摘要
目的研究发育性髋关节脱位（developmental dysplasia of the hip，DDH）闭合复位术后髋臼的发育以及影响因素。方法回顾性分析2005年1月至2008年12月我院收治的并采用闭合复位加石膏固定且获得4年以上随访的DDH患儿62例（74髋）。骨盆正位X线片上测量复位前、复位后6个月及1、2、3、4年的髋臼指数（acetabular index，AI），并记录股骨头坏死（avascular necrosis，AVN）的发生。根据年龄，所有患儿分为3组：A组（O～12个月，14例18髋）、B组（13～18个月，22例24髋）、C组（〉18个月，26例32髋）。根据术后4年的AI值将所有患儿分成2组，正常组（29髋）和异常组（45髋）。采用重复测量的方法分析闭合复位后髋臼发育随时间的变化情况；采用两独立样本的t检验和多重线性回归方法探讨年龄、性别、复位前AI、中心边缘角（center-edgeangle of wiberg，CE）、股骨头中心头距离差（center-head distance discrepancy，CHDD）、单／双侧、AVN等因子与最终AI之间的关系。结果复位前，各组AI无明显差别；复位后各组患儿AI均显著降低。术后4年时，A组A1值（21.9土4.4）。显著小于B组（24.2±3.4）。和C组（26.8±3.8）。，差异有统计学意义（P〈0.05）；B组的AI值显著小于C组，差异有统计学意义（P〈0.05）。所有患儿的AI平均改善率为28.6％，A组改善率34.6％±11.2％显著高于C组24.9％±9.7％，差异有统计学意义（P=0.005）。多重线性回归分析提示复位前的年龄和AI和术后4年的AI值呈正相关（R2=0.617，F=15.031，P〈0.0001），治疗前AI值（β1=0.432，P〈0.0001）的回归系数大于年龄（β2=0.197，P=0.023）。其它因素，如性别、单双侧受累、CE角、AVN等均与术后4年的AI无明显关系（P〉0.05）。结论DDH闭合复位后AI值均能获得显著的降低，并于术后3年趋于稳定。复位时的年龄和治疗前的AI值是影响闭合复位后髋臼发育的重要因素，复位时的年龄和AI与A1的改善率成负相关。
Objective To explore the progress of acetabular index （AI） in patients with developmental dysplasia of the hip （DDH） within 4 years after closed reduction and determine the association between final acetabular index （AI） and various factors. Methods From 2005 to 2008,62 （74 hips） patients diagnosed with DDH underwent closed reduction and were followed up for at least 4 years. Radiological examination was performed during each outpatient visit. They were divided into 3 groups according to age：A （0-12 months,18 hips） ,B （13-18 months,24 hips） and C （〉18 months,32 hips）. Two-way ANOVA for repeated measures was used to evaluate the growth of acetabular over time. And multiple linear regression was employed for analyzing the association between final AI and various factors, including initial treatment age, gender, initial center-stage angle, initial acetabular index, initial CHDD, bilateral involvement or not and avascular necrosis of femoral head. Results No difference existed in ALl among 3 groups prior to reduction （P〉0.05）. AI decreased in all groups after reduction. At 4 years post-reduction, the values of AI of group A （21.9 ±4.4）°were significantly smaller than group B （24. 2±3.4）°and group C （26.8 ±3.8）°（P〈0.05）and group B was significantly lower than group C（P〈0.05）. The total AI improvement rate was 28.6%. And the AI improvement rate of group A （0.35 ±0.11） was significantly higher than that of group C （0.25± 0.10） （P = 0.005）. Linear regression suggested that age and initial AI were significantly correlated with final AI（R2 = 0.617, F = 15.031, P〈0.000 1）. Other factors, such as gender, center-edge angle of Wiberg （CE）, CHDD, bilateral involvement and AVN of the femoral head had no correlations with final AI （P〉0.05）. According to the coefficients, initial AI （[β1 = 0.432, P%0.000 1） had greater effect than age on final AI （β2 = 0.197, P = 0.023）. Conclusions AI decreases in all patients after reduction and achieves a steady angle at 3 years post-reduction. Age and initial AI are early predictors of the progress of AI after closed reduction in DDH patients. And AI improvement rate is negativelv correlated.
出处
《中华小儿外科杂志》
CSCD
北大核心
2014年第9期703-707,共5页
Chinese Journal of Pediatric Surgery
关键词
髋脱位
先天性
年龄组
对比研究
Hip dislocation, congenital
Age groups
Comparative stugy
