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Huang X, Cheng X, Gao S, Liu Y, Su Y, Feng C. Prediction of the Labrum Shape in Patients With Developmental Dysplasia of the Hip Based on Pelvic Radiography. J Pediatr Orthop 2024; 44:e490-e495. [PMID: 38533533 DOI: 10.1097/bpo.0000000000002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND The shape of the labrum is strongly correlated with outcomes of developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) is the generally preferred imaging technique for observing the labrum. PURPOSE We aimed to find a correlation between the labrum shape and anterior-posterior (AP) pelvic measurements in children with DDH. METHODS Preoperative AP pelvic x-ray radiographs and MRI of patients with DDH from January 2019 to December 2021 were retrospectively collected and divided into three groups by labrum shape on MRI: everted, partly inverted, and inverted. The acetabular length ratio (RAL) in patients with unilateral DDH and the ratio of acetabular length to interpedicular distance (RALI) in all patients were calculated. T-tests were used to analyze differences between the groups. Receiver operating characteristic curve (ROC) analysis was performed between the everted group and the partly inverted and inverted groups. RESULTS We found significant differences in RAL between the everted and partly inverted groups, everted and inverted groups, and everted and combined groups. The ROC analysis showed that the best cutoff value for RAL was 0.945 between the everted and combined groups, with an area under the curve (AUC) of 88.4%. The sensitivity at the best RAL value was 0.783, and the specificity was 0.887. Moreover, we observed a significant difference in RALI between the everted, partly inverted, and inverted groups, as well as between the everted and combined groups. The optimal cutoff value for RALI between the everted and combined groups was 0.575, with an AUC of 74.5%. The sensitivity at the best RALI value was 0.765, and the specificity was 0.674. CONCLUSION The RAL or RALI values on pelvic AP radiographs can be used to predict the shape of the labrum. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Xinyan Huang
- Department of Radiology, Children's Hospital of Chongqing Medical University; Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
| | - Xiang Cheng
- Department of Radiology, Children's Hospital of Chongqing Medical University; Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
| | - Sijie Gao
- Department of Radiology, Children's Hospital of Chongqing Medical University
| | - Yinxin Liu
- Department of Radiology, Children's Hospital of Chongqing Medical University
| | - Yuxi Su
- Department of Orthopedics, Children's Hospital of Chongqing Medical University; Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Jiangxi Hospital Affiliated Children's Hospital of Chongqing Medical University
| | - Chuan Feng
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
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Baljoun A, Bradley CS, Verma Y, Wedge JH, Gargan MF, Kelley SP. Intraoperative 3D Fluoroscopy During Open Reduction for DDH: An Effective Alternative to Postoperative CT/MRI. J Pediatr Orthop 2024:01241398-990000000-00568. [PMID: 38779959 DOI: 10.1097/bpo.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Computed tomography CT or magnetic resonance imaging (MRI) has been the most used imaging modality to assess hip reduction in developmental dysplasia of the hip (DDH) after open reduction (OR). In 2015, intraoperative 3D fluoroscopy (3D) was introduced at our center as an alternative to CT/MRI. 3D offers the advantage that if hip reduction is insufficient, it can be addressed at the time of surgery. The purpose of this study was to assess the efficacy of 3D in comparison to CT/MRI. METHODS This was a single-centre, retrospective comparative study of two consecutive cohorts: those with OR and 3D between 2015 and 2017 and those with OR and CT/MRI between 2012 and 2014. Time to imaging, re-imaging, length of stay (LOS), re-operation, and redislocation or subluxation after cast removal were evaluated. RESULTS Forty-two patients (46 hips) had 3D, and 30 patients (32 hips) had CT/MRI. Significant differences were found between groups in time to imaging, cast changes, and LOS. All 3D was intraoperative (46 hips), and only 69% (22 hips) of CT/MRI was on the day of surgery (P<0.01). In the 3D group, 1 hip (2%) had a cast change under the same anesthetic, and 4 hips (13%) from CT/MRI had cast changes in subsequent surgery (P=0.03). The mean LOS in days for 3D was 1.72 and 2.20 for CT/MRI (P=0.03). There were no statistically significant differences between groups in further imaging and subluxations or re-dislocations at cast removal. Two hips (4%) in the 3D group had MRI, but with no further intervention (P=0.51), and at cast removal, there were 3 subluxations in each group (P=0.69) and 1 redislocation in the 3D group (P=1.00). CONCLUSIONS Intraoperative 3D improved time to imaging, allowed for cast changes at surgery and had a shorter LOS. Moreover, there were no significant differences found in adverse outcomes between those who underwent 3D versus CT/MRI. 3D should thus be considered an effective alternative to CT/MRI for assessing hip reduction during OR for DDH. LEVEL OF EVIDENCE Diagnostic Study, level II.
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Affiliation(s)
- Amna Baljoun
- Division of Orthopaedic Surgery, The Hospital for Sick Children
- Department of Surgery, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Yashvi Verma
- Division of Orthopaedic Surgery, The Hospital for Sick Children
| | - John H Wedge
- Division of Orthopaedic Surgery, The Hospital for Sick Children
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Martin F Gargan
- Division of Orthopaedic Surgery, The Hospital for Sick Children
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Simon P Kelley
- Division of Orthopaedic Surgery, The Hospital for Sick Children
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Yu J, Chen T, Fu G, Lyu X, Wang C, Wang Y, Yang Z, Guo W. Follow-up Value of Hip Medial Ultrasound in Infants and Children With Developmental Dysplasia of the Hip Treated With Reduction and Spica Casting. J Pediatr Orthop 2024; 44:236-243. [PMID: 38298014 DOI: 10.1097/bpo.0000000000002626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Closed or open reduction and spica casting are common treatments for children aged 6 to 18 months, as well as infants aged 0 to 6 months whose harness treatment for developmental dysplasia of the hip (DDH) was unsuccessful. The study aimed to quantify the distance between the femoral head and the acetabulum after closed or open reduction and evaluate the dynamic docking progression of the femoral head using serial hip medical ultrasound. METHODS We retrospectively reviewed the medical records and hip medial ultrasound images of a consecutive series of patients with DDH who underwent spica casting after reduction and compared images obtained immediately after reduction and at follow-up. The first cast (stage I) was maintained for 2 to 3 months and scheduled for outpatient repeat ultrasound in 4 to 8 weeks. Then the second cast was placed (stage II), lasting for another 2 to 3 months. The triradiate cartilage-femoral head distance (TFD) was measured in the acetabulum coronal mid-sectional plane. The Wilcoxon signed-rank test was used to compare the TFD values. RESULTS This study included 49 patients. All patients underwent hip medial ultrasound 0 to 3 days after stage I (time 1) and 4 to 8 weeks (time 2) postoperatively, with 24 patients reviewed again 0 to 7 days after stage II. The TFD values in time 1 and time 2 were 6.0 (5.0, 9.0) mm and 5.0 (3.6, 7.0) mm, respectively. There was a statistically significant difference between times 1 and 2 regarding TFD values in 49 close-reduction hips (6.0 vs 5.0 mm, P < 0.001). Similar findings were also observed in 13 open-reduction hips (6.0 vs 5.0 mm, P = 0.023). CONCLUSIONS Hip medial ultrasonography during the period of cast immobilization after reduction in children with DDH can objectively and quantitatively show the dynamic change of the distance between the femoral head and the acetabulum, and can be used to assess reduction of the hip and progression of femoral head docking. LEVEL OF EVIDENCE Level II-prognostic study.
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Affiliation(s)
| | | | - Gang Fu
- Department of Pediatric Orthopaedics
| | | | - Chao Wang
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
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Lankinen V, Vuorinen RL, Helminen M, Bakti K, Välipakka J, Laivuori H, Hyvärinen A. Costs of abduction treatment in developmental dysplasia of the hip. Analysis of 900 patients. Ann Med 2023; 55:2290694. [PMID: 38065688 PMCID: PMC10836239 DOI: 10.1080/07853890.2023.2290694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a disorder of hip development that leads to dysplasia, subluxation, or total hip dislocation. Early detection of DDH is important, and early initiation of abduction treatment is key to successful correction of the hip joint. However, mild forms of DDH, including hip instability without complete dislocation, have good spontaneous healing potential, and a watchful waiting strategy in mild DDH has been found to be safe. In this study, we aimed to evaluate the cost differences between different treatment strategies for DDH. MATERIAL AND METHODS Data were collected retrospectively from the medical records of all children diagnosed with diagnosis and treatment of DDH in Tampere University hospital between 1998 and 2018. In total, 948 patients were included in the study. Patients who underwent casting or operative treatment (n = 48) were excluded from the analysis. All Ortolani positive children were subjected to early abduction treatment. Children with Ortolani negative DDH were subjected to either watchful waiting or early abduction treatment, based on the clinicians' decision. The regression model estimates for the number of clinical visits with and without ultrasound examination were assessed together with cost reports from Tampere University Hospital for the calculation of savings per patient in spontaneous recovery. RESULTS Alpha angles at one month of age (p < 0.001) and treatment method (p < 0.001) affected the number of clinical visits and ultrasound examinations during the treatment follow-up. A low alpha angle predicted closer follow-up, and children with spontaneous recovery had lower numbers of clinical visits and ultrasound examinations than children in abduction treatment. Spontaneous recovery was found to result in approximately 375€/patient savings compared to successful abduction treatment. CONCLUSION With correct patient selection, a watchful waiting strategy is cost-effective in treating mild developmental dysplasia of the hip, considering the high percentage of spontaneous recovery.
