临床小儿外科杂志2024，Vol.23Issue(3)：210-215,6.DOI:10.3760/cma.j.cn101785-202210020-002
血清骨桥蛋白与瘦素联合临床特征对发育性髋关节脱位闭合复位后股骨头坏死的预测价值
Value of combining osteopontin and leptin with clinical features in predicting femoral head necrosis af-ter closed reduction of developmental dislocation of the hip
摘要
Abstract
Objective To explore the value of osteopontin(OPN)and leptin plus clinical features in predicting avascular necrosis(AVN)of femoral head in children with developmental hip dislocation(DHD)after closed reduction.Methods From January 2018 to January 2021,the relevant clinical data were retro-spectively reviewed for 130 hospitalized DHD children undergoing closed reduction under general anesthesia.They were assigned into two groups of AVN and non-AVN.Basic demographics were collected,including gen-der,age,side of affected hip,degree of dislocation,adductor muscle release,presence/absence of ossification nucleus,vascular classification,number of blood vessels,femoral head perfusion change and preoperative ace-tabular index.Height,anterioposterior(AP)and left/right diameters of femoral head were measured.The influ-encing factors of AVN were examined by unconditional Logistic stepwise regression.Receiver operating charac-teristic(ROC)curve was utilized for examining the values of femoral head diameter,AP diameter and serum OPN/leptin in predicting AVN.Results The proportion of patients with vascular type Ⅰ in AVN group and without AVN group was 14(26.92％)and 6(7.69％),respectively.The proportion of B patients with femo-ral head perfusion changes was 28(53.85％)and 28(35.90％),respectively.The proportion of type C changes in femoral head perfusion was 13 cases(25.00％)and 4 cases(5.13％),respectively.The diameter of femoral head was(1.65±0.26)cm in AVN group and(1.88±0.25)cm without AVN group,respective-ly.The anteroposterior diameter of femoral head was(1.74±0.32)cm and(1.95±0.29)cm,respectively.OPN was(11.36±3.72)µg/L and(6.52±2.17)μg/L,respectively.Leptin levels were(44.29±8.35)µg/L and(28.52±6.37)μg/L,respectively.Logistic regression analysis indicated that vascular classification type Ⅰ,femoral head perfusion change class B/C,left/right diameter of femoral head ≤ 1.782 cm,AP diameter of femoral head ≤ 1.856 cm,OPN ≥ 8.049 pg/L and leptin ≥38.075 pg/L were risk factors for AVN(P＜0.05).ROC analysis revealed that area under the curve for predicting AVN was 0.851(95％CI:0.788-0.914),0.787(95％CI:0.711-0.863)and 0.978(95％CI:0.711-0.863).0.959-0.997),0.926(95％CI:0.884-0.967)with a sensitivity of 0.788,0.673,0.885,0.788 and a specificity of 0.769,0.692,0.833,0.795 respectively.Conclusions AVN may be correlated with immature vascular development and poor perfusion of femoral head after closed reduction in DHD children.Left/right and AP diameters of femoral head are measured clinically.And serum level of OPN/leptin may be quantified to provide references for predicting AVN.关键词
发育性髋关节脱位/股骨头缺血性坏死/外科手术/儿童Key words
Ossified Nucleus of Femoral Head/Developmental Dysplasia of The Hip/Surgical Proce-dures,Operative/Child引用本文复制引用
黄乙勇,符凯,洪聪,朱立宁..血清骨桥蛋白与瘦素联合临床特征对发育性髋关节脱位闭合复位后股骨头坏死的预测价值[J].临床小儿外科杂志,2024,23(3):210-215,6.基金项目
海南省临床医学中心建设项目资助(琼卫医函[2021]75号) （琼卫医函[2021]75号）
海南自然科学基金面上项目(20168326) Construction Project of Clinical Medical Center of Hainan Province(QWEH2021-75) （20168326）
Hainan Provincial Natural Science Foundation Project(20168326) （20168326）
