Harris I E, Dickens R, Menelaus M B
Section of Orthopaedic Surgery, Arizona Health Sciences Centre, Tucson.
Clin Orthop Relat Res. 1992 Aug(281):29-33.
Seven hundred twenty congenitally dislocated or subluxated hips in 550 patients less than one year old, treated with the Pavlik harness, were retrospectively reviewed. Overall, 11% of the hips proved irreducible by Pavlik harness treatment, 9% had dysplasia at the end of harness treatment, and 5% developed dysplasia by the age of two years two months (average). Fourteen percent of the hips positive for Ortolani's sign, 6% of the hips positive for Barlow's sign, and 2% of the congenitally subluxated hips required open or closed reduction followed by plaster hip spica immobilization. Avascular necrosis occurred in 0.7% of the hips treated with the Pavlik harness alone. Transient irritability with pain and limited motion of the hip occurred in 1% of the hips. The Pavlik harness is not appropriate for the larger child, most children older than eight months of age, the child in whom the examiner does not get an adequate sense of reduction, the hip that redislocates with the slightest adduction, and the hip that requires excessive flexion to maintain reduction. Pavlik harness treatment should be abandoned in favor of other methods if, after two to four weeks of use, abduction has not improved sufficiently to allow reduction, the hip has not reduced, or the hip remains unstable.
对550例1岁以下采用帕夫利克吊带治疗的先天性髋关节脱位或半脱位患儿的720例髋关节进行了回顾性研究。总体而言，11%的髋关节经帕夫利克吊带治疗后仍无法复位，9%在吊带治疗结束时存在发育不良，5%在两岁零两个月（平均）时出现发育不良。奥尔托拉尼征阳性的髋关节中有14%、巴洛征阳性的髋关节中有6%以及先天性半脱位的髋关节中有2%需要进行切开或闭合复位，随后用髋人字石膏固定。仅使用帕夫利克吊带治疗的髋关节中，0.7%发生了股骨头缺血性坏死。1%的髋关节出现了伴有疼痛的短暂激惹和髋关节活动受限。帕夫利克吊带不适用于较大的儿童，大多数8个月以上的儿童，检查者无法充分判断复位情况的儿童，髋关节在轻微内收时就会重新脱位的情况，以及需要过度屈曲来维持复位的髋关节。如果在使用两到四周后，外展没有充分改善以实现复位、髋关节没有复位或髋关节仍然不稳定，则应放弃帕夫利克吊带治疗，转而采用其他方法。
