Association between ossific nucleus volume changes and postoperative avascular necrosis risk in children with developmental dysplasia of the hip.

This study aimed to investigate the correlation between ossific nucleus volume and avascular necrosis (AVN) in pediatric patients diagnosed with developmental dysplasia of the hip (DDH). Analyzing 211 cases, including 119 open reduction (OR) and 92 closed reduction (CR) procedures, we quantified ossific nucleus volume using magnetic resonance imaging (MRI). Categorizing the OR group based on ossific nucleus volume revealed no statistically significant difference in AVN incidence. Similarly, in the CR cohort, there was no significant discrepancy in AVN occurrence between subgroups with or without the ossific nucleus. Logistic regression in CR identified the international hip dysplasia institute (IHDI) grade as a significant AVN risk factor (p = 0.007). IHDI grades 3 and 4 exhibited a 6.94 times higher likelihood of AVN compared to grades 1 and 2. Across CR and OR, neither initial age nor ossific nucleus volume emerged as AVN risk factors. In conclusion, ossific nucleus volume does not pose a risk for AVN in DDH children undergoing CR or OR, emphasizing the clinical significance of IHDI grading in predicting AVN risk during CR and the importance of early intervention to prevent treatment delays.

Development and validation of a nomogram for predicting the prognosis in children with spinal cord injuries.

AIMS: This research aims to construct and verify an accurate nomogram for forecasting the 3-, 5-, and 7-year outcomes in pediatric patients afflicted with spinal cord injury (SCI). METHODS: Pediatric patients with SCI from multiple hospitals in China, diagnosed between Jan 2005 and Jan 2020, were incorporated into this research. Half of these patients were arbitrarily chosen for training sets, and the other half were designated for external validation sets. The Cox hazard model was employed to pinpoint potential prognosis determinants related to the American Spinal Injury Association (ASIA) and Functional Independence Assessment (FIM) index. These determinants were then employed to formulate the prognostic nomogram. Subsequently, the bootstrap technique was applied to validate the derived model internally. RESULTS: In total, 224 children with SCI were considered for the final evaluation, having a median monitoring duration of 68.0 months. The predictive nomogram showcased superior differentiation capabilities, yielding a refined C-index of 0.924 (95% CI: 0.883-0.965) for the training cohort and a C-index of 0.863 (95% CI: 0.735-0.933) for the external verification group. Additionally, when applying the aforementioned model to prognostic predictions as classified by the FIM, it demonstrated a high predictive value with a C-index of 0.908 (95% CI: 0.863-0.953). Moreover, the calibration diagrams indicated a consistent match between the projected and genuine ASIA outcomes across both sets. CONCLUSION: The crafted and verified prognostic nomogram emerges as a dependable instrument to foresee the 3-, 5-, and 7-year ASIA and FIM outcomes for children suffering from SCI.

Analysis of the association between the acetabular morphology and femoral head in children aged 0-3 years with developmental hip dysplasia.

Background: Magnetic resonance imaging (MRI) has been advocated as a routine examination for preoperative and postoperative assessment of Developmental Dysplasia of the Hip (DDH). However, there is limited research regarding the correlation between acetabulum and femoral head morphology using preoperative MRI measurements. Objective: To explore the correlation between acetabulum and femoral head morphology in children with DDH aged 0-3 years, using MRI measurements as indicators. Methods: A Retrospective Analysis of MRI Data from 172 Children Diagnosed with Developmental Dysplasia of the Hip (DDH) at Nanjing Medical University Affiliated Children's Hospital, spanning from January 2017 to January 2022. Measurements were taken to assess various parameters reflecting hip socket morphology as well as the development status of the femoral head and ossifying nucleus. The correlation between these factors was explored using Pearson correlation analysis and multiple-factor linear regression. Statistical analysis was conducted using SPSS 18.0 software. Results: Pearson correlation analysis revealed statistically significant associations between the length of the ossifying nucleus ratio and age(mo.), BAI, BCAD, CTAD, and CTAD. The height of the ossifying nucleus ratio displayed statistically significant correlations with age(mo.) and BTAD. The length of the femoral head ratio exhibited statistically significant correlations with CAI, BCEA, and BCAD. Furthermore, the height of the femoral head ratio demonstrated a statistically significant correlation with BCEA. After adjusting for age(mo.), BMI, BCEA, and CCEA, BPoAcet and CPoAcet was found to be correlated with the length of the ossifying nucleus ratio. Preoperatively, the CAI, BAxAcet, BPoAcet, CPoAcet, and BTAD were correlated with the height of ossifying nucleus ratio after correcting for age, BMI, BCEA, and CCEA. Conclusion: The measurement parameters of hip socket morphology on MRI are associated with femoral head development, making them potential predictive indicators for femoral head development in DDH patients. These findings offer valuable insights for clinical decisions regarding the timing and approach of surgery in patients with developmental hip dislocation.