Avascular necrosis after treatment of DDH: The protective influence of the ossific nucleus

被引:91
作者
Segal, LS [1 ]
Boal, DK [1 ]
Borthwick, L [1 ]
Clark, MW [1 ]
Localio, AR [1 ]
Schwentker, EP [1 ]
机构
[1] Penn State Univ, Milton S Hershey Med Ctr, Coll Med, Dept Orthopaed & Rehabil, Hershey, PA 17033 USA
关键词
avascular necrosis; developmental dysplasia of the hip (DDH) dislocation; ossific nucleus; reduction; ultrasound;
D O I
10.1097/00004694-199903000-00008
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
We retrospectively reviewed the results of open or closed reduction for developmental dysplasia of the hip (DDH) in 49 children younger than 12 months old, who had 57 hip dislocations. Group A (18 hips) developed partial or complete avascular necrosis (AVN), and group B (39 hips) did not develop AVN. Thirty-eight hips were treated by closed reduction, and 17 had open reduction. One patient with bilateral hip dislocation initially had closed reductions followed by bilateral open reduction 3 months later. With the numbers available for study, there was no significant difference in the occurrence of AVN with respect to variables such as preliminary traction, closed versus open reduction, Pavlik harness use, and age at the time of operative intervention. However, the presence of the ossific nucleus before reduction, detected either by radiographs (p< 0.001) or ultrasonography (p = 0.033) was statistically significant in predicting AVN. Only one (4%) of 25 hips with an ossific nucleus developed AVN, whereas 17 (53%) of 32 hips without an ossific nucleus before reduction developed AVN. Our results suggest that the presence of the ossific nucleus before closed or open reduction for DDH may decrease the risk of AVN.
引用
收藏
页码:177 / 184
页数:8
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