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Affiliation(s)
- Vilma Lankinen
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Riikka-Liisa Vuorinen
- Faculty of Medicine and Health Technology, Tampere University, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences, Tampere University, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
| | - Karim Bakti
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | | | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Hyvärinen
- Faculty of Medicine and Health Technology, Tampere University, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
- Department of Surgery, Mehiläinen Länsi-Pohja Oy, Kemi, Finland
- Department of Pediatric Surgery, Oulu University Hospital, Oulu, Finland
- Clinical Medicine Research Unit, Medical Research Center, University of Oulu, Oulu, Finland
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Chen X, Zhang S, Shi W, Wu D, Huang B, Tao H, He X, Xu N. A deep learning model adjusting for infant gender, age, height, and weight to determine whether the individual infant suit ultrasound examination of developmental dysplasia of the hip (DDH). Front Pediatr 2023; 11:1293320. [PMID: 38046675 PMCID: PMC10690366 DOI: 10.3389/fped.2023.1293320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Objective To examine the correlation between specific indicators and the quality of hip joint ultrasound images in infants and determine whether the individual infant suit ultrasound examination for developmental dysplasia of the hip (DDH). Method We retrospectively selected infants aged 0-6 months, undergone ultrasound imaging of the left hip joint between September 2021 and March 2022 at Shenzhen Children's Hospital. Using the entropy weighting method, weights were assigned to anatomical structures. Moreover, prospective data was collected from infants aged 5-11 months. The left hip joint was imaged, scored and weighted as before. The correlation between the weighted image quality scores and individual indicators were studied, with the last weighted image quality score used as the dependent variable and the individual indicators used as independent variables. A Long-short term memory (LSTM) model was used to fit the data and evaluate its effectiveness. Finally, The randomly selected images were manually measured and compared to measurements made using artificial intelligence (AI). Results According to the entropy weight method, the weights of each anatomical structure as follows: bony rim point 0.29, lower iliac limb point 0.41, and glenoid labrum 0.30. The final weighted score for ultrasound image quality is calculated by multiplying each score by its respective weight. Infant gender, age, height, and weight were found to be significantly correlated with the final weighted score of image quality (P < 0.05). The LSTM fitting model had a coefficient of determination (R2) of 0.95. The intra-class correlation coefficient (ICC) for the α and β angles between manual measurement and AI measurement was 0.98 and 0.93, respectively. Conclusion The quality of ultrasound images for infants can be influenced by the individual indicators (gender, age, height, and weight). The LSTM model showed good fitting efficiency and can help clinicians select whether the individual infant suit ultrasound examination of DDH.
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Affiliation(s)
- Xiaoyi Chen
- Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, China
| | - Shuangshuang Zhang
- Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, China
| | - Wei Shi
- Department of Orthopedics, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, China
| | - Dechao Wu
- Department of Orthopedics, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, China
| | - Bingxuan Huang
- Department of Ultrasound, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, China
| | - Hongwei Tao
- Department of Ultrasound, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, China
| | - Xuezhi He
- Department of Ultrasound, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, China
| | - Na Xu
- Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, China
- Department of Ultrasound, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, China
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Fan ZZ, Yan YB, Sha J, Xu HF, Li C, Liu ZC, Liu J, Huang LY. Risk factors for misdiagnosis in children with developmental dysplasia of the hip: a retrospective single centre study. BMJ Paediatr Open 2023; 7:e001909. [PMID: 37290920 PMCID: PMC10254984 DOI: 10.1136/bmjpo-2023-001909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To investigate risk factors of misdiagnosis at the first visit of children with developmental dysplasia of the hip (DDH) who did not participate in hip ultrasound screening. METHODS A retrospective review was conducted on children with DDH admitted to a tertiary hospital in northwestern China between January 2010 and June 2021. We divided the patients into the diagnosis and misdiagnosis groups according to whether they were diagnosed at the first visit. The basic information, treatment process and medical information of the children were investigated. We made a line chart of the annual misdiagnosis rate to observe the trend in the annual misdiagnosis rate. Univariate and multivariate logistic regression analyses were used to identify significant risk factors for missed diagnosis. RESULTS A total of 351 patients met the inclusion criteria, including 256 (72.9%) patients in the diagnosis group and 95 (27.1%) patients in the misdiagnosis group. The line chart of the annual rate of misdiagnoses among children with DDH from 2010 to 2020 showed no significant change trend. Multiple logistic regression analysis showed that the paediatrics department (v the paediatric orthopaedics department: OR 0.21, p<0.001), the general orthopaedics department (v the paediatric orthopaedics department: OR 0.39, p=0.006) and the senior physician (v the junior physician: OR 2.47, p=0.006) on the misdiagnosis at the first visit of children were statistically significant. CONCLUSION Children with DDH without hip ultrasound screening are prone to be misdiagnosed at their first visit. The annual misdiagnosis rate has not been significantly reduced in recent years. The department and title of the physician are independent risk factors for misdiagnosis.
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Affiliation(s)
- Zong-Zhi Fan
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
- Department of Orthopedics, No 988th Hospital of Joint Logistic Support Force of PLA, Zhengzhou, Henan, China
| | - Ya-Bo Yan
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Jia Sha
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Hui-Fa Xu
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Chao Li
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Zhi-Chen Liu
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Jing Liu
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
| | - Lu-Yu Huang
- Department of Orthopedics, Xijing Hospital,Air Force Military Medical University, Xian, Shaanxi, China
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Sari AS, Karakus O, Gultekin MZ, Senaran H. Acetabular index and acetabular depth ratio in newborns and infants aged 6 months or less with the healthy development of hips: A retrospective cross-sectional study. Medicine (Baltimore) 2023; 102:e33631. [PMID: 37083764 PMCID: PMC10118329 DOI: 10.1097/md.0000000000033631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Abstract
Radiographic assessment of the hip may render critical in the diagnosis of developmental dysplasia of the hip (DDH) in newborns and infants aged ≤6 months. There is no complete dataset on the acetabular index (AI) and acetabular depth ratio (ADR) values in this age group. The objective of this study was to assess the AI and ADR values in newborns and infants aged ≤6 months with healthy development. A retrospective analysis was performed on pelvic radiographs of newborns and infants (≤6 months) between August 2020 and September 2021. There were 3000 children with pelvic radiographic imaging. Normal sonographic findings and radiographs without any structural deformity of the hip were inclusion criteria. A total of 1132 newborns and infants (2264 hips) were analyzed. Measurements of AI and ADR (ischium and pubic bone as landmarks for acetabular depth ratio A [ADR-A] and acetabular depth ratio B [ADR-B]) were performed. Correlation and intraclass correlation coefficient (ICC) values were calculated. Left-sided AI values were significantly higher than the right-sided AI values, except in infants aged 4 to ≤5 months (P < .05). ADR-B values differed significantly between male and female newborns and infants both in terms of the side of the hip measured and age (P < .05). AI values were fairly correlated with age (r = -0.286 for left and r = -0.254 for right) in the negative direction and with ADR-A (r = 0.449 and r = 0.469 for left and right) and ADR-B (r = 0.545 and r = 0.592 for left and right) in the positive direction. Inter-observer ICC was 0.845 to 0.989 (excellent) for AI, 0.534 and 0.904 (moderate to excellent) for ADR-A, and -0.014 and 0.774 (slightly good to good) for ADR-B. Intra-observer ICC was 0.811 to 0.996 (excellent) for AI, 0.575 to 0.98 (moderate to excellent) for ADR-A, and 0.023 to 0.954 (slightly good to excellent) for ADR-B. This study features the first complete data set of AI and ADR measurements, which are essential for pelvic radiographic imaging of hip dysplasia, in newborns and infants aged ≤6 months.
