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浙江大学学报(医学版)  2022, Vol. 51 Issue (4): 454-461    DOI: 10.3724/zdxbyxb-2022-0147
原著     
髋关节脱位患儿闭合复位后再脱位危险因素分析
徐静芳1,杨溢1,俞凯1,徐玮泽1,白冠男2,叶文松1,舒强1,陈文昊1,*
1. 浙江大学医学院附属儿童医院小儿外科 国家儿童健康与疾病临床医学研究中心 国家儿童区域医疗中心,浙江 杭州 310052
2. 浙江大学医学院附属儿童医院儿童保健科 国家儿童健康与疾病临床医学研究 中心 国家儿童区域医疗中心,浙江 杭州 310052
Risk factors for re-dislocation after closed reduction in children with developmental dysplasia of the hip
XU Jingfang1,YANG Yi1,YU Kai1,XU Weize1,BAI Guannan2,YE Wensong1,SHU Qiang1,CHEN Wenhao1,*
1. Department of Pediatric Surgery, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China;
2. Division of Child Health Care, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Regional Medical Center for Children, Hangzhou 310052, China
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摘要:

目的:探讨婴幼儿发育性髋关节发育不良(DDH)闭合复位石膏固定术后再脱位的危险因素。 方法:回顾性分析2015年1月至2017年12月在浙江大学医学院附属儿童医院行内收肌松解+闭合复位+人类位石膏固定治疗的DDH患儿(18月龄及以下)的资料,共88例103髋。根据髋关节脱位的诊断标准统计术后再脱位的发生情况,分为术后复位组和再脱位组,通过单因素分析和多因素logistic回归分析婴幼儿DDH内收肌松解手法复位石膏固定术后发生再脱位的危险因素。 结果:88例103髋中86例99髋成功施行内收肌松解闭合复位石膏固定术,69髋一期闭合复位成功,9髋经二期复位石膏固定后至末次随访未再次脱位,最终78髋(78.8%)患儿闭合复位治疗有效。单因素分析结果显示,闭合复位术前髋臼指数(AI)、国际髋关节发育不良协会(IHDI)分级、术中屈髋角度、术中头臼间距与术后发生再脱位有关。多因素logistic回归分析结果显示,术前AI超过40.5°( OR=5.57, P<0.01),闭合复位术后屈髋角度小于80.5°(OR=4.93, P<0.01),头臼间距超过6.95?mm (OR=8.42, P<0.01)是术后发生再脱位的危险因素。术前AI超过40.5°、屈髋角度小于80.5°、头臼间距超过 6.95?mm联合IHDI分级预测术后再脱位风险的曲线下面积为0.91,敏感度和特异度分别为0.72和0.87。结论:DDH患儿术前AI超过40.5°,术中屈髋角度小于80.5°和头臼间距超过6.95?mm是术后再脱位的危险因素,联合IHDI 分级对术后再脱位有较大的预测价值。

关键词: 发育性髋关节发育不良闭合复位再脱位危险因素回顾性研究    
Abstract:

Objective: To investigate the risk factors for re-dislocation after the closed reduction in children with developmental dysplasia of the hip (DDH). Methods: The clinical data of 88 children aged ≤ 18?months with DDH (103 hips) who were treated with adductor muscle relaxation + closed reduction + plaster fixation at the Children’s Hospital, Zhejiang University School of Medicine from January 2015 to December 2017, were retrospectively analyzed. According to the diagnostic criteria of hip dislocation, patients were divided into two groups: reduction group and re-dislocation group. The univariate and multivariate logistic regression analysis were applied to identify the risk factors for the re-dislocation of children. Results: Eighty-six patients (99 hips) successively underwent the treatment. 69 hips were fixed at the first intention, 9 hips at the second intention, and a total of 78 hips with no re-dislocation occurred till the last follow-up with a rate of 78.8%. The univariate analysis showed that preoperative acetabular index (AI), International Hip Dysplasia Institute (IHDI) grade, intraoperative hip flexion angle, and intraoperative head-socket spacing were significantly related to the occurrence of re-dislocation after closed-reduction. The multivariate logistic regression analysis showed that preoperative AI > 40.5° ( OR=5.57, P<0.01), flexion angle < 80.5° (OR=4.93, P<0.01) and head-socket distance > 6.95?mm (OR=8.42, P<0.01) were risk factors for the re-dislocation. The area under the receiver operator characteristic curve was 0.91 when preoperative AI > 40.5°, flexion angle < 80.5°, head-socket distance > 6.95?mm, and IHDI grade were used to predict the occurrence of re-dislocation, and the sensitivity and specificity were 0.72 and 0.87, respectively.Conclusions: Preoperative AI > 40.5°, intraoperative hip flexion angle < 80.5°, and head-socket distance > 6.95?mm are risk factors for postoperative re-dislocation in children with DDH. These risk factors combining with the IHDI grade would be better to predict the occurrence of re-dislocation.

