| Part Ⅰ:The application of intraoperative hip arthrography in the reduction of dislocated DDH 15.1%)among the closed reduction group,successful reduction were made in 11 hips(11/12,91.7%)and re-dislocation was occurred in 1 hips(1/12,8.3%)among the open reduction group.There was no significant difference between closed reduction group and open reduction group(χ 2=0.022,P=0.881).There was no significant difference between the labrum of type Ⅰ-Ⅲ and Ⅳ-Ⅷ(P>0.05),The re-dislocation rate with type C of ischial overlap sign was higher than that of type A and B(P<0.05).Objective:To investigate the value of intraoperative hip arthrography in the reduction of dislocated DDH.Methods:The clinical data of 58 infants with dislocated DDH and the results of hip arthrography during reduction were analyzed retrospectively.There were 9 male babies and 49 female babies,aged 5-18 months,there were 65 dislocated hips including 51 unilateral dislocation hips and 7 bilateral dislocation hips,39 cases on the left side and 26 cases on the right side.During the operation,hip arthrography was performed,the glenoid labrum was classified according to the position and the shape,the ischial overlap sign was classified according to the relationship between the inner edge of the femoral head and the outer edge of the ischia.The closed reduction or open reduction and plaster external fixation were selected by the factors such as the classifications of the glenoid labrum and the ischial overlap sign,the physical examination,the difficulty of reduction and the stability of reduction.X-ray examination and/or ultrasonography from the medial hip were performed at 1-4 weeks after reduction to evaluate the reduction effect of short-term.Results:Among the 65 dislocated hips in 58 cases,there were labrums of type Ⅰ in 2 hips,type Ⅱ in 26 hips,type Ⅲ in 27 hips,type Ⅳ in 5 hips,type Ⅴ in 2 hips,type Ⅶin 2 hips,type Ⅷ in 1 hip.There were ischial overlap sign of type A in 11 hips,type B in 25 hips,type C in 29 hips.The infants were divided into the closed reduction group(53 hips)and the open reduction group(12 hips),successful reduction were made in 45 hips(45/53,84.9%)and re-dislocation were occurred in 8 hips(8/53,Conclusion:Intraoperative hip arthrography of dislocated DDH can provide necessary imaging information for clinical treatment.The comprehensive analysis on factors such as the classifications of the glenoid labrum and the ischial overlap sign,the physical examination,the difficulty of reduction and the stability of reduction can improve the success rate of reduction and reduce the rate of re-dislocation.Part Ⅱ:The application of ultrasonography from medial hip in early follow-up of dislocated DDH after reductionObjective:To investigate the value of ultrasonography from medial hip in early follow-up of dislocated DDH after reduction.Methods:58 cases of dislocated DDH were diagnosed in pediatric orthopaedics department of Shandong Provincial Hospital from September 2014 to October 2017,including 9 male babies and 49 female babies,aged 5-18 months,there were 65 dislocated hips including 51 unilateral dislocation hips and 7 bilateral dislocation hips,39 cases on the left side and 26 cases on the right side.53 hips were treated with closed reduction and plaster external fixation,12 hips were treated with open reduction and plaster external fixation.The ultrasonography from the medial side of the hip was performed within 1-4 weeks after reduction.The distance between the superior ramus of the pubic bone and the femoral head(PFD)was measured under the condition with plaster external fixation.The reduction and stability of the femoral head were observed,and the early effectiveness was evaluated after the treatment of DDH.Results:116 hips of 58 infants were divided into the normal group(51 hips),the closed reduction group(52 hips)and the open reduction group(13 hips).The PFD values of the normal group,the closed reduction group and the open reduction group were 0.286±0.044cm,0.489±0.277cm and 0.435±0.158cm,respectively.The differences between the normal group and the closed reduction group,the normal group and the open reduction group were statistically significant(P<0.05),and there was no significant difference between the closed reduction group and the open reduction group(P>0.05).According to the reduction effect,116 hips were divided into the normal group(51 hips),the successful reduction group(56 hips)and the unsuccessful reduction group(9 hips).The PFD values of the normal group,the successful reduction group and the unsuccessful reduction group were 0.286±0.044cm,0.399±0.125cm and 0.971 ±0.327cm,respectively.There were statistically significant differences between the PFD values of the normal group and the successful reduction group,the normal group and the unsuccessful reduction group,the successful reduction group and the unsuccessful reduction group Meaning(P<0.05).The cutoff value of PFD on the closed reduction group and the open reduction group was 0.66cm,the sensitivity and the specificity were 89%and 84%,respectively.65 hips were divided into the PFD<0.66cm group and the PFD≥ 0.66cm group according to the cut-off value.53 hips got a successful reduction and 1 hip was failed in the PFD<0.66cm group,3 hips got a successful reduction and 8 hips were failed in the PFD≥0.66cm group,the failure rate of reduction in the PFD≥0.66cm group was significantly higher than that of the PFD<0.66cm group(P<0.05).Conclusion:The measurement of PFD by ultrasonography is simple,repeatable without radiation injury.The ultrasonography from medial hip can be used to evaluate the early effectiveness of dislocated DDH after reduction.Part Ⅲ:The application of MRI high-resolution imaging in the follow-up of dislocated DDHObjective:To evaluate the value of high-resolution MRI in the follow-up and further treatment of dislocated DDHMethods:30 children with dislocated DDH who were followed up for 2 to 7 years after closed reduction or open reduction were selected and performed for 3.0T MRI routine sequence and high-resolution FS-PDWI scanning of hips,respectively,The coronal section images of T1WI,the oblique coronal and oblique sagittal section images of FS-PDWI of the hips were obtained,the bone acetabulum index(BAI)and cartilage acetabulum index(CAI)were measured on the coronal section of T1WI,the lateral,anterior bone and cartilage femoral head coverage were measured on the oblique coronal and oblique sagittal section of FS-PDWI,respectively.To judge whether there were statistical difference in the above measurements of hip among the normal group,the closed reduction group and the open reduction group,and analyze the bone and cartilage factors that affected the stability of femoral head and the effectiveness after reduction,and guided the follow-up and the next clinical treatment Results:The BAI and CAI of the normal group were lower than those of the closed reduction group and the open reduction group(P<0.05),and the open reduction group were lower than the closed reduction group(P<0.05).LB-FHC and AB-FHC of the normal group were higher than those of the closed reduction group and the open reduction group(P<0.05).There was no significant difference in LB-FHC and AB-FHC between the closed reduction group and the open reduction group(P>0.05)The LC-FHC and AC-FHC of the normal group were higher than those of the closed reduction group(P<0.05).There was no significant difference between the normal group and the open reduction group,the closed reduction group and the open reduction group(P>0.05).In order to increase the cartilage coverage of the femoral head and improve the stability of the femoral head,further pelvic or femoral osteotomy should be performed in the children with lower coverage of bone and cartilage femoral head than the normal side after reduction.According to the clinical treatment standard(Both the LC-FHC and the AC-FHC were less than 75%),4 of 41 dislocated hips in this group were treated with further osteotomy,and 37 hips were followed up.The MRI measurement of LC-FHC and AC-FHC should be used to judge the effectiveness of reduction and guide follow-up and the clinical treatment.Conclusion:High-resolution MRI can be used to measure the acetabulum index and the femoral head coverage of hips after reduction.The lateral and anterior cartilaginous femoral head coverage can be used to judge the medium and long-term effectiveness of DDH,and provide data support for the follow-up and further treatment of DDH infants. |
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