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Affiliation(s)
- Ahmet Sinan Sari
- Konya City Hospital, Department of Orthopedics and Traumatology, Konya, Turkey
- Fier Memorial Regional Hospital, Department of Orthopedics and Traumatology, Fier, Albania
| | - Ozgun Karakus
- Balikesir City Hospital, Department of Orthopedics and Traumatology, Balikesir, Turkey
| | | | - Hakan Senaran
- Bezmialem Vakif University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
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Payne ER, Harris MD, Harris-Hayes M, Nahal C, Kamenaga T, Clohisy JC, Pascual-Garrido C. Greater hip abductor size in prearthritic patients with developmental dysplasia of the hip versus femoroacetabular impingement. J Orthop Res 2023; 41:852-861. [PMID: 35949149 DOI: 10.1002/jor.25426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/31/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) are common hip pathologies and important risk factors for osteoarthritis, yet the disease mechanisms differ. DDH involves deficient femoral head coverage and a shortened abductor moment arm, so this study hypothesized that the cross-sectional area (CSA) of the gluteus medius/minimus muscle complex and the stabilizing iliocapsularis muscle would be larger in DDH versus FAI, without increased fatty infiltration. A longitudinal cohort identified prearthritic patients with DDH or FAI who underwent imaging before surgery. Patients with DDH and FAI (Cam, Pincer, or Mixed) were 1:1 matched based on age, sex, and body mass index. Magnetic resonance imaging was used to measure the gluteus medius/minimus complex and iliocapsularis in two transverse planes. Amira software was used to quantify muscle and noncontractile tissue. Paired samples t-tests were performed to compare muscle size and composition (p < 0.05). There were no differences in the iliocapsularis muscle. Patients with DDH had significantly larger CSA of the gluteus medius/minimus complex at both transverse planes, and the noncontractile tissue proportion did not differ. The mean difference in overall muscle CSA at the anterior inferior iliac spine was 4.07 ± 7.4 cm2 (p = 0.005), with an average difference of 12.1%, and at the femoral head this was 2.40 ± 4.37 cm2 (p = 0.004), with an average difference of 20.2%. This study reports a larger CSA of the gluteus medius/minimus muscle complex in DDH compared to FAI, without a difference in noncontractile tissue, indicating increased healthy muscle in DDH.
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Affiliation(s)
- Emma R Payne
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael D Harris
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marcie Harris-Hayes
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chadi Nahal
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Yu J, Chen T, Lyu X, Wang Y, Wang L, Guo Z, Guo W, Fu G. Is Hip Medial Ultrasound More Accurate Than Radiography for Determining the Status of Hip Reduction in Children Treated With a Spica Cast? A Retrospective Diagnostic Accuracy Study. Clin Orthop Relat Res 2023; 481:592-605. [PMID: 36099306 PMCID: PMC9928857 DOI: 10.1097/corr.0000000000002366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is the most common hip abnormality in children. Closed or open reduction and cast immobilization are the most commonly used treatments for patients aged 6 to 18 months with dislocation; they are also used in children younger than 6 months when brace treatment is not effective. During cast immobilization, surgeons need reliable and timely imaging methods to assess the status of hip reduction to ensure successful treatment and avoid complications. Several methods are used, but they have disadvantages. We developed and, in this study, evaluated a hip medial ultrasound method to evaluate the status of hip reduction in children treated with a spica cast. QUESTION/PURPOSE Is hip medial ultrasound more accurate than radiography for determining the status of hip reduction in children treated with a spica cast? METHODS Between November 2017 and December 2020, we treated 136 patients with closed or open reduction and spica casting for DDH in our department. These children were 3 to 18 months old at the time of surgical reduction and had a specific medical history, physical examination findings, or AP radiographic evidence of unilateral or bilateral DDH. None had a concomitant femoral/acetabular osteotomy procedure in these hips. All patients underwent hip medial ultrasound, AP radiography, and MRI under sedation within 2 to 7 days after open or closed reduction. The examination time was from the second day after reduction to enable the patient to recover from anesthesia. MRI was performed within 7 days after reduction because of a few long appointment times, and ultrasound and AP radiography were always performed 1 or 2 days before MRI. Based on that, 65% (88 of 136 [88 hips]) of patients were excluded due to the absence of MRI, ultrasound, or AP radiography; 3% (4 of 136 [4 hips]) of patients were excluded because of concurrent congenital spina bifida, Larson syndrome, or Prader-Willi syndrome; and 1% (1 of 136 [1 hip]) of patients were excluded because the patient underwent MRI before ultrasound. A total of 32% (43 of 136 [43 hips]) of patients were eligible for analysis in this cross-sectional diagnostic study, and these 43 patients underwent AP radiography, ultrasound, and MRI. In this retrospective study, the mean age at the time of surgery was 10 ± 4 months (male:female ratio 5:38; unilateral DDH: 34; bilateral DDH: 9). To ensure the independence of the results, the study was limited to one hip per patient (in patients with bilateral DDH, the right hip was evaluated). The reduction of 43 hips (left:right ratio 26:17; closed:open reduction ratio 30:13) was evaluated by MRI, hip medial ultrasound, and radiography. Children with spica casts were placed in the supine position, which is necessary to expose the perineum for ultrasound. We used a broad-spectrum, microconvex, and intracavitary probe. The acetabular medial wall was identified by the triradiate cartilage of the ischial tuberosity and the pubis superior, and the femoral head was identified by the femoral neck. Then, the acetabulum coronal midsectional plane was used to determine the positions of the femoral head and acetabulum and to measure the triradiate cartilage-femoral distance. MRI examinations were performed using a 1.5-T MRI system with an eight-channel body coil. Each reviewer evaluated each reduction independently. Additionally, to further assess the hip medial ultrasound method's reliability and reproducibility, we investigated the interobserver and intraobserver agreement in evaluating the reduction using hip medial ultrasound. Using ultrasound or radiography, the reviewers classified hips as reduced, uncertain status, or dislocated. MRI was considered the gold standard for assessing hip reduction, and the reviewers classified hips as reduced or dislocated by MRI. Patients with hips with an uncertain reduction status according to ultrasound or radiography were retained in the analysis. Thus, the test results of radiography and ultrasound were classified into three classifications (positive, negative, or uncertain) in the present study. The test was considered positive or negative when patients were assessed with dislocation or without dislocation, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasound and radiography were calculated and compared. We combined uncertain and positive into the positive classification to be conservative in the statistical choices. The specificity, sensitivity, PPV, and NPV were analyzed based on this premise. Furthermore, a subgroup analysis was conducted by sex. MRI evaluation revealed that 41 hips were reduced and two hips were dislocated. RESULTS The sensitivity, specificity, PPV, and NPV of ultrasound were 100% (95% CI 16% to 100%), 95% (95% CI 84% to 99%), 50% (95% CI 7% to 93%), and 100% (95% CI 91% to 100%), respectively. The sensitivity, specificity, PPV, and NPV of radiography were 50% (95% CI 1% to 99%), 68% (95% CI 52% to 82%), 7% (95% CI 0% to 34%), and 97% (95% CI 82% to 100%), respectively. Ultrasound showed a higher specificity (95% versus 68%; p < 0.001) and PPV (50% versus 7%; p = 0.02) than radiography. The sensitivity, specificity, PPV, and NPV of ultrasound were 100% (95% CI 16% to 100%), 94% (95% CI 81% to 99%), 50% (95% CI 7% to 93%), and 100% (95% CI 90% to 100%), respectively, for female patients (with only five male patients, we could not perform these analyses in this group). The sensitivity, specificity, PPV, and NPV of radiography were 50% (95% CI 1% to 99%), 64% (95% CI 46% to 79%), 7% (95% CI 0% to 34%), and 96% (95% CI 79% to 100%), respectively, for female patients. The κ values for intra- and interobserver reliability both were 1.0. CONCLUSION Hip medial ultrasound can directly visualize the femoral head and acetabulum. Hip medial ultrasound is more reliable than radiography as a preliminary evaluation method and does not involve irradiation. We recommend using hip medial ultrasound during outpatient follow-up visits for patients younger than 2 years treated with hip reduction and cast immobilization. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Jingmiao Yu
- Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China
| | - Tao Chen
- Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China
| | - Xuemin Lyu
- Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Beijing, China
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yukun Wang
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Lifang Wang
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Beijing, China
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Wen Guo
- Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China
| | - Gang Fu
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
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Abstract
BACKGROUND Developmental dysplasia of the hip represents a spectrum of deformity. Residual dysplasia at 2 years of age is associated with an increased risk for osteoarthritis and functional limitations. We compared the prognostic value of 6-month imaging modalities and aimed to identify optimal diagnostic metrics for the prediction of residual dysplasia. METHODS After IRB approval, patients who underwent Pavlik treatment between 2009 and 2018 with 2-year follow-up were identified. Sonographs [ultrasound (US)] and radiographs (x-ray) were obtained at 6-month and 2-year-old visits. Dysplasia at 2 years was defined as an acetabular index (AI) >24 degrees. Receiver operating characteristic curves were constructed to quantitatively compare the prognostic ability of US and x-ray-based measures at 6 months. Youden's index [(YI) (values range from 0 (poor test) to 1 (perfect test)] was used to evaluate existing cutoffs at 6 months of age (normal measurements: alpha angle (AA) ≥60 degrees, femoral head coverage (FHC) ≥50%, and AI <30 degrees) relative to newly proposed limits. RESULTS Fifty-nine patients were included, of which 28.8% of patients (95% CI: 17.3 to 40.4%) had acetabular dysplasia at 2 years. After adjusting for sex, AA [Area under the Curve (AUC): 80] and AI (AUC: 79) at 6 months of age were better tests than FHC (AUC: 0.77). Current diagnostic cutoffs for AA (YI: 0.08), AI (YI: 0.0), and FHC (YI: 0.06) at 6 months had poor ability to predict dysplasia at 2 years. A composite test of all measures based on proposed cutoffs (AA ≥73 degrees, FHC > 62% and AI ≤24 degrees) was a better predictor of dysplasia at 2 years (Youden's index (YI): 0.63) than any single metric. CONCLUSIONS The rate of residual dysplasia remains concerning. The 6-month x-ray and US both play a role in the ongoing management of the developmental dysplasia of the hip. The prediction of dysplasia is maximized when all metrics are considered collectively. Existing parameters were not accurate; We recommend the following cutoffs: AA ≥73 degrees, FHC > 62%, and AI ≤24 degrees. These cutoffs must be validated. LEVEL OF EVIDENCE Prognostic Level II.