Key words: Developmental dysplasia of the hip    Closed reduction    Re-dislocation    Risk factors    Retrospective study
收稿日期: 2022-04-12 出版日期: 2022-11-16
CLC:  R274  
基金资助: 浙江省基础公益研究计划(LY20H060001)
通讯作者: 陈文昊   
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引用本文:

徐静芳,杨溢,俞凯,徐玮泽,白冠男,叶文松,舒强,陈文昊. 髋关节脱位患儿闭合复位后再脱位危险因素分析[J]. 浙江大学学报(医学版), 2022, 51(4): 454-461.

XU Jingfang,YANG Yi,YU Kai,XU Weize,BAI Guannan,YE Wensong,SHU Qiang,CHEN Wenhao. Risk factors for re-dislocation after closed reduction in children with developmental dysplasia of the hip. J Zhejiang Univ (Med Sci), 2022, 51(4): 454-461.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2022-0147        https://www.zjujournals.com/med/CN/Y2022/V51/I4/454

图1  屈髋角度、头臼间距测量示意图 α:屈髋角度;h:头臼间距(股骨干骺端中点与P线的水平距离).
图2  2015年1月至2017年12月浙江大学医学院附属儿童医院DDH患儿的治疗情况 DDH:发育性髋关节发育不良.

因 素

再脱位组( n=30)

复位组( n=69)

OR

P

术前因素

?

性别(男/女)

2/28

3/66

0.64

>0.05

侧别(左/右)

22/8

39/30

2.12

>0.05

复位年龄(月)

10.17±5.05

9.57±4.15

1.03

>0.05

术前AI(°)

41.00 (34.75, 44.35)

36.00 (34.00, 39.50)

1.13

<0.01

是/否支具治疗

9/21

20/49

1.05

>0.05

IHDI分型 Ⅱ级

0

29

4.02

<0.01

Ⅲ级

22

31

Ⅳ级

8

9

术中因素

?

屈髋角度(°)

77.00 (73.00, 83.50)

86.50 (76.25, 94.75)

3.52

0.01

头臼间距(mm)

7.10 (4.40, 8.33)

3.70 (1.45, 5.65)

1.39

<0.01

表1  DDH患儿闭合复位石膏固定术后再脱位术前和术中因素的单因素分析结果
  

因 素

回归系数

标准误

Walds χ 2

OR

P

术前AI超过40.5°

1.72

0.58

8.88

5.57

<0.01

屈髋角度小于80.5°

1.59

0.59

7.24

4.93

<0.01

头臼间距超过6.95?mm

2.13

0.61

12.04

8.42

<0.01

IHDI分型Ⅳ级

1.05

0.72

2.11

2.87

>0.05

表2  DDH患儿闭合复位石膏固定术后再脱位多因素 logistic回归分析结果

指 标

敏感度

特异度

AUC (95% CI)

术前AI超过40.5°

0.53

0.81

0.75(0.64~0.86)

屈髋角度小于80.5°

0.73

0.65

0.68(0.55~0.80)

头臼间距超过 6.95?mm

0.53

0.90

0.69(0.58~0.80)

IHDI分型Ⅳ级

0.47

0.73

0.71(0.61~0.81)

四因素联合预测

0.72

0.87

0.91(0.86~0.97)

表3  髋关节脱位患儿闭合复位后再脱位风险预测的受试者操作特征曲线分析结果
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