Outcomes following open reduction for late-presenting developmental dysplasia of the hip
Outcomes following open reduction for late-presenting developmental dysplasia of the hip
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DOI：
10.1302/1863-2548.12.170078
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发表时间：
2018-08-01
影响因子：
1.4
通讯作者：
Moscona-Mishy, L.
中科院分区：
文献类型：
--
作者：
Castaneda, P.;Masrouha, K. Z.;Moscona-Mishy, L.
目的 晚期出现髋关节发育不良 (DDH) 的患者更有可能需要切开复位术。由于许多发展中国家没有强制筛查，迟发 DDH 的发病率仍然相对较高。我们报告了一系列晚期就诊患者的切开复位术的临床和影像学结果。患者和方法这是对 645 名接受切开复位术或与骨盆截骨术联合治疗的患者的 712 个髋关节进行的回顾性研究。总共有 91 个髋关节仅进行了切开复位术，621 个髋关节进行了切开复位和骨盆截骨术。 221 个髋关节进行了股骨缩短术。手术时的平均年龄为 2.1 岁（1 至 6.5 岁），平均随访时间为 9.3 年（6 至 14 岁）。我们使用奥克兰儿童医院髋关节评估评分 (CHOHES) 来确定功能结果，并使用 Severin 分类来评估放射学结果。还记录和分析了股骨头缺血性坏死 (AVN) 发生率和是否需要再次手术。 结果 80%（570 髋）的影像学结果良好（Severin I 型或 II 型），87% 在最终随访时 CHOHES 评分 > 90。 AVN 发生率为 14%，再脱位发生率为 2%。接受切开复位术和骨盆截骨术的患者的影像学结果更好，再次手术率更低。在老年患者中观察到结局较差的趋势。 结论 在接受切开复位的晚期 DDH 患者中，在至少六年的随访中，良好的临床和影像结果的比例很高。接受切开复位术结合骨盆截骨术的患者获得良好影像学结果的比例较高，并发症（尤其是再次手术）的发生率较低。
Purpose Patients with late-presenting developmental dysplasia of the hip (DDH) are more likely to require an open reduction. Since many developing countries do not have mandated screening, there continues to be a relatively high incidence of late-presenting DDH. We report the clinical and radiographic outcomes of open reduction in a series of patients who presented late.Patients and methods This was a retrospective review of 712 hips in 645 patients that underwent open reduction, alone or in combination with a pelvic osteotomy. In all, 91 hips had open reduction alone and 621 had open reduction and pelvic osteotomy. Femoral shortening was performed in 221 hips. The mean age at the time of surgery was 2.1 years (1 to 6.5) and the mean follow-up time was 9.3 years (6 to 14). We used the Children's Hospital Oakland Hip Evaluation Score (CHOHES) to determine functional outcomes and the Severin classification was used to evaluate radiographic outcomes. The rate of avascular necrosis (AVN) and the need for a reoperation were also recorded and analyzed.Results In all 80% (570 hips) had good radiographic outcomes (Severin type I or II) and 87% had a CHOHES score of > 90 at final follow up. There was a 14% rate of AVN and only a 2% rate of redislocation. Better radiographic outcomes and lower reoperation rates were seen with patients who underwent both an open reduction and pelvic osteotomy. A trend was observed towards worse outcomes in older patients.Conclusions There was a high rate of good clinical and radiographic outcomes at a minimum six-year follow-up in patients with late-presenting DDH who underwent open reduction. Those who underwent open reduction in combination with a pelvic osteotomy had a higher rate of good radiographic outcomes and a lower rate of complications, particularly reoperation.