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11
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Sha J, Huang L, Chen Y, Fan Z, Lin J, Yang Q, Li Y, Yan Y. Clinical thought-based software for diagnosing developmental dysplasia of the hip on pediatric pelvic radiographs. Front Pediatr 2023; 11:1080194. [PMID: 37063681 PMCID: PMC10098126 DOI: 10.3389/fped.2023.1080194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Abstract
Background The common methods of radiographic diagnosis of developmental dysplasia of the hip (DDH) include measuring hip parameters and quantifying the degree of hip dislocation. However, clinical thought-based analysis of hip parameters may be a more effective way to achieve expert-like diagnoses of DDH. This study aims to develop a diagnostic strategy-based software for pediatric DDH and validate its clinical feasibility. Methods In total, 543 anteroposterior pelvic radiographs were retrospectively collected from January 2017 to December 2021. Two independent clinicians measured four diagnostic indices to compare the diagnoses made by the software and conventional manual method. The diagnostic accuracy was evaluated using the receiver operator characteristic (ROC) curves and confusion matrix, and the consistency of parametric measurements was assessed using Bland-Altman plots. Results In 543 cases (1,086 hips), the area under the curve, accuracy, sensitivity, and specificity of the software for diagnosing DDH were 0.988-0.994, 99.08%-99.72%, 98.07%-100.00%, and 99.59%, respectively. Compared with the expert panel, the Bland-Altman 95% limits of agreement for the acetabular index, as determined by the software, were -2.09°-2.91° (junior orthopedist) and -1.98°-2.72° (intermediate orthopedist). As for the lateral center-edge angle, the 95% limits were -3.68°-5.28° (junior orthopedist) and -2.94°-4.59° (intermediate orthopedist). Conclusions The software can provide expert-like analysis of pelvic radiographs and obtain the radiographic diagnosis of pediatric DDH with great consistency and efficiency. Its initial success lays the groundwork for developing a full-intelligent comprehensive diagnostic system of DDH.
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Affiliation(s)
- Jia Sha
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Luyu Huang
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Yaopeng Chen
- School of Telecommunications Engineering, Xidian University, Xi’an, China
- Guangzhou Institute, Xidian University, Xi’an, China
| | - Zongzhi Fan
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Jincong Lin
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
| | - Qinghai Yang
- School of Telecommunications Engineering, Xidian University, Xi’an, China
| | - Yi Li
- School of Telecommunications Engineering, Xidian University, Xi’an, China
- Correspondence: Yabo Yan Yi Li
| | - Yabo Yan
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi’an, China
- Correspondence: Yabo Yan Yi Li
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12
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Hart DA. Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle? Front Physiol 2023; 14:1127689. [PMID: 37113695 PMCID: PMC10126777 DOI: 10.3389/fphys.2023.1127689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Sex differences have been reported for diseases of the musculoskeletal system (MSK) as well as the risk for injuries to tissues of the MSK system. For females, some of these occur prior to the onset of puberty, following the onset of puberty, and following the onset of menopause. Therefore, they can occur across the lifespan. While some conditions are related to immune dysfunction, others are associated with specific tissues of the MSK more directly. Based on this life spectrum of sex differences in both risk for injury and onset of diseases, a role for sex hormones in the initiation and progression of this risk is somewhat variable. Sex hormone receptor expression and functioning can also vary with life events such as the menstrual cycle in females, with different tissues being affected. Furthermore, some sex hormone receptors can affect gene expression independent of sex hormones and some transitional events such as puberty are accompanied by epigenetic alterations that can further lead to sex differences in MSK gene regulation. Some of the sex differences in injury risk and the post-menopausal disease risk may be "imprinted" in the genomes of females and males during development and sex hormones and their consequences only modulators of such risks later in life as the sex hormone milieu changes. The purpose of this review is to discuss some of the relevant conditions associated with sex differences in risks for loss of MSK tissue integrity across the lifespan, and further discuss several of the implications of their variable relationship with sex hormones, their receptors and life events.
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13
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Holstad IG, Faergemann C. Surgical procedures in infants with early diagnoses of developmental dysplasia of the hip. A prospective 4-year follow-up study. J Orthop 2022; 34:373-378. [PMID: 36275488 PMCID: PMC9579446 DOI: 10.1016/j.jor.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 10/31/2022] Open
Abstract
Background Dysplastic hips infants may normalize spontaneously without any intervention due to the natural growth. However, some infants need one or more surgical interventions to achieve stable and non-dysplastic hips. The purpose of this study is to determine the proportion of infants diagnosed with DDH before the age of 6 months undergoing surgical procedures of the hip(s) before the age of four years and to determine the number and types of surgical procedures in each infant. Methods A prospective and consecutive study of all infants aged 0-6 months diagnosed with dysplasia of the hips in the combined paediatric orthopaedic and radiologic examination in the Region of Southern Denmark 2013-2017. From medical records, we obtained information about all surgical procedures in the hips including open or closed reductions, arthrographies, tenotomies, and pelvic osteotomies before the age of 4 years. Results Overall, 281 infants with hip dysplasia were included. The median age at first examination was 48 days. In 254 (90%) of the infants, the hips resolved spontaneously, and 27 (10%) needed one or more surgical interventions. Overall, the 27 infants had 47 surgical intervention as 12 infants had more than one intervention. One infants had five surgical interventions. The most frequent surgical procedures were closed reduction and arthrography with or without adductor tenotomy (58%) and pelvic osteotomy (27%). Among infants with surgical interventions, 23 (8.2%) had unstable hips, and four (1.4%) had stable hips. All four infants with stable hips had an arthrography and none required a pelvic osteotomy. Discussion This study supports the propensity for spontaneous normalization early dysplasia of the hips in infants. Only a small proportion of the infants needed surgical interventions to achieve stable and non-dysplastic hips.
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Affiliation(s)
- Ingebrigt Grimstad Holstad
- Section for Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Odense University Hospital, J.B. Winslow Vej 4, DK-5000, Odense C, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J. B. Winslow Vej 4, DK-5000, Odense C, Denmark
| | - Christian Faergemann
- Section for Pediatric Orthopaedics, Department of Orthopaedics and Traumatology, Odense University Hospital, J.B. Winslow Vej 4, DK-5000, Odense C, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J. B. Winslow Vej 4, DK-5000, Odense C, Denmark
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14
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Clinical Efficacy and Safety of Ibuprofen plus Traction, Reposition, and Hip Spica Cast in the Treatment of Developmental Dysplasia of the Hip. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1213133. [PMID: 35983005 PMCID: PMC9381201 DOI: 10.1155/2022/1213133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/10/2022] [Accepted: 07/17/2022] [Indexed: 11/17/2022]
Abstract
Objective. To assess the clinical efficacy and safety of ibuprofen plus traction, reposition, and hip spica cast in the treatment of developmental dysplasia of the hip (DDH). Methods. Between January 2019 and July 2020, 60 children with DDH treaded in department of orthopedics of our institution were assessed for eligibility and recruited. They were assigned at a ratio of 1 : 1 to receive either traction + reposition + hip spica cast plus analgesia pump (observation group) or traction + reposition + hip spica cast plus analgesia pump and oral ibuprofen (control group). The outcome measures included clinical efficacy, pain scores, unexpected pain calls, the dosage of analgesia pump, and adverse events. Results. The two groups had similar clinical efficacy (
). The patients given oral ibuprofen were associated with significantly lower pain scores at 24 h and 72 h postoperatively versus those without oral ibuprofen (
). Analgesics with oral ibuprofen resulted in fewer unexpected pain calls versus analgesics without oral ibuprofen within 72 h postoperatively (
). The application of oral ibuprofen in the analgesia pump showed great improvement in lowering the dosage of analgesia pump versus the absence of ibuprofen (
). The incidence of adverse events was similar between the two groups of patients (
). Conclusion. Traction + reposition + hip spica cast plus analgesia pump and oral ibuprofen effectively mitigated postoperative pain in children with DDH and reduces analgesic drug dosage with a high safety profile.
