骨化核对发育性髋关节脱位术后股骨头缺血性坏死的影响研究OA北大核心CSTPCD

Objective To explore the effect of ossified nuclei on avascular necrosis of femoral head(AVN)in children aged 6-24 month with developmental dysplasia of the hip(DDH)and examine whether or not DDH therapy should be deferred until the emergence of ossified nuclei.Methods The clinical data of hip joint in children with DDH aged 6 to 24 months who received plaster fixation in Kunming Children's Hospital from January 2018 to January 2022 were retrospectively analyzed.According to the necrosis of the hip head at the last follow-up,it was divided into:AVN(+)group(Kalamchi-MacEwen type Ⅰ～Ⅳ),AVN(-)group(Kalamchi-MacEwen type no necrosis),The femoral head was divided into clinical AVN(+)group(Kalam-chi-MacEwen type Ⅱ to Ⅳ)and clinical AVN(-)group(Kalamchi-MacEwen type Ⅰ or no necrosis)accord-ing to whether clinical necrosis occurred,and were divided into 6 to 12 months of age group,12 to 18 months of age group and 18 to 24 months of age group according to operative age.The ossified nucleus status,gender,side,age,mode of operation,preoperative IHDI classification,preoperative Al value,and abduction Angle of the affected hip were compared between the AVN(+)group and the AVN(-)group,and the independent influ-encing factors of postoperative AVN were evaluated by multivariate Logistic regression analysis.receiver operat-ing characteristic curve(ROC)was drawn based on independent influencing factors to evaluate its diagnostic efficacy for postoperative AVN after DDH.The status of ossified nucleus of hip in clinical AVN(+)group and clinical AVN(-)group were compared to analyze the influence of ossified nucleus status on clinical AVN.The incidence of AVN,clinical AVN,redislocation and residual acetabular dysplasia(RAD)of the affected hip in the 6-12 months age group,the 12-18 months age group and the 18-24 months age group were analyzed.Results A total of 221 hips were included in the study.The AVN(+)group had 54 hips and the AVN(-)group had 167 hips.In all affected hips,the incidence of AVN with ossified nucleus was 18.1％,and the inci-dence of ANV without ossified nucleus was 37.5％.The incidence of AVN with ossified nucleus was significant-ly lower than that without ossified nucleus(P=0.002).Multivariate Logistic regression analysis showed that the status of ossified nucleus(OR=3.064,95％CI:1.486-6.319),abducting Angle(OR=1.184,95％CI:1.110-1.264),preoperative IHDI classification(OR=3.821,95％CI:1.465～9.968)were independent in-fluencing factors for postoperative AVN after DDH(P＜0.05).ROC Curve analysis showed that the best trun-cation value of abduction Angle for predicting AVN after DDH was 63.5°,the Area Under Curve(AUC)was 0.752,the sensitivity was 0.500,and the specificity was 0.934.The incidence of clinical AVN in patients with ossified nucleus was 14.1％,and the incidence of clinical ANV in patients without ossified nucleus was 26.4％.The incidence of clinical AVN in patients with ossified nucleus was significantly lower than that in pa-tients without ossified nucleus(P=0.026).The incidence of AVN in 6-12 months,12-18 months and 18-24 months age groups was 20.0％,31.7％and 46.1％,respectively.The clinical incidence of AVN was 11.3％,25.0％and 26.1％,and the rate of redislocation was 1.7％,8.3％and 13.0％,respectively.The RAD rates were 27.0％,45.0％and 54.3％,respectively.There was no significant difference in the incidence of AVN among the three operative age groups(P=0.224),but the incidence of AVN and redislocation were clinically significant.Conclusions The status of ossified nucleus,abduction Angle and preoperative IHDI type were independent fac-tors for postoperative AVN in DDH affected hips.The appearance of ossified nucleus has a protective effect on the femoral head and can significantly reduce the incidence of AVN and clinical AVN.However,with the increase of age,the incidence of clinical AVN,the rate of re-dislocation and the rate of RAD will increase,which will lead to a worse prognosis.Therefore,it is recommended that DDH treatment should be performed as soon as possible when there are indications of reduction,without waiting for the appearance of ossified nucleus.