目的:创伤性髋关节脱位在儿童和青少年时期非常罕见。这项多中心研究的目的是分析儿童大量创伤性髋关节脱位的当前流行病学和损伤形态。这可以提供对儿童髋关节脱位的更好理解,并有助于发展治疗方法,以防止长期影响。
方法:本回顾性研究,匿名多中心研究包括患者,17岁以下,急性创伤性髋关节脱位和开放性生长板。患者来自16家德国医院。排除标准包括数据不足,髋关节发育不良的阳性病史,或者与综合症有关,神经或结缔组织疾病诱发髋关节脱位。对患者的人体测量数据和扫描进行了分析(X射线,MRI,CT),收集于1979年至2021年之间。性别,错位时的年龄,相关骨折,损伤机制,初始治疗包括脱位和复位之间的时间,减少的方法,对复位后的治疗算法以及所有记录的并发症和伴随损伤进行了评估。
结果:76例患者符合纳入标准。在4-8岁和11-15岁有两个年龄高峰。八岁以下年龄组女孩的发病率增加,有轻微创伤的人,在八岁以上的人群中,有更多的男孩,有中度和重度创伤的人。89.9%的病例发生背位脱位。单纯性伤害在所有年龄段都占主导地位。伴随的伤害很少发生在8岁之前;然而,它们随着髋臼骨化的增加而增加,在11-15岁的青少年中有32%出现撕脱伤。在76名患者中,4经历了一个自发的,67一关闭和5一初级打开还原。84%的儿童在6小时内进行了减少;但是,在约10%的病例中,直到24小时后才进行复位。在复位后的34名儿童中发现了需要干预的伴随损伤。并发症包括敏感性障碍形式的神经刺激(n=6)以及15.8%的患者(n=12)的股骨头缺血性坏死(AVN)。
结论:创伤性髋关节脱位在儿童和青少年时期罕见,并发症发生率高。最严重的并发症,股骨头坏死,发生在16%的病例中。轻伤,尤其是年幼的孩子,足以导致错位。后脱位更常见,主要发生为单一损伤;然而,随着年龄的增长,必须考虑伴随的伤害。儿童继续经历延迟的减少。直到减少的时间长度,年龄和伴随损伤的严重程度在股骨头坏死的发展中起作用;然而,这个话题需要额外的调查。
OBJECTIVE: Traumatic hip dislocations are very rare in childhood and adolescence. The aim of this multi-centre study is to analyse the current epidemiology and injury morphology of a large number of traumatic hip dislocations in children. This can provide a better understanding of childhood hip dislocations and contribute to the development of a therapeutic approach in order to prevent long-term impacts.
METHODS: This retrospective, anonymised multi-centre study included patients, aged up to 17 years, with acute traumatic hip dislocations and open growth plates. The patients came from 16 German hospitals. Exclusion criteria included insufficient data, a positive history of hip dysplasia, or an association with syndromal, neurological or connective tissue diseases predisposing to hip dislocation. An analysis was carried out on the patients\' anthropometric data and scans (X-ray, MRI, CT), which were collected between 1979 and 2021. Gender, age at the time of dislocation, associated fractures, mechanism of injury, initial treatment including time between dislocation and reduction, method of reduction, treatment algorithm following reduction and all documented complications and concomitant injuries were evaluated.
RESULTS: Seventy-six patients met the inclusion criteria. There were two age peaks at 4-8 years and 11-15 years. There was an increased incidence of girls in the under-eight age group, who had mild trauma, and in the group of over-eights there were more boys, who had moderate and severe trauma. Dorsal dislocation occurred in 89.9% of cases. Mono-injuries dominated across all age groups. Concomitant injuries rarely occurred before the age of eight; however, they increased with increasing ossification of the acetabulum and appeared as avulsion injuries in 32% of 11-15-year-olds. Of the 76 patients, 4 underwent a spontaneous, 67 a closed and 5 a primary open reduction. A reduction was performed within 6 h on 84% of the children; however, in around 10% of cases a reduction was not performed until after 24 h. Concomitant injuries needing intervention were identified in 34 children following reduction. Complications included nerve irritation in the form of sensitivity disorders (n = 6) as well as avascular necrosis (AVN) of the femoral head in 15.8% of the patients (n = 12).
CONCLUSIONS: Traumatic hip dislocations are rare in childhood and adolescence and have high complication rates. The most severe complication, femoral head necrosis, occurred in 16% of cases. Minor injuries, especially in younger children, are enough to cause a dislocation. Posterior dislocation was more frequent and primarily occurred as a mono-injury; however, concomitant injuries must be considered with increasing age. Children continue to experience delayed reductions. The length of time until reduction, age and the severity of the concomitant injury play a role in the development of femoral head necrosis; however, this topic requires additional investigation.