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15
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Gather KS, Mavrev I, Gantz S, Dreher T, Hagmann S, Beckmann NA. Outcome Prognostic Factors in MRI during Spica Cast Therapy Treating Developmental Hip Dysplasia with Midterm Follow-Up. CHILDREN 2022; 9:children9071010. [PMID: 35883994 PMCID: PMC9318343 DOI: 10.3390/children9071010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 12/02/2022]
Abstract
Closed reduction followed by spica casting is a conservative treatment for developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) can verify proper closed reduction of the dysplastic hip. Our aim was to find prognostic factors in the first MRI to predict the possible outcome of the initial treatment success by means of ultrasound monitoring according to Graf and the further development of the hip dysplasia or risk of recurrence in the radiological follow-up examinations. A total of 48 patients (96 hips) with DDH on at least one side, and who were treated with closed reduction and spica cast were included in this retrospective cohort study. Treatment began at a mean age of 9.9 weeks. The children were followed for 47.4 months on average. We performed closed reduction and spica casting under general balanced anaesthesia. This was directly followed by MRI to control the position/reduction of the femoral head without anaesthesia. The following parameters were measured in the MRI: hip abduction angle, coronal, anterior and posterior bony axial acetabular angles and pelvic width. A Graf alpha angle of at least 60° was considered successful. In the radiological follow-up controls, we evaluated for residual dysplasia or recurrence. In our cohort, we only found the abduction angle to be an influencing factor for improvement of the DDH. No other prognostic factors in MRI measurements, such as gender, age at time of the first spica cast, or treatment involving overhead extension were found to be predictive of mid-term outcomes. This may, however, be due to the relatively small number of treatment failures.
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Affiliation(s)
- Katharina Susanne Gather
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (I.M.); (S.G.); (S.H.); (N.A.B.)
- Correspondence: ; Tel.: +49-6221-56-35491
| | - Ivan Mavrev
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (I.M.); (S.G.); (S.H.); (N.A.B.)
| | - Simone Gantz
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (I.M.); (S.G.); (S.H.); (N.A.B.)
| | - Thomas Dreher
- Pediatric Orthopedics and Traumatology, Children’s University Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland;
| | - Sébastien Hagmann
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (I.M.); (S.G.); (S.H.); (N.A.B.)
| | - Nicholas Andreas Beckmann
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (I.M.); (S.G.); (S.H.); (N.A.B.)
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16
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Chen T, Zhang Y, Wang B, Wang J, Cui L, He J, Cong L. Development of a Fully Automated Graf Standard Plane and Angle Evaluation Method for Infant Hip Ultrasound Scans. Diagnostics (Basel) 2022; 12:diagnostics12061423. [PMID: 35741233 PMCID: PMC9222165 DOI: 10.3390/diagnostics12061423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/04/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Graf’s method is currently the most commonly used ultrasound-based technique for the diagnosis of developmental dysplasia of the hip (DDH). However, the efficiency and accuracy of diagnosis are highly affected by the sonographers’ qualification and the time and effort expended, which has a significant intra- and inter-observer variability. Methods: Aiming to minimize the manual intervention in the diagnosis process, we developed a deep learning-based computer-aided framework for the DDH diagnosis, which can perform fully automated standard plane detection and angle measurement for Graf type I and type II hips. The proposed framework is composed of three modules: an anatomical structure detection module, a standard plane scoring module, and an angle measurement module. This framework can be applied to two common clinical scenarios. The first is the static mode, measurement and classification are performed directly based on the given standard plane. The second is the dynamic mode, where a standard plane from ultrasound video is first determined, and measurement and classification are then completed. To the best of our knowledge, our proposed framework is the first CAD method that can automatically perform the entire measurement process of Graf’s method. Results: In our experiments, 1051 US images and 289 US videos of Graf type I and type II hips were used to evaluate the performance of the proposed framework. In static mode, the mean absolute error of α, β angles are 1.71° and 2.40°, and the classification accuracy is 94.71%. In dynamic mode, the mean absolute error of α, β angles are 1.97° and 2.53°, the classification accuracy is 89.51%, and the running speed is 31 fps. Conclusions: Experimental results demonstrate that our fully automated framework can accurately perform standard plane detection and angle measurement of an infant’s hip at a fast speed, showing great potential for clinical application.
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Affiliation(s)
- Tao Chen
- Department of Ultrasound, Beijing Jishuitan Hospital, The 4th Clinical College, Peking University, Beijing 100035, China;
- Correspondence: (T.C.); (L.C.)
| | - Yuxiao Zhang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen 518057, China; (Y.Z.); (B.W.); (J.W.)
| | - Bo Wang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen 518057, China; (Y.Z.); (B.W.); (J.W.)
| | - Jian Wang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen 518057, China; (Y.Z.); (B.W.); (J.W.)
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China;
| | - Jingnan He
- Department of Ultrasound, Beijing Jishuitan Hospital, The 4th Clinical College, Peking University, Beijing 100035, China;
| | - Longfei Cong
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen 518057, China; (Y.Z.); (B.W.); (J.W.)
- Correspondence: (T.C.); (L.C.)
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17
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Garcia S, Demetri L, Starcevich A, Gatto A, Swarup I. Developmental Dysplasia of the Hip: Controversies in Management. Curr Rev Musculoskelet Med 2022; 15:272-282. [PMID: 35489017 DOI: 10.1007/s12178-022-09761-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Many aspects of developmental hip dysplasia (DDH) care and evaluation are still active areas of debate. Recent studies have provided more insight into these topics such as strategies for reducing osteonecrosis, assessing hip reduction after closed and open reduction, and the management of residual acetabular dysplasia. RECENT FINDINGS The presence of the ossific nucleus at the time of reduction does not alter the risk of osteonecrosis. The risk of osteonecrosis may be higher when hips are immobilized in excessive abduction. Limited sequence MRI may be the best choice for assessing hip reduction after closed and open reduction; however, new technologies are emerging such as 3D fluoroscopy and perfusion MRI. The treatment of residual acetabular dysplasia with bracing has been shown to be effective and the decision to perform a pelvic osteotomy is based on patient-specific factors. The spectrum of DDH treatment has evolved over the past several decades. Recent studies have provided insights into strategies for osteonecrosis prevention, hip evaluation during after reduction, and the management of residual acetabular dysplasia. However, there is ample room for additional and more rigorous studies guiding advanced imaging for assessing hip reduction such as 3D fluoroscopy and perfusion MRI, as well as the management of residual acetabular dysplasia.
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Affiliation(s)
- Steven Garcia
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Leah Demetri
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ana Starcevich
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Andrew Gatto
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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18
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Li J, Zhao B, Ji H, Ding W. Application Value of Combined Diagnosis of Ultrasound, MRI, and X-Ray in Developmental Dysplasia of the Hip in Children. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1632590. [PMID: 35115901 PMCID: PMC8791747 DOI: 10.1155/2022/1632590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022]
Abstract
Objective To explore the application value of the combined diagnosis of ultrasound, MRI, and X-ray in developmental dysplasia of the hip (DDH) in children. Methods Ninety children with suspected DDH admitted to our hospital from June 2017 to June 2020 were selected as the research objects to conduct a retrospective study. According to the age of the children, they were divided into a group with 0-6 months (group X), a group with 7-12 months (group Y), and a group older than 12 months (group Z), with 30 cases in each group. X-ray and high-frequency ultrasound were performed in all groups, and MRI examination was added to the children in groups Y and Z to compare the diagnostic value of the three imaging examinations in DDH children. Results No obvious differences in the general data and maternal risk factors were observed among the three groups (P < 0.05). The final comprehensive diagnostic results were taken as the gold standard, including 23 cases with acetabular dysplasia, 28 cases with subluxation of the femoral head, 31 cases with complete dislocation of the femoral head, and 8 non-DDH cases. The diagnostic accuracy of the three methods from high to low was MRI, high-frequency ultrasound, and X-ray, with obviously higher diagnostic accuracy of MRI than that of X-ray (P < 0.05). The ROC curves showed that the diagnostic efficacy from high to low was MRI + high-frequency ultrasound + X-ray, high-frequency ultrasound + X-ray, MRI, high-frequency ultrasound, and X-ray. Conclusion Ultrasound combined with X-ray has obvious advantages in the diagnosis of children at low months of age, while MRI has outstanding advantages in the diagnosis of children at high months of age. MRI combined with ultrasound and X-ray can significantly improve the diagnostic accuracy of DDH and provide objective data support for the clinical treatment of children.
