| ObjectiveTo investigate the effect of unilateral developmental dislocation of the hip children treated with open reduction,pelvic Salter osteotomy and femoral shortening and derotation osteotomy.MethodsA total of 53 children with unilateral developmental dislocation of the hip who have had treated with open reduction,pelvic osteotomy and femoral shortening and derotation osteotomy and were admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2018 were collected.McKay was used for assessing the function results of the hip.The postoperative hip joint on the last pelvic anteroposterior X-ray line was graded by Severin imaging method.The acetabular index(AI)and the center-edge angle(CEA)of preoperation and postoperation were measured to compare.Then investigate the effects of age,sex,side of dislocation and type of dislocation on them.At the last follow-up,the necrosis of the femoral head and its possible influencing factors were studied.The length of the bilateral femur at different time points after surgery was measured and recorded,and the difference in the growth of the bilateral femur were analyzed.ResultsThe average follow-up period was 24.5(7.6 to 61.7)months.According to the McKay hip clinical function evaluation criteria at the last follow-up,the excellent and good rate was 94.34%(50 hips/53 hips).According to Severin imaging rating standard,the excellent and good rate was 84.91%(45 hips/53 hips).4 hips(7.55%)had avascular necrosis of varying severity,of which 1 hip was type Ⅰ and 3 hips were type Ⅱ.There were significant differences between the preoperative and final follow-up acetabular index and center-edge angle(t=19.673,P<0.001;t=19.898,P<0.001).According to the 20 children who were followed up for more than 2 years,there was significant difference between the acetabular index postoperatively,acetabular index at different stages after surgery showed a gradual downward trend(F=23.310,P<0.001).The acetabular index after type Ⅰ,Ⅱ and Ⅲ dislocation was better than that of type Ⅳ dislocation,and the acetabular development of children younger than 3.5 years old at the last follow-up was better than that of the group older than 3.5 years old.A total of 39 children were followed up for more than 1 year.The length of the femur on the operative side was shorter than that on the non-operative side from 3 months to 1 year after the operation,but the difference was not statistically significant(F=0.598,P=0.442).With the extension of the follow-up time,the length of the femur on both sides increased with statistically significant changes(F=419.001,P=0.001).There was an interactive effect between the length of the femur on different sides and the follow-up time.With the extension of the follow-up time,the growth rate of the femur on the operative side and the non-operative side was different(F=5.076,P=0.009),and the growth rate of the femur on the operative side was faster.The Pearson correlation coefficient between the age of the children at the time of operation and the growth length of the operative femur from 3 months to 6 months after operation was(r=-0.017,P=0.919),indicating that there was no correlation.The Pearson correlation coefficient between the age at the time of operation and the growth length of the operative femur from 6 months to 1 year after operation was(r=-0.326,P=0.043),indicating a certain negative correlation between the two things,that is,with the increase of age at the time of operation,the growth length of the operative side of the femur would decrease to a certain extent from 6 months to 1 year after operation.Conclusion1.Open reduction、pelvic Salter osteotomy and femoral shortening and derotation osteotomy to unilateral developmental dislocation of the hip in children is a highly effective method,with good prognosis.2.The growth rate of the operative femur was faster than that of the non-operative femur from 3 months to 1 year after operation.3.Postoperative development of acetabulum of children younger than 3.5 years old at the time of operation was better than that of children older than 3.5 years old.And children with hip is type Ⅰ,Ⅱ,Ⅲ dislocation is better than that of type Ⅳdislocation.4.This study was a retrospective study,with bias in case selection,small number of cases,short follow-up time,and immature bone development at the last follow-up.Complications such as necrosis of the femoral head and leg length discrepancy need to be observed with the change of time to be detected and treated in time. |
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