发育性髋关节发育不良(developmental dysplasia of the hip, DDH)作为最常见的儿童髋关节先天畸形,对儿童髋关节功能具有重大影响。闭合复位作为一种常用的治疗方法,在发育性髋关节发育不良的治疗过程中起到了重要作用。同心圆复位以及髋臼的发育潜能是闭合复位能够成功进行的前提条件。闭合复位的传统方法已广为接受,但仍有许多学者在不同方面提出改进。而关于闭合复位的适用范围,目前仍有许多争议。故本文对闭合复位治疗发育性髋关节发育不良研究进展进行综述。
Developmental dysplasia of the hip (DDH) is the most common congenital deformity of the hip joint in children, which has a significant impact on the function of the hip joint. As a commonly used treatment method, closed reduction plays an important role in the treatment of developmental dysplasia of the hip. Concentric reduction and the development potential of the acetabulum are prerequisites for successful closed reduction. The traditional process of closed reduction is widely accepted, but there are still some researchers who propose improvements in different aspects. There are still many controversies about the indications of closed reduction. Therefore, this article reviews the research progress of closed reduction in the treatment of developmental dysplasia of the hip.
发育性髋关节发育不良,闭合复位,保守治疗, Developmental Dysplasia of the Hip Closed Reduction Conservative Treatment摘要
发育性髋关节发育不良(developmental dysplasia of the hip, DDH)作为最常见的儿童髋关节先天畸形,对儿童髋关节功能具有重大影响。闭合复位作为一种常用的治疗方法,在发育性髋关节发育不良的治疗过程中起到了重要作用。同心圆复位以及髋臼的发育潜能是闭合复位能够成功进行的前提条件。闭合复位的传统方法已广为接受,但仍有许多学者在不同方面提出改进。而关于闭合复位的适用范围,目前仍有许多争议。故本文对闭合复位治疗发育性髋关节发育不良研究进展进行综述。
关键词
发育性髋关节发育不良,闭合复位,保守治疗
Research Progress of Closed Reduction and Hip Spica Casting in the Treatment of Developmental Dysplasia of the Hip
Qian Sun
Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Department of Orthopedics, Children’s Hospital of Chongqing Medical University, Chongqing
Developmental dysplasia of the hip (DDH) is the most common congenital deformity of the hip joint in children, which has a significant impact on the function of the hip joint. As a commonly used treatment method, closed reduction plays an important role in the treatment of developmental dysplasia of the hip. Concentric reduction and the development potential of the acetabulum are prerequisites for successful closed reduction. The traditional process of closed reduction is widely accepted, but there are still some researchers who propose improvements in different aspects. There are still many controversies about the indications of closed reduction. Therefore, this article reviews the research progress of closed reduction in the treatment of developmental dysplasia of the hip.
Keywords:Developmental Dysplasia of the Hip, Closed Reduction, Conservative Treatment
孙 乾. 闭合复位石膏外固定术治疗发育性髋关节发育不良的相关研究进展Research Progress of Closed Reduction and Hip Spica Casting in the Treatment of Developmental Dysplasia of the Hip[J]. 外科, 2022, 11(02): 30-36. https://doi.org/10.12677/HJS.2022.112006
参考文献ReferencesYang, S., Zusman, N., Lieberman, E., et al. (2019) Developmental Dysplasia of the Hip. Pediatrics, 143, e20181147.
<br>https://doi.org/10.1542/peds.2018-1147Harsanyi, S., Zamborsky, R., Krajciova, L., et al. (2020) Develop-mental Dysplasia of the Hip: A Review of Etiopathogenesis, Risk Factors, and Genetic Aspects. Medicina (Kaunas), 56, E153.
<br>https://doi.org/10.3390/medicina56040153Mellerowicz, H.H., Matussek, J. and Baum, C. (1998) Long-Term Results of Salter and Chiari Hip Osteotomies in Developmental Hip Dysplasia. A Survey of over 10 Years Follow-Up with a New Hip Evaluation Score. Archives of Orthopaedic and Trauma Surgery, 117, 222-227. <br>https://doi.org/10.1007/s004020050233Dezateux, C. and Rosendahl, K. (2007) Developmental Dysplasia of the Hip. The Lancet, 369, 1541-1552.
<br>https://doi.org/10.1016/S0140-6736(07)60710-7Verbruggen, S.W. and Nowlan, N.C. (2017) Ontogeny of the Human Pelvis. The Anatomical Record, 300, 643-652.