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Affiliation(s)
- Jian Li
- Department of Ultrasonography, Binzhou Hospital of Traditional Chinese Medicine, Binzhou 256601, Shandong, China
| | - Bo Zhao
- Department of Ultrasonography, Binzhou Hospital of Traditional Chinese Medicine, Binzhou 256601, Shandong, China
| | - Honghua Ji
- Department of Ultrasonography, Binzhou Hospital of Traditional Chinese Medicine, Binzhou 256601, Shandong, China
| | - Wei Ding
- Department of Ultrasonography, People's Hospital of Rizhao, Rizhao 276826, Shandong, China
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Mateo CM, Johnston PR, Wilkinson RB, Tennermann N, Grice AW, Chuersanga G, Ward VL. Sociodemographic and Appointment Factors Affecting Missed Opportunities to Provide Neonatal Ultrasound Imaging. J Am Coll Radiol 2022; 19:112-121. [PMID: 35033298 DOI: 10.1016/j.jacr.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to assess disparities in outpatient imaging missed care opportunities (IMCOs) for neonatal ultrasound by sociodemographic and appointment factors at a large urban pediatric hospital. METHODS A retrospective review was performed among patients aged 0 to 28 days receiving one or more outpatient appointments for head, hip, renal, or spine ultrasound at the main hospital or satellite sites from 2008 to 2018. An IMCO was defined as a missed ultrasound or cancellation <24 hours in advance. Population-average correlated logistic regression modeling estimated the odds of IMCOs for six sociodemographic (age, sex, race/ethnicity, language, insurance, and region of residence) and seven appointment (type of ultrasound, time, day, season, site, year, and distance to appointment) factors. The primary analysis included unknown values as a separate category, and the secondary analysis used multiple imputation to impute genuine categories from unknown variables. RESULTS The data set comprised 5,474 patients totaling 6,803 ultrasound appointments. IMCOs accounted for 4.4% of appointments. IMCOs were more likely for Black (odds ratio [OR], 3.31; P < .001) and other-race neonates (OR, 2.66; P < .001) and for patients with public insurance (OR, 1.78; P = .002). IMCOs were more likely for appointments at the main hospital compared with satellites (P < .001), during work hours (P = .021), and on weekends (P < .001). Statistical significance for primary and secondary analyses was quantitatively similar and qualitatively identical. CONCLUSIONS Marginalized racial groups and those with public insurance had a higher rate of IMCOs in neonatal ultrasound. This likely represents structural inequities faced by these communities, and more research is needed to identify interventions to address these inequities in care delivery for vulnerable neonatal populations.
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Affiliation(s)
- Camila M Mateo
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Patrick R Johnston
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Ronald B Wilkinson
- Information Services Department, Boston Children's Hospital, Boston, Massachusetts
| | - Nicole Tennermann
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
| | - Amanda W Grice
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Geeranan Chuersanga
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
| | - Valerie L Ward
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Boston Children's Hospital, Boston, Massachusetts; Senior Vice-President, Chief Equity and Inclusion Officer, and Director, Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts.
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20
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Gou P, Li J, Li X, Shi M, Zhang M, Wang P, Liu X. Clinical features and management of the developmental dysplasia of the hip in congenital muscular torticollis. INTERNATIONAL ORTHOPAEDICS 2022; 46:883-887. [PMID: 34997287 DOI: 10.1007/s00264-021-05279-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE A consistent relationship between CMT and DDH has been established. However, whether the presence of CMT has effect on clinical outcomes of DDH remains unanswered. This study aimed to evaluate clinical features and management of DDH in patients with CMT. METHODS We reviewed the medical records of 54 patients (91 hips) simultaneously diagnosed with DDH and CMT and included 54 patients (97 hips) with only DDH by random number method as the control group. Clinical and examination outcomes were recorded and compared, respectively. RESULTS The mean follow-up was 18.1 ± 14.5 months (range, 2 to 72 mo). In the DDH and CMT group, the age of initial treatment was lower (100.8 ± 92.3 vs. 229.0 ± 157.4 d, P < 0.001), and the rate of male significantly increased (42.6% vs. 11.1%, P < 0.001). Before treatment, development degree of hip was better than that of the DDH group. Therefore, patients with CMT had approximately 14 times greater odds of conservative treatment success than children in the DDH group (OR, 13.84; 95% CI, 3.16 to 60.60). CONCLUSION We concluded that CMT was not the risk factor for the failure of treatment. On the contrary, the identification of CMT may be beneficial to early discovery and treatment of DDH when we remain vigilant to perform physical exam and screen imaging of DDH for patients with CMT.
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Affiliation(s)
- Pan Gou
- Department of Orthopedic, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Jun Li
- Department of Orthopedic, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Xiang Li
- Department of Orthopedic, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Mingyan Shi
- Department of Orthopedic, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Man Zhang
- Department of Orthopedic, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Peikang Wang
- Department of Orthopedic, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China
| | - Xing Liu
- Department of Orthopedic, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No. 136 of Zhong Shan Er Lu, Chongqing, 400014, China.
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21
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Fludder CJ, Keil BG, Neave MJ. Case report: Morphological changes evident after manual therapy in two cases of late-diagnosed developmental dysplasia of the hip. Front Pediatr 2022; 10:1045812. [PMID: 36776679 PMCID: PMC9909744 DOI: 10.3389/fped.2022.1045812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/28/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Late diagnosed Developmental Dysplasia of the Hip (DDH) is the detection of DDH after 3 months of age and is associated with significantly poorer outcomes than when diagnosed and managed early. Late diagnosed DDH has lower rates of success with bracing, higher rates of surgery and higher rates of complications, including avascular necrosis of the femoral head and early osteoarthritis of the hip. We describe two cases of late-diagnosed DDH which demonstrated changes in femoroacetabular joint morphology on radiographic interpretation after a 6-month trial period of manual therapy. CASE PRESENTATION Two cases (13 and 30 months of age) with late-diagnosed DDH presented to a private chiropractic clinic for conservative, non-bracing management. One case had unilateral DDH and the other bilateral DDH. A trial of manual therapy was utilized over a 6-month period. Both cases demonstrated changes to femoroacetabular morphology as well as improvements in gross motor activity and lower extremity muscle tone. CONCLUSION Manual therapy, as an adjunct or alternative to static bracing, may be of benefit in individuals with late-diagnosed DDH not responding to bracing, and prior to more invasive interventions. Additional cases of manual therapy-based management of this condition are required to inform the design of future trials to investigate this hypothesis.
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22
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Gou P, Gao K, Wang X, Liu X. The nomogram predicting the early failure rate of the Pavlik harness for developmental dysplasia of the hip in infants under 6 months of age. Front Pediatr 2022; 10:1018641. [PMID: 36263153 PMCID: PMC9574333 DOI: 10.3389/fped.2022.1018641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of our study was to develop a nomogram predicting the early failure rate of Pavlik harness in infants under 6 months of age with developmental dysplasia of the hip (DDH). METHODS We retrospectively analyzed the clinical data of 227 patients (372 hips) with DDH who were treated with Pavlik harness at our institution from August 2019 to January 2022. Fifty-eight patients (102 hips) failed the Pavlik harness treatment, and 169 patients (270 hips) were successfully treated. Then, the independent risk factors for treatment failure were determined via univariate and multivariate logistic regression and used to generate the nomogram predicting the failure rate of the Pavlik harness. RESULTS It was found that age at initial treatment (OR 1.031, 95% CI 1.022-1.040, P < 0.001), angle α (OR 0.723, 95% CI 0.671-0.779, P < 0.001), and concomitant deformity (OR 0.129, 95% CI 0.036-0.459, p = 0.002) were independent risk factors for treatment failure. The nomogram showed good discrimination [the area under the curve (AUC): 0.862], good calibration, and a net benefit in the range of probabilities between 5 and 90% according to the decision curve analysis. CONCLUSION This study successfully established the nomogram prediction model based on three independent risk factors. Due to the high level of predicting accuracy, this nomogram could be a useful resource for pediatric orthopedic surgeons to identify patients at major risk of Pavlik harness failure who might need more reliable treatments.
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Affiliation(s)
- Pan Gou
- Orthopedic Center of Children, Chongqing Medical University, Chongqing, China
| | - Kai Gao
- Orthopedic Center of Children, Chongqing Medical University, Chongqing, China
| | - Xiaoting Wang
- Orthopedic Center of Children, Chongqing Medical University, Chongqing, China
| | - Xing Liu
- Orthopedic Center of Children, Chongqing Medical University, Chongqing, China
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23
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Karout L, Naffaa L. Pediatric Hip Disorders: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:149-163. [PMID: 34836561 DOI: 10.1016/j.rcl.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hip disorders are a wide range of conditions commonly affecting patients in the pediatric age group. Reaching an accurate diagnosis of these conditions in children may be challenging. The optimal use of image modalities in the approach of a child with possible hip pathology is essential, which allows radiologists and clinicians to narrow the differential diagnosis and reach a definitive diagnosis, which can consequently result in early and appropriate interventions leading to improved outcomes. Therefore, this article aims to provide practicing radiologists and clinicians with up-to-date and evidence-based imaging spectrum guidelines and recommendations for common pediatric hip disorders.
