线评分优良率92.68%、87.80%均高出对照组75.61%、68.29%,差异有统计学意义(P<0.05)。研究组远期遗留畸形率显著少于对照组,研究组远期遗留畸形率9.76%显著少于对照组26.83%,差异有统计学意义(P<0.05)。结论蛙式石膏联合牵引的效果更为理想,可促进患儿影像学指标改善,提高髋关节活动度及功能,远期遗留畸形率更少,安全性高,值得临床推广使用。

Objective To study the effect of frog cast combined with traction in the treatment of infants and children with developmen-tal hip dysplasia.Methods Eighty-two cases of infants and children with developmental hip dysplasia admitted to Hangzhou Children's Hos-pital from April 2020 to September 2023 were retrospectively included for observation,and 41 of them who received frog cast combined with traction treatment were included in the study group,and the other 41 children who took traction treatment were included in the control group.The two groups were compared in terms of clinical data(gender,age in months,weight,affected side,staging),imaging indexes[Acetabular Index(AI),Central Edge Angle(CE),Acetabular Sharp Angle],hip mobility,hip function(McKay),Severin X-ray score,and the rate of long-term residual deformities(re-dislocations,acetabular dysplasia,and ischemic necrosis of the femoral head,etc.).Results Comparing the clinical data of the two groups,the differences were not statistically significant(all P>0.05).Before treatment,there was no statistically significant difference in imaging indexes between the two groups(P>0.05).After treatment,AI(22.84±3.53)°and acetabular Sharp angle(38.46±4.05)°were lower in the study group than in the control group(30.19±4.12)°and(42.37±5.18)°but CE(24.25±3.06)°was higher than that in the control group(20.97±2.55)°,the differences were statistically sig-nificant(all P<0.05).Before treatment,there was no statistically significant difference in hip joint mobility between the two groups(P>0.05).After treatment,abduction(43.06±5.25)°,external rotation(50.19±6.20)°,flexion(121.09±25.30)°,and internal rotation mobility(55.30±6.94)°were higher in the study group than in the control group(40.23±5.01)°,(47.36±5.88)°,(116.24±23.20)°,and(51.25±6.02)°,and the differences were statistically significant(all P<0.05).The McKay and Severin X-ray scores of the study group were 92.68% and 87.80% better than those of the control group(75.61% and 68.29%),and the differences were statisti-cally significant(all P<0.05).The long-term residual deformity rate of the study group was significantly lower than that of the control group.The long-term residual deformity rate of the study group was 9.76%,which was significantly lower than that of the control group(26.83%),and the difference was statistically significant(P<0.05).Conclusion Frog cast combined with traction is more effective,can promote the improvement of children's imaging indexes,improve the mobility and function of the hip joint,the long-term residual de-formity rate is less,and the safety is high,it is worth promoting the use of clinical.