<br>https://doi.org/10.1002/ar.23541Ráliš, Z. and Mckibbin, B. (1973) Changes in Shape of the Human Hip Joint during Its Development and Their Relation to Its Stability. The Journal of Bone and Joint Surgery British Volume, 55, 780-785.
<br>https://doi.org/10.1302/0301-620X.55B4.780Weiner, L.S., Kelley, M.A., Ulin, R.I., et al. (1993) Develop-ment of the Acetabulum and Hip: Computed Tomography Analysis of the Axial Plane. Journal of Pediatric Orthopedics, 13, 421-425.
<br>https://doi.org/10.1097/01241398-199307000-00001Harrison, T. (1961) The Influence of the Femoral Head on Pelvic Growth and Acetabular Form in the Rat. Journal of Anatomy, 95, 12.Archer, C.W., Buxton, P., Hall, B.K., et al. (2006) Mechanical Regulation of Secondary Chondrogenesis. Biorheology, 43, 355-370.Zuscik, M.J., Hilton, M.J., Zhang, X., et al. (2008) Regulation of Chondrogenesis and Chondrocyte Differentiation by Stress. Journal of Clinical Investigation, 118, 429-438. <br>https://doi.org/10.1172/JCI34174Kotlarsky, P., Haber, R., Bialik, V., et al. (2015) Developmental Dysplasia of the Hip: What Has Changed in the Last 20 Years? World Journal of Orthope-dics, 6, 886-901. <br>https://doi.org/10.5312/wjo.v6.i11.886Brougham, D.I., Broughton, N.S., Cole, W.G., et al. (1988) The Predictability of Acetabular Development after Closed Reduction for Congenital Dislocation of the Hip. The Journal of Bone and Joint Surgery. British Volume, 70, 733-736.
<br>https://doi.org/10.1302/0301-620X.70B5.3192570Li, L., Zhang, L., Li, Q., et al. (2012) Development of the Osseous and Cartilaginous Acetabular Index in Normal Children and Those with Developmental Dysplasia of the Hip: A Cross-Sectional Study Using MRI. The Journal of Bone and Joint Surgery British Volume, 94, 1625-1631. <br>https://doi.org/10.1302/0301-620X.94B12.29958Li, Y., Xu, H., Li, J., et al. (2015) Early Predictors of Ace-tabular Growth after Closed Reduction in Late Detected Developmental Dysplasia of the Hip. Journal of Pediatric Or-thopaedics B, 24, 35-39.
<br>https://doi.org/10.1097/BPB.0000000000000111Tonnis, D. (1976) Normal Values of the Hip Joint for the Evaluation of X-Rays in Children and Adults. Clinical Orthopaedics and Related Research, 119, 39-47. <br>https://doi.org/10.1097/00003086-197609000-00007Sibiński, M., Murnaghan, C. and Synder, M. (2006) The Value of Preliminary Overhead Traction in the Closed Management of DDH. International Orthopaedics, 30, 268-271. <br>https://doi.org/10.1007/s00264-006-0080-4Park, K.-B., Vaidya, V.N., Shin, H., et al. (2018) Prereduction Traction for the Prevention of Avascular Necrosis before Closed Reduction for Developmental Dysplasia of the Hip: A Meta-Analysis. Therapeutics and Clinical Risk Management, 14, 1253. <br>https://doi.org/10.2147/TCRM.S166531Sucato, D.J., De La Rocha, A., Lau, K., et al. (2017) Overhead Bry-ant’s Traction Does Not Improve the Success of Closed Reduction or Limit AVN in Developmental Dysplasia of the Hip. Journal of Pediatric Orthopaedics, 37, e108-e113. <br>https://doi.org/10.1097/BPO.0000000000000747Vitale, M.G. and Skaggs, D.L. (2001) Developmental Dysplasia of the Hip from Six Months to Four Years of Age. Journal of the American Academy of Orthopaedic Surgeons, 9, 401-411.
