The objective of this study was to evaluate the incidence of avascular necrosis (AVN) of the femoral head in children less than 3 years of age with developmental dysplasia of the hip (DDH) treated with closed reduction, open reduction alone and open reduction combined with osteotomy. We reviewed clinical trials from the PubMed, EMBASE and Cochrane Library databases (up to November 2020) that were related to closed reduction, open reduction alone and open reduction combined with osteotomy for the treatment of children under 3 years of age with DDH. The screening and quality evaluation of the literature were performed independently by two researchers. In case of disagreement, a third researcher resolved the discourse. Finally, the data were extracted, and the R software and GeMTC program package were used to conduct a network meta-analysis (NMA). The evaluation index was the incidence of AVN. Fourteen articles were included. The NMA showed that in terms of the incidence of AVN, cases treated with open reduction alone were higher than those with closed reduction, and the difference was statistically significant. Open reduction alone had the highest probability (94.4%) of having the highest incidence of AVN, followed by open reduction combined with osteotomy (5.5%) and closed reduction (0.1%). In the treatment of children with DDH who are younger than 3 years old, open reduction alone is most likely to be the treatment with the highest incidence of AVN, followed by open reduction combined with osteotomy. The closed reduction had the smallest probability of AVN.

本研究的目的是评估闭合复位、单纯切开复位和切开复位联合切开复位治疗的 3 岁以下发育性髋关节发育不良（DDH）儿童股骨头缺血性坏死（AVN）的发生率。截骨术。我们回顾了PubMed、EMBASE和Cochrane 图书馆数据库（截至 2020 年 11 月）中与闭合复位、单独开放复位和开放复位联合截骨术相关的临床试验用于治疗 3 岁以下患有 DDH 的儿童。文献的筛选和质量评价由两名研究人员独立进行。如果出现分歧，第三位研究人员解决了话语。最后提取数据，利用R软件和GeMTC程序包进行网络荟萃分析（NMA）。评价指标为AVN的发生率。包括十四篇文章。NMA显示，在AVN的发生率方面，单纯切开复位治疗的病例高于闭合复位治疗的病例，差异有统计学意义。单纯切开复位的 AVN 发生率最高（94.4%），其次是切开复位联合截骨术（5.5%）和封闭式减少（0.1%）。在3岁以下DDH患儿的治疗中，单纯切开复位最有可能是AVN发生率最高的治疗，其次是切开联合截骨。封闭归约的 AVN 概率最小。