Curry L C, Gibson L Y
Texas Christian University, Harris College of Nursing, Fort Worth.
Nurse Pract. 1992 May;17(5):49-55. doi: 10.1097/00006205-199205000-00014.
Hip dislocation is the musculoskeletal condition most commonly missed during neonatal examinations. Failure to diagnose the condition can lead to long-term disability and is a common target in pediatric legal suits concerning damage to the musculoskeletal system. Early neonatal assessment for hip dislocation includes an examination using the Barlow and Ortolani tests. Later examinations include assessment of gluteal folds, knee height and the degree of hip abduction. The preferred treatment is use of the Pavlik harness, an outpatient treatment regime that provides effective reduction in 90 percent of the cases. The harness uses flexion and free abduction to direct the femoral head into the acetabulum; it uses time, gravity and motion to position the hip in a reduced position. The harness requires three to six months of continuous wear for the hip to become radiographically stable. Health care providers are instrumental in diagnosing congenital hip dislocation and teaching families how to promote the infant's physical and psychosocial well-being. If this condition is not detected until after the infant is 6 weeks old, or the harness is ineffective after three weeks, skin traction, closed reduction and spica-cast application may be needed. Open reduction and recasting are also options. In rare cases, total hip replacement is necessary in later life.
髋关节脱位是新生儿检查中最常被漏诊的肌肉骨骼疾病。未能诊断出该疾病会导致长期残疾，并且是涉及肌肉骨骼系统损伤的儿科法律诉讼中的常见目标。新生儿早期髋关节脱位评估包括使用巴洛试验和奥托拉尼试验进行检查。后期检查包括评估臀褶、膝高和髋关节外展程度。首选治疗方法是使用帕夫利克吊带，这是一种门诊治疗方案，90%的病例通过它能有效复位。该吊带利用屈曲和自由外展将股骨头引导至髋臼；它利用时间、重力和运动将髋关节置于复位位置。该吊带需要持续佩戴三到六个月，髋关节才能在影像学上稳定。医疗保健提供者在诊断先天性髋关节脱位以及教导家庭如何促进婴儿的身心健康方面发挥着重要作用。如果直到婴儿6周后才发现这种情况，或者吊带在三周后无效，则可能需要进行皮肤牵引、闭合复位和髋人字石膏固定。切开复位和重新打石膏也是选择。在极少数情况下，后期可能需要进行全髋关节置换。