<br>https://doi.org/10.5435/00124635-200111000-00005Murphy, R.F. and Kim, Y.J. (2016) Surgical Manage-ment of Pediatric Developmental Dysplasia of the Hip. Journal of the American Academy of Orthopaedic Surgeons, 24, 615-624. <br>https://doi.org/10.5435/JAAOS-D-15-00154中华医学会小儿外科分会骨科学组, 中华医学会骨科学分会小儿创伤矫形学组. 发育性髋关节发育不良临床诊疗指南(0-2岁) [J]. 中华骨科杂志, 2017, 37(11): 641-650.Aksoy, M.C. (2007) Closed Reduction in the Treatment of Developmental Dysplasia of the Hip. Acta Orthopaedica et Traumatologica Turcica, 41, 25-30.严格, 张郑, 南国新, 王忠良, 宿玉玺, 何波, 覃佳强. 改良半硬化高分子绷带人类位固定治疗发育性髋关节脱位[J]. 中华关节外科杂志: 电子版, 2020, 14(5): 534-539.周庆和, 黎艺强, 刘远忠, 等. 闭合复位动态石膏固定治疗儿童发育性髋关节发育不良的疗效分析[J]. 临床小儿外科杂志, 2018, 17(10): 742-746.Rampal, V., Sabourin, M., Erdeneshoo, E., et al. (2008) Closed Reduction with Traction for Developmental Dysplasia of the Hip in Children Aged between One and Five Years. Journal of Bone & Joint Surgery British Volume, 90, 858-863. <br>https://doi.org/10.1302/0301-620X.90B7.20041Kaneko, H., Kitoh, H., Mishima, K., et al. (2013) Long-Term Outcome of Gradual Reduction Using Overhead Traction for Developmental Dysplasia of the Hip over 6 Months of Age. Journal of Pediatric Orthopedics, 33, 628-634.
<br>https://doi.org/10.1097/BPO.0b013e31829b2d8bFukiage, K., Futami, T., Ogi, Y., et al. (2015) Ultra-sound-Guided Gradual Reduction Using Flexion and Abduction Continuous Traction for Developmental Dysplasia of the Hip: A New Method of Treatment. Bone and Joint Journal, 97-B, 405-411. <br>https://doi.org/10.1302/0301-620X.97B3.34287Terjesen, T., Horn, J. and Gunderson, R.B. (2014) Fifty-Year Follow-Up of Late-Detected Hip Dislocation: Clinical and Radiographic Outcomes for Seventy-One Patients Treated with Traction to Obtain Gradual Closed Reduction. Journal of Bone & Joint Surgery, 96, e28. <br>https://doi.org/10.2106/JBJS.M.00397Li, Y., Guo, Y., Li, M., et al. (2018) Acetabular Index Is the Best Pre-dictor of Late Residual Acetabular Dysplasia after Closed Reduction in Developmental Dysplasia of the Hip. Internation-al Orthopaedics, 42, 631-640.
<br>https://doi.org/10.1007/s00264-017-3726-5Li, Y., Lin, X., Liu, Y., et al. (2020) Effect of Age on Radio-graphic Outcomes of Patients Aged 6-24 Months with Developmental Dysplasia of the Hip Treated by Closed Reduction. Journal of Pediatric Orthopaedics B, 29, 431-437.
<br>https://doi.org/10.1097/BPB.0000000000000672Kitoh, H., Kitakoji, T., Katoh, M., et al. (2006) Prediction of Acetabular Development after Closed Reduction by Overhead Traction in Developmental Dysplasia of the Hip. Journal of Orthopaedic Science, 11, 473-477.
<br>https://doi.org/10.1007/s00776-006-1049-2Mansour, E., Eid, R., Romanos, E., et al. (2017) The Management of Residual Acetabular Dysplasia: Updates and Controversies. Journal of Pediatric Orthopaedics B, 26, 344-349. <br>https://doi.org/10.1097/BPB.0000000000000358Özdemir, N. and Surat, A. (2002) Treatment of Develop-mental Dysplasia of the Hip before Walking: Results of Closed Reduction and Immobilization in Hip Spica Cast. The Turkish Journal of Pediatrics, 44, 122-127.Vaquero-Picado, A., Gonzalez-Moran, G., Garay, E.G., et al. (2019) Developmental Dysplasia of the Hip: Update of Management. EFORT Open Reviews, 4, 548-556. <br>https://doi.org/10.1302/2058-5241.4.180019Khoshhal, K.I., Kremli, M.K., Zamzam, M.M., et al. (2005) The Role of Arthrography-Guided Closed Reduction in Minimizing the Incidence of Avascular Necrosis in Developmental Dysplasia of the Hip. Journal of Pediatric Orthopaedics B, 14, 256-261. <br>https://doi.org/10.1097/01202412-200507000-00004Novais, E.N., Hill, M.K., Carry, P.M., et al. (2016) Is Age or Surgical Approach Associated with Osteonecrosis in Patients with Developmental Dysplasia of the Hip? A Me-ta-Analysis. Clinical Orthopaedics and Related Research®, 474, 1166-1177. <br>https://doi.org/10.1007/s11999-015-4590-5Wang, Y.J., Yang, F., Wu, Q.J., et al. (2016) Association be-tween Open or Closed Reduction and Avascular Necrosis in Developmental Dysplasia of the Hip: A PRISMA-Compliant Meta-Analysis of Observational Studies. Medicine (Baltimore), 95, e4276. <br>https://doi.org/10.1097/MD.0000000000004276Luhmann, S.J., Bassett, G.S., Gordon, J.E., et al. (2003) Reduction of a Dislocation of the Hip Due to Developmental Dysplasia: Implications for the Need for Future Surgery. JBJS, 85, 239-243.
