El Ferzli Julie, Abuamara Saad, Eurin Danielle, Le Dosseur Patrick, Dacher Jean-Nicolas
Department of Radiology, CHU Charles Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France.
Eur Radiol. 2004 Jan;14(1):73-7. doi: 10.1007/s00330-003-1944-2. Epub 2003 Jun 12.
Real-time ultrasonography has been used for diagnosis and screening of developmental dysplasia of the hip for several years. If diagnostic criteria are well established, the use of sonography in follow-up of treated infants remains extremely variable. The aims of this study were (a). to describe the normal sonographic anatomy of the infant abducted hip on an anterior axial view, and (b). to define the role of this approach in the follow-up of developmental dysplasia treated by Pavlik harness. Thirty-eight patients with Pavlik harness had anterior axial sonograms in addition to their usual clinical and sonographic follow-up. Normal anatomy was inferred from the examination of 25 clinically proven normal hips in the same population. The best criterion of a normal positioning of the femoral head appears to be the alignment of the pubic bone and the femoral metaphysis. Pavlik harness was the only treatment in 32 patients. It was directly efficient in 22, after readjustment in 10 patients. Reduction was shown by anterior sonography in all of them. In 6 children, sonography showed no reduction and subsequent treatment by closed or open reduction was carried out. Anterior axial sonogram can show reduction of a dislocated hip in children with Pavlik harness, but it does not evaluate its stability. It helps optimize the settings of the harness, and may predict a poor outcome, but it does not identify the cause of non-reducibility.
实时超声检查已用于髋关节发育不良的诊断和筛查数年。如果诊断标准已经确立,那么超声检查在接受治疗的婴儿随访中的应用仍然极不统一。本研究的目的是:(a)描述婴儿外展髋关节在前轴位上的正常超声解剖结构;(b)确定这种检查方法在 Pavlik 吊带治疗发育性髋关节发育不良随访中的作用。38 例使用 Pavlik 吊带的患者除了接受常规临床和超声随访外,还进行了前轴位超声检查。通过对同一人群中 25 例经临床证实为正常的髋关节进行检查推断出正常解剖结构。股骨头正常定位的最佳标准似乎是耻骨与股骨干骺端的对齐。32 例患者仅接受了 Pavlik 吊带治疗。其中 22 例直接有效,10 例经重新调整后有效。所有患者的前位超声检查均显示复位。6 例患儿超声检查显示未复位,随后进行了闭合或切开复位治疗。前轴位超声检查可显示 Pavlik 吊带治疗患儿脱位髋关节的复位情况,但不能评估其稳定性。它有助于优化吊带的设置,并可能预测不良预后,但不能确定不可复位的原因。