Articulated Hip Distraction A Treatment Option for Femoral Head Avascular Necrosis in Adolescence
Articulated Hip Distraction A Treatment Option for Femoral Head Avascular Necrosis in Adolescence
复制标题
DOI：
10.1097/bpo.0b013e31819903b9
复制
发表时间：
2009-03-01
影响因子：
1.7
通讯作者：
Feldman, David S.
中科院分区：
文献类型：
--
作者：
Gomez, Jaime A.;Matsumoto, Hiroko;Feldman, David S.
目的：描述关节髋关节牵引治疗青少年股骨头缺血性坏死(AVN)的临床结果。为了更好地了解在这一人群中实施髋关节分离手术的有效性和适应症，我们对结果进行了分析。方法：对31个股骨头AVN患者行AHD治疗，进行回顾性分析。治疗时平均年龄为14.7岁。评估患者术前及术后疼痛和生理受限程度，以及术后活动范围。结果：术后平均随访18.7年。术后随访时间为57.4个月。其中股骨头移位10例，特发性股骨头移位5例，髋关节发育不良3例，其他12例。手术前后疼痛评分差异有统计学意义(P<；0.001)，大部分患者(78.6%，n=22)治疗后疼痛减轻。多因素回归模型显示，与其他病因的患者相比，慢性硬膜下血肿患者的疼痛改善较少(优势比，22.7；P=0.035)。所有患者在治疗前都有活动受限；在术后评估中，我们的患者中有一半(n=14)报告他们的日常活动没有限制。8名患者在使用固定器时出现轻微并发症。随访时，5例患者(17.2%)转为全髋关节置换或关节融合术。5年存活率为90.6%，10年存活率为77.7%，15年存活率为38.8%。结论：髋关节牵引置换术治疗青少年症状性AVN患者，术后4.7年疼痛减轻，日常活动受限。关节纵裂不是AVN的最终解决方案。随随访时间延长，患者症状加重。继发于SCFE的AVN患者似乎不像其他患者那样从该手术中受益。关节髋关节置换术是一种安全、合适的手术方式。该手术可能能够在早期推迟确定的手术程序，恢复功能并提高患者的生活质量。
Purpose: To describe the clinical outcomes of adolescent patients treated with articulated hip distraction (AHD) for avascular necrosis (AVN) of the femoral head. Outcomes were examined in order to better understand the usefulness of and indications for performing hip arthrodiastasis in this patient population.Methods: Retrospective review was performed on 31 hips with femoral head AVN treated with AHD. Mean age at treatment was 14.7 years. Preoperative and follow-up pain and physical limitations, as well as follow-up range of motion, were assessed.Results: Follow-up assessment was obtained at 18.7 years. Time of follow-Lip was 57.4 months after distraction. The etiologies of AVN were the following: 10 slipped capital femoral:epiphysis (SCFE), 5 idiopathic AVN, 3 with hip dysplasia, and 12 others. There was a significant difference in pain preoperatively and postoperatively (P < 0.001), most patients (78.6%, n = 22) had less pain after the treatment. Multivariate regression model demonstrated that patients with SCFE were likely to have less improvement in pain than patients with other etiologies (odds ratio, 22.7; P = 0.035). All patients had activity limitations before the treatment; at the postoperative assessment, half Of Our patients (n = 14) reported no limitations in their regular daily activities. Eight patients had minor complications with the fixator. At follow-up, 5 patients (17.2%) converted to total hip replacement or arthrodesis. Survival rates were 90.6% at 5 years, 77.7% at 10 years, and 38.8% at 15 years.Conclusions: Hip distraction arthroplasty in adolescent patients with symptomatic AVN reduces the amount of pain and limitation in daily activities at a follow-Lip of 4.7 years. Arthrodiastasis is not the final solution to AVN. With longer follow-up, patient's symptoms increases. Patients with AVN secondary to SCFE do not seem to benefit from this procedure as much as other patients do. Articulated hip distraction is a safe and appropriate procedure to perform in these patients. The procedure might be able to delay definitive surgical procedures at an early age, restoring function and improving the patient's quality of life.