Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA.
J Bone Joint Surg Am. 2010 Jan;92(1):113-20. doi: 10.2106/JBJS.H.01880.
In developmental dysplasia, Pavlik harness treatment of hips with a positive Ortolani sign fails in up to 40% of such patients; however, no study has described factors for failure associated with ultrasonographic parameters. The goal of this study was to describe unique ultrasonographic markers in hips with a positive Ortolani sign that are associated with Pavlik harness failure.
A retrospective review was performed of all patients less than six months old who were treated for developmental dysplasia of the hip with a Pavlik harness from 1991 to 2005 at a single institution. Inclusion criteria for this study were patients with a hip that was dislocated but reducible (a positive Ortolani sign), treatment with a Pavlik harness, and an ultrasound examination performed within four weeks after the initiation of treatment. The initial coronal ultrasound studies were graded with use of the Graf classification, the percentage of femoral head coverage, labral morphology, and two new measurements: superior femoral head displacement relative to the labrum and total femoral head displacement.
Eighty-five patients with 115 hips fitting the inclusion criteria were identified. Pavlik harness treatment was successful in seventy-two hips (63%) and failed in forty-three hips (37%). Increased beta angle, decreased femoral head coverage, an inverted labrum, decreased superior femoral head displacement relative to the labrum, and decreased total femoral head displacement were significantly correlated with Pavlik harness failure (p < 0.001 for all). A finding of 0 degrees of superior femoral head displacement relative to the labrum was seen in 98% of the hips with successful Pavlik harness treatment. Total femoral head displacement of less than -30 degrees was found in 89% of the hips with a failure of Pavlik harness treatment.
We identified two new objective measurements on static ultrasound examinations of the hip that are associated with the outcome of Pavlik harness treatment in patients with developmental dysplasia and a positive Ortolani sign. A femoral head positioned below the labrum is strongly associated with success of the Pavlik harness treatment, whereas a hip with a femoral head that is located substantially superior and lateral to the labrum is associated with Pavlik harness treatment failure. The presence of a deficient cartilaginous anlage and an inverted labrum may provide a pathoanatomical explanation for Pavlik harness treatment failure.
在发育性髋关节发育不良中，使用帕夫利克吊带治疗出现阳性 Ortolani 征的髋关节，有高达 40%的失败率；然而，目前尚无研究描述与超声参数相关的失败因素。本研究的目的是描述与帕夫利克吊带治疗失败相关的、出现阳性 Ortolani 征的髋关节的独特超声标志物。
我们对 1991 年至 2005 年在单一机构中因发育性髋关节发育不良而接受帕夫利克吊带治疗的年龄小于 6 个月的所有患者进行了回顾性研究。本研究的纳入标准为髋关节脱位但可复位（出现阳性 Ortolani 征）、接受帕夫利克吊带治疗、且在治疗开始后 4 周内行超声检查的患者。初始冠状面超声检查采用 Graf 分类进行分级，评估股骨头覆盖率、盂唇形态以及两个新的测量指标：相对于盂唇的股骨头上方移位程度和股骨头总移位程度。
符合纳入标准的 85 例患者共 115 髋，其中 72 髋（63%）的帕夫利克吊带治疗成功，43 髋（37%）的治疗失败。β角增大、股骨头覆盖率减小、盂唇倒置、相对于盂唇的股骨头上方移位程度减小以及股骨头总移位程度减小与帕夫利克吊带治疗失败显著相关（p 值均＜0.001）。在帕夫利克吊带治疗成功的髋关节中，98%的髋关节出现股骨头上方相对于盂唇无移位的情况。在帕夫利克吊带治疗失败的髋关节中，有 89%的髋关节股骨头总移位程度＜-30 度。
我们在发育性髋关节发育不良且出现阳性 Ortolani 征的患者的髋关节静态超声检查中发现了两个新的客观测量指标，它们与帕夫利克吊带治疗的结果相关。位于盂唇下方的股骨头与帕夫利克吊带治疗的成功密切相关，而位于盂唇上方和外侧的髋关节与帕夫利克吊带治疗失败相关。软骨发育不全和盂唇倒置可能为帕夫利克吊带治疗失败提供了一种病理解剖学解释。
