发育性髋关节发育不良闭合复位后影响股骨近端形态发育的因素分析

目的]探讨闭合复位治疗发育性髋关节发育不良(developmental dysplasia of the hip,DDH)后股骨近端形态改变的发生及其影响因素。方法]回顾分析本院2000年1月～2006年12月采取闭合复位的DDH患儿258例,其中106例(160髋)获得随访;年龄6～36个月,平均16.9个月。其中男12例,女94例,左侧脱位34例,右侧脱位18例,双侧脱位54例。脱位程度按Tnnis分型:Ⅰ型23髋,Ⅱ型81髋,Ⅲ型31髋,Ⅳ型25髋。所有患儿均随访2～11年,平均5.1年。所有患儿术前均行双下肢悬吊牵引4～24 d,平均13.4 d。全麻下行经皮长收肌腱切断、手法复位后动力蛙式石膏固定3个月,外展支具固定3个月。采用Bucholz-Ogden分型评价闭合复位后股骨近端形态改变。对DDH患儿性别、年龄、脱位程度、牵引时间、复位后固定时间、复位前骨化核出现与否、家族遗传史、胎位、复位前是否能行走等多变量进行Logistic多因素回归分析,探讨这些因素与闭合复位后股骨近端形态改变的相关性。结果]在获得随访的160髋中有31髋发生股骨近端形态改变(19.4%),其中Bucholz-OgdenⅠ型27髋(16.9%),Ⅱ型2髋(1.25%),Ⅲ型1髋(0.625%),Ⅳ型1髋(0.625%)。经Logistic多因素回归分析,复位时患儿年龄(OR=7.006,P<0.01)、脱位程度(OR=5.116,P<0.001)、牵引时间(OR=0.261,P=0.023)及复位后固定时间(OR=3.991,P=0.03)与闭合复位后股骨近端病理形态改变存在明显相关性。而患儿性别、复位前骨化核出现与否、家族遗传史、胎位、复位前是否能行走等无明显相关性(P>0.05)。结论]复位前的皮牵引时间14～24 d有助于减轻股骨近端形态的病理改变,复位时患儿年龄越大、脱位程度越高、复位后固定时间越长,股骨近端形态病理改变越严重。

Influencing factors of proximal femur after closed reduction treatment of the developmental dysplasia of the hip

Objective] To research the morphological development of the proximal femur after closed reduction treatment of the infant developmental dysplasia of the hip(DDH) and analyze the related factors.Methods]One hundred and six DDH patients(160 hips) treated by combined closed reduction method from 2000 to 2006 were followed up with mean followed-up time of 5.1(2-11)years.According to Tonnis classification,there were 23 hips of Grade I dislocation,81 hips of Grade II,31 hips of Grade III,25 hips of Grade IV.All patients were performed preliminary traction with mean time of 13.4(4-19)days,adductor tenotomy under general anesthesia,and immobilization in dynamic frog type plaster fixtion for 3 months,then replacement with abduction brace for 3 months.We evaluated the morphological development of the proximal femur after closed reduction treatment of DDH through the classification of Bucholz-Ogden.Logistic regression analysis was used to analyze the interrelated factors of gender,age,dislocation degree,traction time,fixed time,the presence or absence of the femoral head ossific nucleus,the presence or absence of genetic history,ability of walking before reduction et al.The correlation of these variables and morphologic changes of the femoral proximal femur about closed reduction was studied.Results]Thirty-one of 160 hips morphologic change in proximal femur(19.4%),with 27 hips of Bucholz-Ogden type Ⅰ(16.9%),2 hips of type Ⅱ(1.25%),1 hip of type Ⅲ(0.625%),1 hip of typeⅣ(0.625%).According to the Logistic multiple regression analysis,there were four related factors: the age at the reduction(OR=7.006,P<0.01),dislocation degree(OR=5.116,P<0.001),traction time(OR=0.261,P=0.023) and fixed time(OR=3.991,P=0.03),and other factors hadn’t clear correction(P>0.05).Conclusion]The preliminary traction time of 14~24 days help relaxe the morphologic change of the proximal femur.The older age at reduction,the higher degree of dislocation and the longer fixed time after reduction,the more seriously morphologic change of the proximal femur could be found.