Prediction of acetabular development after closed reduction by overhead traction in developmental dysplasia of the hip
Prediction of acetabular development after closed reduction by overhead traction in developmental dysplasia of the hip
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DOI：
10.1007/s00776-006-1049-2
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发表时间：
2006-09-01
影响因子：
1.7
通讯作者：
Ishiguro, Naoki
中科院分区：
文献类型：
--
作者：
Kitoh, Hiroshi;Kitakoji, Takahiko;Ishiguro, Naoki
背景。髋关节发育不良（DDH）复位后髋臼发育的预测对于确保髋臼成形术的最佳时机和避免不必要的手术是重要的。本研究的目的是寻找通过头顶牵引（OHT）减少髋臼发育不良的早期和可靠的预测因素。我们回顾性分析了40例经OHT治疗DDH的患者的45个髋部，没有额外的手术。闭合复位时的平均年龄为9.3个月，最后一次检查时的平均年龄为17.3岁。根据Severin的分类定义骨骼成熟时残留的髋关节发育不良。评估了以下变量作为最终结果的可能预测因素：复位时的年龄、脱位的严重程度、髋臼指数（AI）的连续测量、Wiberg中心边缘角（CE）和中心头部差异距离（CHDD）。62%的髋部在Severin I/II期有满意的结果，38%的髋部在Severin III期有不满意的结果。双侧DDH的预后明显差于单侧DDH。术后4年及以上，不满意组的平均AI显著大于满意组。同样，术后5年及以上，满意组的平均CE大于不满意组。在单侧病例中，复位后1年未受累髋关节的AI和CE也与受累髋关节的最终结局相关。术后4年的AI和术后5年的CE是预测最终预后的最早指标。在OHT复位后的4或5年，将仔细考虑是否需要髋臼成形术。双侧DDH和单侧DDH未受累髋关节髋臼覆盖率差是脱位髋关节髋臼发展不利的预后因素。
Background. The prediction of acetabular development after reduction of developmental dysplasia of the hip (DDH) is important to ensure optimal timing of acetabuloplasty and to avoid unnecessary surgery. The objective of this study was to find early and reliable predictors of future acetabular dysplasia in the hips reduced by overhead traction (OHT).Methods. We retrospectively reviewed 45 hips in 40 patients treated by OHT for DDH without additional procedures. The average age at the time of closed reduction was 9.3 months, and the average age at the latest examination was 17.3 years. Residual hip dysplasia at skeletal maturity was defined according to Severin's classification. The following variables were evaluated as possible predictors of the final outcome: age at reduction, severity of the dislocation, serial measurements of acetabular index (AI), center-edge angle of Wiberg (CE), and the center-head discrepancy distance (CHDD).Results. Sixty-two percent of the hips had satisfactory results in Severin I/II and 38% had unsatisfactory results in Severin III. Bilateral DDH showed significantly poorer outcome than unilateral DDH. The average AI of the unsatisfactory group was significantly greater than that of the satisfactory group at 4 years or more after reduction. Similarly, the average CE of the satisfactory group was greater than that of the unsatisfactory group at 5 years or more after reduction. In unilateral cases, the AI and the CE of the uninvolved hip at 1 year after reduction also correlated with the final outcome of the involved hip.Conclusions. The AI of 4 years and the CE of 5 years after reduction were the earliest predictors of the final outcome. Careful consideration for the need of acetabuloplasty would be given at 4 or 5 years after reduction by OHT. Bilateral DDH and poor acetabular coverage of the uninvolved hip in unilateral DDH were the prognostic factors of unfavorable acetabular development of the dislocated hip.