<br>https://doi.org/10.2106/00004623-200302000-00009Sibinski, M., Synder, M., Domzalski, M., et al. (2004) Risk Factors for Avascular Necrosis after Closed Hip Reduction in Developmental Dysplasia of the Hip. Ortopedia, Traumatologia, Rehabilitacja, 6, 60-66.Xu, M., Gao, S., Sun, J., et al. (2013) Predictive Values for the Severity of Avascular Necrosis from the Initial Evaluation in Closed Reduction of Developmental Dysplasia of the Hip. Journal of Pediatric Orthopaedics B, 22, 179-183.
<br>https://doi.org/10.1097/BPB.0b013e32835f1f7aSankar, W.N., Gornitzky, A.L., Clarke, N.M.P., et al. (2019) Closed Reduction for Developmental Dysplasia of the Hip: Early-Term Results from a Prospective, Multicenter Cohort. Journal of Pediatric Orthopaedics, 39, 111-118.
<br>https://doi.org/10.1097/BPO.0000000000000895Clarke, N.M., Jowett, A.J. and Parker, L. (2005) The Sur-gical Treatment of Established Congenital Dislocation of the Hip: Results of Surgery after Planned Delayed Intervention Following the Appearance of the Capital Femoral Ossific Nucleus. Journal of Pediatric Orthopaedics, 25, 434-439. <br>https://doi.org/10.1097/01.bpo.0000158003.68918.28Roposch, A., Odeh, O., Doria, A.S., et al. (2011) The Presence of an Ossific Nucleus Does Not Protect against Osteonecrosis after Treatment of Developmental Dysplasia of the Hip. Clinical Orthopaedics and Related Research®, 469, 2838-2845. <br>https://doi.org/10.1007/s11999-011-1801-6Zhang, Z., Li, H., Li, H., et al. (2020) Timing for Closed Reduc-tion Procedure for Developmental Dysplasia of the Hip and Its Failure Analysis. BMC Musculoskeletal Disorders, 21, Article No. 613.
<br>https://doi.org/10.1186/s12891-020-03635-1Terjesen, T. (2018) Long-Term Outcome of Closed Reduction in Late-Detected Hip Dislocation: 60 Patients Aged Six to 36 Months at Diagnosis Followed to a Mean Age of 58 Years. Journal of Children’s Orthopaedics, 12, 369-374.
<br>https://doi.org/10.1302/1863-2548.12.180024Salter, R.B. (1961) Innominate Osteotomy in the Treatment of Congenital Dislocation and Subluxation of the Hip. The Journal of Bone and Joint Surgery British Volume, 43, 518-539. <br>https://doi.org/10.1302/0301-620X.43B3.518Schoenecker, P.L., Dollard, P.A., Sheridan, J.J., et al. (1995) Closed Reduction of Developmental Dislocation of the Hip in Children Older than 18 Months. Journal of Pediatric Or-thopedics, 15, 763-767.
<br>https://doi.org/10.1097/01241398-199511000-00008Alassaf, N. (2020) Treatment of Developmental Dyspla-sia of the Hip (DDH) between the Age of 18 and 24 Months. European Journal of Orthopaedic Surgery & Traumatol-ogy, 30, 637-641. <br>https://doi.org/10.1007/s00590-019-02601-5徐宏文. 儿童发育性髋关节发育不良的治疗: 闭合复位还是开放复位? [J]. 临床小儿外科杂志, 2018, 17(10): 721-725.