Abstract：
OBJECTIVE: To investigate the necessity of performing capsulorrhaphy during open reduction of DDH.
METHODS: A single-centre, prospective, randomized controlled trial was conducted between 2015 and 2020. The study included 82 hips in 67 patients with developmental dysplasia of the hip (DDH) who were treated with open reduction via the anterior approach. Patients were randomized into two equal groups (41 hips in each group); group A (capsulorrhaphy was done) and group B (capsulorrhaphy was not done). Dega osteotomy was performed in all cases, while femoral derotation shortening osteotomy was performed only in four hips in group A and four hips in group B. The mean age at the time of surgery was 33 ± 22.3 months. The follow-up period was 24 months for all patients. At the final follow-up, maintenance of reduction was chosen as the primary outcome and was assessed radiologically by the Severin\'s grading system. Secondary outcome measures were functional evaluation (by using the modified McKay\'s criteria), Shenton line assessment, acetabular index measurement, and complications.
RESULTS: According to the Severin\'s grading system, concentric reduction was achieved in 36 hips in group A and 37 hips in group B, subluxation occurred in three hips in each group, and redislocation was encountered in two hips in group A and one hip in group B. There was no statistically significant difference between both groups (p-value = 0.239). According to the modified McKay\'s criteria, the results were satisfactory (excellent and good) in 34 hips (82.9%) in group A and 36 hips (87.8%) in group B. The difference was statistically insignificant (p-value = 0.352). The rate of complications was higher in group A (17.1%) than group B (12.2%) (p-value = 0.532).
CONCLUSIONS: The stability of the hip joint after open reduction depends mainly on adequate removal of soft tissue obstacles that impede reduction and proper correction of the bony configuration of the hip using pelvic and/or femoral osteotomy. So, the authors believe that capsulorrhaphy is not necessary in the surgical management of DDH, provided that adequate soft tissue and bony gestures are combined.
METHODS: A single-centre, prospective, randomized controlled trial was conducted between 2015 and 2020. The study included 82 hips in 67 patients with developmental dysplasia of the hip (DDH) who were treated with open reduction via the anterior approach. Patients were randomized into two equal groups (41 hips in each group); group A (capsulorrhaphy was done) and group B (capsulorrhaphy was not done). Dega osteotomy was performed in all cases, while femoral derotation shortening osteotomy was performed only in four hips in group A and four hips in group B. The mean age at the time of surgery was 33 ± 22.3 months. The follow-up period was 24 months for all patients. At the final follow-up, maintenance of reduction was chosen as the primary outcome and was assessed radiologically by the Severin\'s grading system. Secondary outcome measures were functional evaluation (by using the modified McKay\'s criteria), Shenton line assessment, acetabular index measurement, and complications.
RESULTS: According to the Severin\'s grading system, concentric reduction was achieved in 36 hips in group A and 37 hips in group B, subluxation occurred in three hips in each group, and redislocation was encountered in two hips in group A and one hip in group B. There was no statistically significant difference between both groups (p-value = 0.239). According to the modified McKay\'s criteria, the results were satisfactory (excellent and good) in 34 hips (82.9%) in group A and 36 hips (87.8%) in group B. The difference was statistically insignificant (p-value = 0.352). The rate of complications was higher in group A (17.1%) than group B (12.2%) (p-value = 0.532).
CONCLUSIONS: The stability of the hip joint after open reduction depends mainly on adequate removal of soft tissue obstacles that impede reduction and proper correction of the bony configuration of the hip using pelvic and/or femoral osteotomy. So, the authors believe that capsulorrhaphy is not necessary in the surgical management of DDH, provided that adequate soft tissue and bony gestures are combined.
摘要：
目的：探讨DDH切开复位术中进行包膜修补术的必要性。
方法：单中心，prospective,随机对照试验于2015年至2020年进行.该研究包括67例发育性髋关节发育不良（DDH）患者的82髋，这些患者通过前路切开复位治疗。患者被随机分为两个相等的组（每组41髋）；A组（进行包膜缝合术）和B组（未进行包膜缝合术）。所有病例均进行了Dega截骨术,而A组仅在4髋和B组4髋进行股骨旋转缩短截骨术，手术时的平均年龄为33±22.3个月。所有患者的随访期均为24个月。在最后的后续行动中，选择维持减量作为主要结局,并通过Severin的分级系统进行放射学评估.次要结局指标是功能评估(通过使用修改后的McKay标准)，申顿行评估，髋臼指数测量,和并发症。
结果：根据Severin的评分系统，A组36髋和B组37髋同心复位,每组三髋脱位,A组2髋和B组1髋再脱位,两组间无统计学差异(p值=0.239)。根据修改后的麦凯标准,A组34髋(82.9%)和B组36髋(87.8%)结果满意(优、好),差异有统计学意义(p值=0.352)。A组并发症发生率（17.1%）高于B组（12.2%）（p值=0.532）。
结论：切开复位后髋关节的稳定性主要取决于使用骨盆和/或股骨截骨术充分去除阻碍复位的软组织障碍和正确矫正髋骨形态。所以,作者认为，在DDH的外科治疗中，包膜修补术是不必要的，前提是结合了足够的软组织和骨骼手势。
方法：单中心，prospective,随机对照试验于2015年至2020年进行.该研究包括67例发育性髋关节发育不良（DDH）患者的82髋，这些患者通过前路切开复位治疗。患者被随机分为两个相等的组（每组41髋）；A组（进行包膜缝合术）和B组（未进行包膜缝合术）。所有病例均进行了Dega截骨术,而A组仅在4髋和B组4髋进行股骨旋转缩短截骨术，手术时的平均年龄为33±22.3个月。所有患者的随访期均为24个月。在最后的后续行动中，选择维持减量作为主要结局,并通过Severin的分级系统进行放射学评估.次要结局指标是功能评估(通过使用修改后的McKay标准)，申顿行评估，髋臼指数测量,和并发症。
结果：根据Severin的评分系统，A组36髋和B组37髋同心复位,每组三髋脱位,A组2髋和B组1髋再脱位,两组间无统计学差异(p值=0.239)。根据修改后的麦凯标准,A组34髋(82.9%)和B组36髋(87.8%)结果满意(优、好),差异有统计学意义(p值=0.352)。A组并发症发生率（17.1%）高于B组（12.2%）（p值=0.532）。
结论：切开复位后髋关节的稳定性主要取决于使用骨盆和/或股骨截骨术充分去除阻碍复位的软组织障碍和正确矫正髋骨形态。所以,作者认为，在DDH的外科治疗中，包膜修补术是不必要的，前提是结合了足够的软组织和骨骼手势。
