Lauge-Pedersen Henrik, Gustafsson Johan, Hägglund Gunnar
Department of Orthopedics, Lund University Hospital, Lund, Sweden.
Acta Orthop. 2006 Apr;77(2):257-61. doi: 10.1080/17453670610045993.
There is no concensus on the optimal treatment time for unstable hips in the newborn. We analyzed the efficiency of a treatment program that has been used for 10 years at our hospital, in which all unstable hips (subluxatable, Barlow-positive and Ortolani-positive) are treated with the von Rosen splint for 6 weeks.
Between 1988 and 1997, 32,171 children were born alive at the hospital. During this period 247 children had a clinically unstable hip diagnosed. 223 of the 247 children underwent a radiographic follow-up after 5-15 years.
1 patient with bilateral instability and treated with a splint for 6 weeks showed a dislocated left hip at the radiographic examination at 8 months, which is part of the screening program, and needed operative treatment. 1 patient did not follow the treatment program and showed a dislocated hip at the age of 3. Another 4 patients required more treatment than the 6 weeks with the splint. We found no dysplastic hips at the radiographic follow-up. There was no late dysplasia and there were no late dislocations in children born in Lund between 1988 and 1997 who were diagnosed at other Swedish centers that treat developmental dysplasia of the hip (DDH).
We conclude that the present screening and 6-week treatment in a von Rosen splint prevent almost all cases of late dysplasia and late dislocation of the hip.
对于新生儿不稳定髋关节的最佳治疗时间尚无共识。我们分析了我院已使用10年的一种治疗方案的有效性，该方案中所有不稳定髋关节（可半脱位、巴洛试验阳性和奥托兰尼试验阳性）均使用冯·罗森夹板治疗6周。
1988年至1997年间，我院共有32171名活产婴儿。在此期间，有247名儿童被诊断为临床不稳定髋关节。这247名儿童中有223名在5至15年后接受了影像学随访。
1例双侧不稳定且用夹板治疗6周的患儿在8个月时的影像学检查中显示左髋关节脱位，这是筛查项目的一部分，需要手术治疗。1例患儿未遵循治疗方案，3岁时出现髋关节脱位。另外4例患儿需要超过6周的夹板治疗。在影像学随访中未发现发育不良的髋关节。1988年至1997年在隆德出生、在其他瑞典治疗发育性髋关节发育不良（DDH）的中心被诊断出的儿童中，没有晚期发育不良和晚期脱位的情况。
我们得出结论，目前的筛查以及使用冯·罗森夹板进行6周治疗可预防几乎所有晚期髋关节发育不良和晚期髋关节脱位病例。
