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OA北大核心CSTPCD
Value of combining osteopontin and leptin with clinical features in predicting femoral head necrosis af-ter closed reduction of developmental dislocation of the hip
目的 探讨骨桥蛋白(osteopontin,OPN)、瘦素(leptin)联合临床特征对发育性髋关节脱位患儿闭合复位后股骨头缺血性坏死(avascular necrosis of femoral head,AVN)的预测价值.方法 回顾性分析2018年1月至2021年1月海南省妇女儿童医学中心收治的130例发育性髋关节脱位患儿临床资料,患儿均于全身麻醉下行闭合复位治疗,随访18个月.根据是否并发AVN分为AVN组(n=52)和无AVN组(n=78).收集所有患儿一般资料(包括性别、年龄、患髋侧别、脱位程度、内收肌松解情况、有无骨化核、血管分型、血管数量、股骨头灌注改变情况、术前髋臼指数),测量股骨头高度、前后径、左右径,检测血清OPN及瘦素水平;采用非条件Logistic逐步回归分析发育性髋关节脱位患儿并发AVN的影响因素.采用受试者工作特征(receiver operating characteristic,ROC)曲线分析股骨头左右径及前后径、血清OPN及leptin对于预测发育性髋关节脱位患儿并发AVN的价值.结果 AVN组和无AVN组中血管分型为Ⅰ型者分别为14例(14/52,26.92％)和6例(6/78,7.69％);股骨头灌注改变为B类者分别为28例(28/52,53.85％)和28例(28/78,35.90％);股骨头灌注改变为C类者分别为13例(13/52,25.00％)和4例(4/78,5.13％).AVN组和无AVN组股骨头左右径分别为(1.65±0.26)cm和(1.88±0.25)cm;股骨头前后径分别为(1.74±0.32)cm 和(1.95±0.29)cm;OPN 分别为(11.36± 3.72)μg/L 和(6.52±2.17)μg/L;瘦素分别为(44.29±8.35)µg/L 和(28.52±6.37)μg/L;Logistic 回归分析结果显示,血管分型Ⅰ型、股骨头灌注改变为B类和C类、股骨头左右径≤1.782 cm、股骨头前后径≤1.856 cm、OPN ≥8.049 μg/L、瘦素≥38.075 pg/L是发育性髋关节脱位患儿并发AVN的危险因素(P＜0.05);ROC曲线分析结果显示,股骨头左右径、股骨头前后径、血清OPN及瘦素预测发育性髋关节脱位患儿并发AVN的曲线下面积分别为0.851(95％CI:0.788～0.914)、0.787(95％CI:0.711～0.863)、0.978(95％CI:O.959～0.997)、0.926(95％CI:0.884～0.967),灵敏度分别为 0.788、0.673、0.885、0.788,特异度分别为0.769、0.692、0.833、0.795.结论 发育性髋关节脱位患儿并发AVN可能与股骨头血管发育不成熟、闭合复位治疗后股骨头灌注差等因素有关.临床可测量股骨头左右径及前后径,并检测血清OPN和瘦素水平,为预测AVN的发生提供参考.
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.
黄乙勇;符凯;洪聪;朱立宁
海南省妇女儿童医学中心小儿骨科,海口 570100
发育性髋关节脱位股骨头缺血性坏死外科手术儿童
Ossified Nucleus of Femoral HeadDevelopmental Dysplasia of The HipSurgical Proce-dures,OperativeChild
《临床小儿外科杂志》 2024 (003)
210-215 / 6
海南省临床医学中心建设项目资助(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);Hainan Provincial Natural Science Foundation Project(20168326)
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