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Affiliation(s)
- Lina Karout
- Department of Radiology, Massachusetts General Hospital, 25 New Chardon Street, Boston, MA 02114, USA
| | - Lena Naffaa
- Radiology Department, University of Central Florida, Nemours Children's Hospital, 6535 Nemours Parkway, Orlando, FL 32827, USA.
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Berger-Groch J, Jandl NM, Strahl A, Bechler U, Beil FT, Stuecker MH. Ultrasound as a diagnostic tool for femoral head containment disorders in children between one and 12 years of age. J Child Orthop 2021; 15:496-502. [PMID: 34858537 PMCID: PMC8582606 DOI: 10.1302/1863-2548.15.210092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/23/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Ultrasound has been used to diagnose hip dysplasia in neonates and to screen until the end of their first year. For older children, femoral head containment disorders such as developmental dysplasia of the hip, Legg-Calvé-Perthes disease or cerebral palsy are usually diagnosed with plain radiographs. The aim of the present study was to evaluate ultrasound in comparison with radiographic imaging in children up to age 12 years and to determine reference values for sonographic containment parameters. METHODS Hip ultrasound and radiographic imaging were acquired on the same day and then compared. As a reference, normal acetabular angle and acetabulum head index were determined on radiographs. Lateral cartilage distance (LCD), lateral head distance (LHD) and femoral head extrusion angle (HA) were measured on ultrasound images. RESULTS We included 96 patients with 167 healthy hips in the study. A total of 55 patients were female and 41 male. The mean age was 5.2 years (sd 3.3; 1.0 to 11.9). LCDultrasound, LHDultrasound and HAultrasound correlated significantly with radiographic parameters. The following ultrasound values were calculated as limits for impending loss of containment: LCDultrasound ≥ 6.5 mm, LHDultrasound ≥ 3.3 mm and HAultrasound ≥ 27.6°. CONCLUSION Ultrasound is a simple, radiation-free diagnostic tool to detect femoral head containment disorders, even in children older than one year. This study provides reference values for hip ultrasound in children up to 12 years. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Josephine Berger-Groch
- Department of Trauma Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Paediatric Orthopaedic Surgery, Orthopaedic Hospital Bad Bramstedt, Bad Bramstedt, Germany.,Correspondence should be sent to Dr. Josephine Berger-Groch, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. E-mail:
| | - Nico Maximilian Jandl
- Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Paediatric Orthopaedic Surgery, Orthopaedic Hospital Bad Bramstedt, Bad Bramstedt, Germany
| | - Andre Strahl
- Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Bechler
- Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Paediatric Orthopaedic Surgery, Orthopaedic Hospital Bad Bramstedt, Bad Bramstedt, Germany
| | - Frank Timo Beil
- Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Paediatric Orthopaedic Surgery, Orthopaedic Hospital Bad Bramstedt, Bad Bramstedt, Germany
| | - Markus H.F. Stuecker
- Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Paediatric Orthopaedic Surgery, Orthopaedic Hospital Bad Bramstedt, Bad Bramstedt, Germany
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25
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Prenatal Screening for Developmental Displacement of the Hip: The BUDDHA (Pre-Birth Ultrasound for Developmental Displacement of the Hip Assessment) Study. Diagnostics (Basel) 2021; 11:diagnostics11050868. [PMID: 34065897 PMCID: PMC8150805 DOI: 10.3390/diagnostics11050868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/01/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: developmental dysplasia of the hip has an incidence of 3–5 out of 1000 children. Currently, only postnatal screening is available. Objective: to test the feasibility of a method based on Graf technique application at antenatal ultrasound in assessing the normal development of the hip in unselected term fetuses. Methods: a prospective cohort study in a single university tertiary hospital from January 2017 to January 2020. Single uncomplicated term pregnancies (37–40 weeks) attending our center for routine ultrasound were consecutively recruited for the purpose of the study. A 3D volume acquisition was launched on the coxofemoral joint of the fetus by a single expert operator, and offline analysis was then performed in the multiplanar mode by two operators (blinded to each other analysis) in order to measure the alpha and beta angles according to our modified Graf technique. Intra- and inter-observer variations were calculated. Reference charts for normal values of both angles were produced. Postnatal ultrasound was then performed to measure the Graf angles in newborns, confirming a normal development of the hip. Results: in the study period, 433 uncomplicated term pregnancies underwent 3D ultrasound for the assessment of the fetal hip. One case was subsequently excluded because of confirmed postnatal diagnosis of developmental dysplasia of the hip. The measurement of our modified Graf angles was feasible at prenatal ultrasound with a good reproducibility. The inter-rater and intra-rater reliability of both angles was substantial. Reference charts for normal values of both angles were produced. Conclusions: the evaluation of the coxofemoral joint in fetuses at term of gestation has never been attempted before. The Graf technique application, currently employed at postnatal ultrasound, may also be adapted to prenatal ultrasound with a substantial reproducibility. However, there was no evidence of a linear relationship between prenatal and postnatal alpha angles and beta angles. Further research is needed to establish if developmental dysplasia of the hip could be diagnosed antenatally.
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Measuring the Acetabular Index: An Accurate and Reliable Alternative Method of Measurement. AJR Am J Roentgenol 2021; 217:172-176. [PMID: 33909466 DOI: 10.2214/ajr.20.23358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. In children (4 months to 8 years old), radiographic measurements of the acetabular index are the preferred method to assess developmental hip dysplasia. However, the acetabular index has been criticized as having variable reliability owing to difficulty identifying the correct anatomic landmarks. An alternative method of measuring the acetabular index using the ischium is being proposed to avoid the variability of the triradiate cartilage line as a reference point. With the alternative method, the acetabular index is derived by measuring the angle between a line connecting the ischial tuberosi-ties and a line connecting the inferomedial and superolateral edges of the acetabulum. The purpose of this study was to evaluate the accuracy and reliability of this alternative method of measuring the acetabular index compared with the traditional method. MATERIALS AND METHODS. Children 4 months to 8 years old who presented for evaluation of developmental dysplasia of the hip were included. Two physicians, each using both the traditional and the alternative method, measured acetabular indexes on all radiographs. Accuracy was defined as mean absolute error less than 6°. Reliability was calculated by means of intraclass correlation coefficient (ICC). RESULTS. Pelvic radiographs of 40 children (324 hips) were included. The mean age was 23.7 months (range, 4-96 months) and mean acetabular index was 24.2° (range, 8-50°). The alternative method was associated with mean absolute error of 2.50°, which is significantly below the threshold of 6° (t < 0.001). Intrarater reliability for the traditional method was high (ICC, 0.81) and for the alternative method was very high (ICC, 0.92). Interrater reliability for the traditional method was high (ICC, 0.89) and for the alternative method was very high (ICC, 0.91). CONCLUSION. Measuring the acetabular index using the alternative method has very high accuracy and intrarater and interrater reliability.
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27
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Cheon JE, Kim JY, Choi YH, Kim WS, Cho TJ, Yoo WJ. MRI risk factors for development of avascular necrosis after closed reduction of developmental dysplasia of the hip: Predictive value of contrast-enhanced MRI. PLoS One 2021; 16:e0248701. [PMID: 33735261 PMCID: PMC7971487 DOI: 10.1371/journal.pone.0248701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/03/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose of this study was to identify imaging risk factors on contrast-enhanced hip MRI after closed reduction of developmental dysplasia of the hip (DDH) that could predict future development of avascular necrosis (AVN) of the femoral head. Materials and methods Fifty-eight infants (F: M = 53: 5, aged 3–18 months) who underwent immediate postoperative contrast-enhanced hip MRI after closed reduction of DDH were included in this study. Quality of reduction (concentric vs eccentric reduction with or without obstacles), abduction angle of the hip, presence of ossific nucleus, and pattern of contrast enhancement of the femoral head were retrospectively evaluated on MRI. Interobserver agreement of contrast enhancement pattern on MRI were evaluated by two radiologists. Development of AVN was determined through radiographic findings at 1 year after reduction. Results AVN of the femoral head developed in 13 (22%) of 58 patients. Excessive abduction of the hip joint (OR 4.65, [95% CI 1.20, 18.06] and global decreased enhancement of the femoral head (OR 71.66, [95% CI 10.54, 487.31]) exhibited statistically significant differences between the AVN and non-AVN groups (P < 0.05). Eccentric reduction (P = 0.320) did not show statistically significant difference between two groups and invisible ossific nucleus (P = 0.05) showed borderline significance. Multi-variable logistic regression indicated that global decreased enhancement of the femoral head was a significant risk factor of AVN (OR 27.92, 95% CI [4.17, 350.18]) (P = 0.0031). Interobserver agreement of contrast enhancement pattern analysis and diagnosis of AVN were good (0.66, 95% CI [0.52, 0.80]). Conclusion Contrast-enhanced hip MRI provides accurate anatomical assessment of the hip after closed reduction of DDH. Global decreased enhancement of the femoral head could be used as a good predictor for future development of AVN after closed reduction of DDH.
