两种髋人类位髋人字石膏治疗婴幼儿髋关节发育不良比较

Comparison of two kinds of hip spica cast for developmental dysplasia of the hip in infant

摘要:

［目的］比较闭合复位膝上与标准人类位髋人字石膏固定治疗婴幼儿发育性髋关节发育不良的临床效果。［方法］回顾性分析 2010 年 1 月—2018 年 12 月伊犁州新华医院小儿骨科治疗 121 例年龄 6~18 个月的 DDH 患儿的临床资料。依据与患者家长沟通结果，58 例 （76 髋） 采用膝上髋人类位髋人字石膏固定 （膝上组），63 例 （80 髋） 采用常规标准髋人类位髋人字石膏固定 （标准组）。比较两组临床及影像资料。［结果］两组患者均一次复位成功，膝上组的早期再脱位率 11.8%（9/76），标准组为 2.5%（2/80），两组间差异有统计学意义（P<0.05）。再脱位的患儿均择期行切开复位术，并排除之后的研究。两组患儿透视次数、带石膏的时间、石膏压疮等差异均无统计学意义（P>0.05）。两组患儿平均随访时间（5.3±2.0）年。拆除石膏后开始站立时间、开始行走时间差异无统计学意义 （P>0.05）。影像方面，与治疗前相比，末次随访时两组患儿 T?nnis 评级均显著改善 （P<0.05）。与拆石膏后相比，末次随访时两组 Severin 评级和 CE 角均无明显改变（P>0.05）。随时间推移两组患者 AI 均显著增加 （P<0.05）。相应时间点，两组间 T?nnis 评级、Severin 评级、CE 角和 AI 角的差异均无统计学意义（P>0.05）。末次随访时，膝上组股骨头坏死率为 14.9％（10/67），标准组为 16.7％（13/78），差异无统计学意义（P>0.05）。［结论］ 闭合复位膝上人类位髋人字石膏固定是治疗 6～18 个月 DDH 的有效方法，但早期关节再脱位的风险高于标准人类位髋人字石膏。

Abstract:

[Objective] To compare the clinical results of closed reduction and fixation in human position with above-knee hip spica cast versus standard hip spica cast for developmental dysplasia of the hip in infants. [Methods] A retrospective study was performed on 6~18 month-age 121 children who received closed reduction and external fixation in human position with hip spica cast in our department from January 2010 to December 2018. According to the results of communication with the parents of the infant, 58 infant (76 hips) were fixed with above-knee cast (AK group), while the other 63 cases (80 hips) had standard hip spica cast used (SD group). The clinical and imaging data of the two groups were compared. [Results] The early redislocation rate was 11.8% (9/76) in the AK group, whereas 2.5% (2/80) in the SD group, which proved statistically significant between them (P＜0.05). All children with redislocation were changed to open reduction, and were excluded from further evaluation of this study. There were no significant differences in fluoroscopy times, time in plaster, and incidence of pressure sores between the two groups (P＞0.05). All the children were followed up for (5.3±2.0) years on an average, and there was no sig- nificant difference in the time to start standing and to walking after the plaster removed between the two groups (P＜0.05). Radiographically children in both groups got significant improvement in T?nnis grades at the latest follow-up compared with those pre-treatment (P＜0.05). In addition, the Severin grade and center-edge angle (CE) in both groups remained unchanged at the latst follow-up compared with those just after cast removal (P＞0.05), whereas acetabular index (AI) increased significantly over time in both groups (P＜0.05). At any corresponding time points, there were no significant differences in T?nnis grade, Severin grade, CE and AI between the two groups (P＜0.05). At the latest follow-up, the femoral head necrosis rate was 14.9% (10/67) in the AK group, while 16.7% (13/78) in the SD group, which was not statistical-ly significant (P＞0.05). [Conclusion] Closed reduction and fixation with hip spica cast is an effective treatment for DDH in 6~18 monthage infant, the above-knee hip spica cast has higher risk of early redislocation than the standard hip spica cast. Key words: developmental dysplasia of the hip, closed reduction plaster fixation, human position, above-k