背景:骨盆和股骨截骨术是治疗发育性髋关节发育不良(DDH)的有效方法,神经源性髋关节脱位(NDH),和Legg-Calvé-Perthes病(LCPD)。这项研究的目的是评估DDH儿童髋关节重建后的中期结果。NDH,和LCPD。
方法:在一项回顾性研究中,73名DDH儿童(2-19岁)的X射线,NDH,和LCPD是之前测量的,3个月,在髋关节重建手术后的最后随访(FU)(切开复位,以及2008年至2018年间的股骨和/或骨盆截骨术±软组织手术)。髋部几何形状的测量包括髋臼指数(AI),中心边缘角(CE),和Reimers迁移索引(RMI)。最终FU的平均随访时间为4.9年。P值设为P<0.05。
结果:手术后(股骨截骨术:84髋,索尔特无名截骨术:21髋,彭伯顿截骨术:30髋,切开复位:28髋,Chiari截骨术:4髋,和软组织释放:24髋),髋部几何参数明显改善。然而,在最后的FU,与术后3个月的数据相比,股骨头偏侧化(RMI)的髋关节几何形状恶化(RMI:术前/3个月/最终FU:40.6±16.1%/6.1±9.0/15.4±16.0%;CE:11.3°±20.0°/30.2°±9.5°/27.9±15.4°;AI:28.8°±9.6°/19.1°7.6°±18.3)。亚组分析未显示有关DDH中RMI进展的差异,NDH,和LCPD在最终FU。不管是什么基础疾病,在所有三组中均观察到侧向化(DDH,NDH,和LCPD),术后3个月与最大随访的X射线比较具有统计学意义(DDH;NDH;LCPD:2.7±6.8%/7.6±10.1%;13.7±15.3%/22.8±19.8%;1.7±4.1%/14.9±11.3%)。DDH或NDH患者的其他软组织释放技术未显示术后差异,具有统计学意义。关于外科技术,发现下RMI与i骨截骨术之间存在联系。在25名患者中,(34%)并发症:浅表皮损8例,深部皮损3例,内收收缩3例,半脱位2例,铸型脱位2例,股骨头坏死2例,1例恢复,1例植入钢板感染,1例顺应性问题,1例骨延迟愈合,1例膝关节屈肌收缩。
结论:这项研究的基本结果表明,在4.9年的随访中,髋关节的几何形状有了显着改善,并证明了以前发表的文献的发现。此外,该研究能够显示所有患者组的RMI进展,接受了重建手术,尽管有基本的髋关节几何数据(AI,CE角度)没有改变。这些发现与基础病理学无关。34%的患者发生并发症,并涉及髋关节重建手术后所有已知的不良事件。这清楚地表明了为什么需要进行年度随访检查,以免错过正确的翻修手术指征。
结论:证据级别:IV级,案例系列。
背景:本手稿是一项前瞻性随机临床试验的一部分,在德国临床试验注册DRKS-ID中注册:DRKS00016861。
BACKGROUND: Pelvic and femoral osteotomies have been effective methods to treat developmental dysplasia of the hip (DDH), neurogenic dislocation of the hip (NDH), and Legg-Calvé-Perthes disease (LCPD). The aim of this
study was to evaluate the mid-term results after hip reconstruction in children with
DDH, NDH, and LCPD.
METHODS: In a retrospective
study, X-rays of 73 children (2-19 years) with
DDH, NDH, and LCPD were measured before, 3 months, and at final follow-up (FU) after hip reconstructive surgery (open reduction, and femoral and/or pelvic osteotomy ± soft-tissue procedures between 2008 and 2018). Measurement of hip geometry included acetabular index (AI), center-edge angle (CE), and Reimers migration index (RMI). Mean follow-up time at final FU was 4.9 years. P value was set P < 0.05.
RESULTS: After surgery (femoral osteotomy: 84 hips, Salter innominate osteotomy: 21 hips, Pemberton osteotomy: 30 hips, open reduction: 28 hips, Chiari osteotomy: 4 hips, and soft-tissue release: 24 hips), hip geometry parameters improved significantly. Nevertheless, at final FU, there was deterioration in hip geometry with femoral head lateralization (RMI) compared to the data at 3 months after surgery (RMI: preop/3 months/final FU: 40.6 ± 16.1%/6.1 ± 9.0/15.4 ± 16.0%; CE: 11.3° ± 20.0°/30.2° ± 9.5°/27.9 ± 15.4°; AI: 28.8° ± 9.6°/19.1° ± 7.6°/18.3 ± 7.6°). Sub-group analysis did not show differences concerning the progression of RMI in DDH, NDH, and LCPD at final FU. Regardless of basic disease, the lateralization was observed in all three groups (DDH, NDH, and LCPD) and statistically significant comparing X-rays 3 months postoperatively to maximum follow-up (DDH; NDH; LCPD: 2.7 ± 6.8%/7.6 ± 10.1%; 13.7 ± 15.3%/22.8 ± 19.8%; 1.7 ± 4.1%/14.9 ± 11.3%). Additional soft-tissue release techniques in patients with DDH or NDH did not show postoperative differences with statistical significance. Concerning surgical techniques, a connection between the lower RMI and the procedure of osteotomy of the ilium was found. In 25 patients, (34%) complications were observed: superficial skin lesions in 8, deep skin lesions in 3, contraction of adductors in 3, subluxation in 2, dislocations of the cast in 2, osteonecrosis of the femoral head in 2 cases, reluxation in 1, infection of the implanted plate in 1, compliance problem in 1, delayed bone healing in 1, and contraction of knee flexors in 1 case.
CONCLUSIONS: The basic results of this study show a significant improvement of hip geometry at a follow-up of 4.9 years and prove findings of previously published literature. Moreover, the
study was able to show a progression of RMI in all patient groups, which have undergone reconstructive surgery, despite basic hip geometry data (AI, CE angle) did not change. Those findings were independent from underlying pathology. Complications were counted in 34% of the patients and involved all known adverse events after hip reconstructive surgery. This makes clear why annual follow-up checks are needed not to miss the right indication for revision surgery.
CONCLUSIONS: Evidence level: Level IV, case series.
BACKGROUND: This manuscript is part of a prospective randomized clinical
trial, registered in the German Clinical Trials Register DRKS-ID: DRKS00016861.