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Affiliation(s)
- Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology and Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul National University Hospital, Seoul, Korea
- Division of Pediatric Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Tae-Joon Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- Division of Pediatric Orthopedics, Seoul National University Children’s Hospital, Seoul, Korea
| | - Won Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- Division of Pediatric Orthopedics, Seoul National University Children’s Hospital, Seoul, Korea
- * E-mail:
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Oussoren E, Wagenmakers MAEM, Link B, van der Meijden JC, Pijnappel WWMP, Ruijter GJG, Langeveld M, van der Ploeg AT. Hip disease in Mucopolysaccharidoses and Mucolipidoses: A review of mechanisms, interventions and future perspectives. Bone 2021; 143:115729. [PMID: 33130340 DOI: 10.1016/j.bone.2020.115729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022]
Abstract
The hips are frequently involved in inheritable diseases which affect the bones. The clinical and radiological presentation of these diseases may be very similar to common hip disorders as developmental dysplasia of the hip, osteoarthritis and avascular necrosis, so the diagnosis may be easily overlooked and treatment may be suboptimal. Mucopolysaccharidosis (MPS) and Mucolipidosis (ML II and III) are lysosomal storage disorders with multisystemic involvement. Characteristic skeletal abnormalities, known as dysostosis multiplex, are common in MPS and ML and originate from intra-lysosomal storage of glycosaminoglycans in cells of the cartilage, bones and ligaments. The hip joint is severely affected in MPS and ML. Hip pathology results in limitations in mobility and pain from young age, and negatively affects quality of life. In order to better understand the underlying process that causes hip disease in MPS and ML, this review first describes the normal physiological (embryonic) hip joint development, including the interplay between the acetabulum and the femoral head. In the second part the factors contributing to altered hip morphology and function in MPS and ML are discussed, such as abnormal development of the pelvic- and femoral bones (which results in altered biomechanical forces) and inflammation. In the last part of this review therapeutic options and future perspectives are addressed.
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Affiliation(s)
- Esmee Oussoren
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Margreet A E M Wagenmakers
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Bianca Link
- Division of Metabolism, Connective Tissue Unit, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Jan C van der Meijden
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W W M Pim Pijnappel
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Clinical Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - George J G Ruijter
- Department of Clinical Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Mirjam Langeveld
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Ans T van der Ploeg
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Clinical Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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29
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Sepúlveda MF, Pérez JA, Saban EA, Castañeda LE, Sepúlveda DF, Birrer EAM. Developmental dysplasia of the hip screening programme in Chile. J Child Orthop 2021; 15:35-41. [PMID: 33643456 PMCID: PMC7907761 DOI: 10.1302/1863-2548.15.200240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) encompasses a wide pathological spectrum, from mild acetabular dysplasia to complete congenital hip dislocation at birth. Screening policies have been implemented in an effort to effectively identify and treat patients with DDH. Since 2009 there has been a national DDH programme in Chile. The current study evaluates the results of the programme in patients born between 2010 and 2015. METHODS Records of patients hospitalized from 1st January 2010 to 31st December 2019 were retrieved from national databases. Those born from 1st January 2010 to 31st December 2015 who underwent a procedure for DDH under general anaesthesia during their first five years of life were selected. Sex, first surgical procedure and age at first surgical procedure were analyzed. The incidence of DDH that required major surgical treatment was calculated. RESULTS A total of 961 children born from 1st January 2010 to 31st December 2015 underwent a procedure for DDH during their first five years of life. The number of major procedures was significantly lower than the number of minor procedures (269 vs 692). The incidence of major procedures was 0.18 per 1000 live births. Girls underwent a higher number of procedures than boys (831 vs 130), whereas 39.2% of the boys and 26.2% of the girls had major procedures. The mean age at the time of the first procedure was 15.35 months (sd 10.09; range 0.03 to 55.92 months). CONCLUSION The present study suggests that the Chilean National DDH Screening Program is an appropriate programme with substantial benefits with respect to public health. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Matías F. Sepúlveda
- Universidad Austral de Chile, Valdivia, Chile,Hospital Base de Valdivia, Valdivia, Chile,Correspondence should be sent to Matías F. Sepúlveda, Yungay 773, Depto 501, Valdivia, Chile. E-mail:
| | | | | | - Luis E. Castañeda
- Programa de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Zhao P, Cheng J, Li B, Nie D, Li C, Gui S, Wang H, Zhang Y. Up-regulation of the expressions of MiR-149-5p and MiR-99a-3p in exosome inhibits the progress of pituitary adenomas. Cell Biol Toxicol 2021; 37:633-651. [PMID: 33400021 DOI: 10.1007/s10565-020-09570-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
This study explored the function of microRNAs (miRNAs) in invasive pituitary adenomas (IPA), and developed a microRNA-exosome strategy for the disease treatment. Differentially expressed miRNAs and tumor-associated markers in IPA, non-invasive pituitary adenoma (NIPA), and rat pituitary adenoma cells were identified by bioinformatics analysis and qRT-PCR. Then, the cells were treated by miR-149-5p and miR-99a-3p mimics or inhibitors, or incubated with modified exosome with overexpressed or silenced miRNAs. The cell behaviors were analyzed by molecular experiments. Xenograft assays were constructed by injection of pituitary adenoma cells and exosome into NU/NU nude mice. Tumor size, weight, and expressions of markers related to miRNAs and angiogenesis were determined. Target genes for miR-99a-3p and miR-149 were predicted and verified by bioinformatics analysis and molecular experiments. Twenty differentially expressed miRNAs were identified, among which miR-99a-3p and miR-149 were inhibited in both pituitary adenoma cells and tissues significantly. Expressions of E-cadherin and p53 were down-regulated, while those of MMP-2, MMP-9, N-cadherin, Vimentin, and VEGF were up-regulated in pituitary adenoma cells and tissues, especially in IPA. Further experiments revealed that overexpressed miR-149 and miR-99a-3p inhibited the growth and metastasis of pituitary adenoma cells and tube formation of endothelial cells. MiR-149 and miR-99a-3p overexpressed by exosome showed similar suppressive effects on cell viability, metastasis, tube formation ability, in vivo tumor growth, and expressions of angiogenesis-related markers. Further analysis showed that NOVA1, DTL, and RAB27B were targeted by miR-99a-3p. This study found that overexpressed miR-149-5p and miR-99a-3p induced by exosome could suppress the progression of IPA. 1. MiR-149-5p and miR-99a-3p affect the expression of EMT- and ECM-related markers and tumor-related genes in rat pituitary adenoma cells treated with exosomes. 2. Exosome inhibited the tumor growth. 3. Overexpressed miR-149-5p and miR-99a-3p induced by exosome.
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Affiliation(s)
- Peng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Jianhua Cheng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Bin Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ding Nie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Chuzhong Li
- Department of Cell Biology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Hongyun Wang
- Department of Cell Biology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yazhuo Zhang
- Department of Cell Biology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Jia H, Wang L, Chang Y, Song Y, Liu Y, Zhang F, Feng J, Yang X, Sheng M. Assessment of irreducible aspects in developmental hip dysplasia by magnetic resonance imaging. BMC Pediatr 2020; 20:550. [PMID: 33278888 PMCID: PMC7718709 DOI: 10.1186/s12887-020-02420-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The developmental dysplasia of the hip (DDH) can cause a wide range of pathological changes, and often requires surgical treatment. Preoperative evaluation is very important for DDH. We aimed to assess the diagnostic capability of magnetic resonance imaging (MRI) for irreducible aspects preventing hip reduction in DDH. METHODS A total of 39 pediatric patients who received DDH evaluation in pediatric orthopedics from January 2015 to December 2019 were included. The samples included 4 cases of bilateral DDH and 35 cases of unilateral DDH, a total of 43 hip joint samples. All patients underwent surgical treatment, pathological examination and MRI of hip joint. RESULTS With pathological results or intraoperative findings as the gold standard, the sensitivity and specificity of MRI were 90.3% and 83.3% for the affected labrum, 92% and 83.3% for thickening of the round ligament, 90.0% and 91.3% for atrophy of the iliopsoas muscle, and 100% and 100% for fibrofatty pulvinar tissue and joint effusion, respectively. CONCLUTIONS The MRI showed an extraordinary capability of detecting these irreducible factors and helped surgeon choose the appropriate treatment strategies.
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Affiliation(s)
- Huihui Jia
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Liang Wang
- Department of Orthopaedics, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, 215000, PR China
| | - Yan Chang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, PR China
| | - Yongrui Song
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Yuqi Liu
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Fuyong Zhang
- Department of Orthopaedics, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Jie Feng
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China
| | - Xiaodong Yang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, PR China
| | - Mao Sheng
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215000, PR China.
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