| Objective: To analyze the occurrence of redislocation after open reduction in children with developmental dislocation of the hip,to explore its related influencing factors,and to provide reference for the prevention of redislocation.Methods: Retrospective analysis was conducted on children with developmental dislocation of hip at the age of 18 months to 8 years who underwent open reduction in our hospital from January 2009 to January 2021.The following data were collected through the medical record system:(1)general characteristics of the children(sex,age,side,);(2)imaging characteristics of developmental dysplasia of the hip(DDH)(preoperative T(?)nnis grade,AI,collo-diaphyseal angle of the femur,);(3)Laboratory test results during the perioperative period(Preoperative hemoglobin,ALT,albumin levels before and after surgery);(4)Treatment procedure and intraoperative conditions(operation time,intraoperative blood loss);(5)Post-operative follow-up results(Post-operative Mckay grading,post-operative AI);(6)Redislocation after operation.SPSS25.0 software was used for data analysis.The children were divided into group A(redislocation)and group B(without redislocation),and the influencing factors of redislocation were analyzed.Results:(1)Among the 296 children with DDH,70 were males and 226 were females,the average age was 3.3±1.0 years.Operation procedures: Open reduction alone,open reduction + pelvic osteotomy,open reduction + pelvic osteotomy +femoral osteotomy accounted for 17.9%,48.0% and 34.1%,respectively.(2)Postoperative redislocation in 43 cases,the incidence rate was 14.5%.The time of redislocation diagnosis ranged from 7d to 5.6 years after operation,with a median time of 2.6 months.(3)Univariate analysis: General characteristics: Children in group A were significantly older at the time of open reduction treatment [(3.9±1.4)years vs.(3.2±1.2)years,P<0.001],there were no significant differences in gender,family history of DDH,and the proportion of children who had received closed reduction between the two groups(P>0.05).The proportion of bilateral lesions in group A was significantly higher than that in group B(25.6% vs.12.3%,P=0.046).There was no significant difference in preoperative T(?)nnis grade,preoperative AI and neck-shaft angle between the two groups(P>0.05).Operation procedure and intraoperative situation: The proportion of open reduction + pelvic osteotomy + femoral osteotomy in group A was lower than that in group B(16.3% vs.37.1%,P=0.027),the operation time was longer [(125.8±25.3)min vs.(107.6±20.8)min,P < 0.001],and the intraoperative blood loss was more [(84.2±28.3)ml vs.(65.2±21.6)ml,P<0.001].Post-operative follow-up results: The postoperative Mckay grade in group A was worse than that in group B(P=0.041),and the excellent and good rate was lower(77.8% vs.90.8%,P=0.005).The postoperative AI of group A was higher than that of group B [(26.1±7.3)° vs.(22.7±4.2)°,P<0.001].Laboratory test results: There were no significant differences in preoperative hemoglobin,preoperative and postoperative ALT,preoperative and postoperative Alb between the two groups(P>0.05).(4)Multivariate analysis: The results of conditional logistic regression analysis showed that age,operation procedure,bilateral DDH and postoperative AI were independent influencing factors of redislocation after open reduction.Conclusion: The incidence of redislocation after surgical treatment of Developmental dislocation of the hip dislocation was related to age,bilateral morbidity,surgical plan,surgical duration,intraoperative blood loss,postoperative Mckay functional grade of hip joint,and postoperative AI,The choice of surgical plan is an important influencing factor,and the older the age,the bilateral dislocation,and the greater the postoperative AI,the higher the risk of postoperative redislocation. |
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