Pollet Virginie, Pruijs Hans, Sakkers Ralph, Castelein René
Robert Debré Children's Hospital, Paris, France.
J Pediatr Orthop. 2010 Jul-Aug;30(5):437-42. doi: 10.1097/BPO.0b013e3181df85ab.
We retrospectively studied the outcome of Pavlik harness treatment in late-diagnosed hip dislocation in infants between 6 and 24 months of age (Graf type 3 and 4 or dislocated hips on radiographs) treated in our hospital between 1984 and 2004. The Pavlik harness was progressively applied to improve both flexion and abduction of the dislocated hip. In case of persistent adduction contracture, an abduction splint was added temporarily to improve the abduction.
We included 24 patients (26 hips) between 6 and 24 months of age who presented with a dislocated hip and primarily treated by Pavlik harness in our hospital between 1984 and 2004. The mean age at diagnosis was 9 months (range 6 to 23 mo). The average follow-up was 6 years 6 months (2 to 12 y). Ultrasound images and radiographs were assessed at the time of diagnosis, one year after reposition and at last follow-up.
Twelve of the twenty-six hips (46%) were successfully reduced with Pavlik harness after an average treatment of 14 weeks (4 to 28 wk). One patient (9%) needed a secondary procedure 1 year 9 months after reposition because of residual dysplasia (Pelvis osteotomy). Seventeen of the 26 hips were primary diagnosed by Ultrasound according to the Graf classification. Ten had a Graf type 3 hip and 7 hips were classified as Graf type 4. The success rate was 60% for the type 3 hips and 0% for the type 4 hips. (P=0.035). None of the hips that were reduced with the Pavlik harness developed an avascular necrosis (AVN). Of the hips that failed the Pavlik harness treatment, three hips showed signs of AVN, 1 after closed reposition and 2 after open reposition.
The use of a Pavlik harness in the late-diagnosed hip dislocation type Graf 3 can be a successful treatment option in the older infant. We have noticed few complications in these patients maybe due to progressive and gentle increase of abduction and flexion, with or without temporary use of an abduction splint. The treatment should be abandoned if the hips are not reduced after 6 weeks. None of the Graf 4 hips could be reduced successfully by Pavlik harness. This was significantly different from the success rate for the Graf type 3 hips.
Therapeutic study, clinical case series: Level IV.
我们回顾性研究了1984年至2004年在我院接受治疗的6至24个月大婴儿晚期诊断的髋关节脱位（Graf 3型和4型或X线片显示髋关节脱位）采用 Pavlik 吊带治疗的结果。逐渐应用 Pavlik 吊带以改善脱位髋关节的屈曲和外展。若存在持续性内收挛缩，则临时加用外展夹板以改善外展。
我们纳入了1984年至2004年在我院接受 Pavlik 吊带主要治疗的24例（26髋）6至24个月大的髋关节脱位患儿。诊断时的平均年龄为9个月（范围6至23个月）。平均随访时间为6年6个月（2至12年）。在诊断时、复位后1年及末次随访时评估超声图像和X线片。
26髋中的12髋（46%）在平均治疗14周（4至28周）后通过 Pavlik 吊带成功复位。1例患者（9%）在复位后1年9个月因残留发育不良（骨盆截骨术）需要二次手术。根据 Graf 分类，26髋中的17髋最初通过超声诊断。10髋为 Graf 3型髋关节，7髋被分类为 Graf 4型。3型髋关节的成功率为60%，4型髋关节的成功率为0%（P = 0.035）。通过 Pavlik 吊带复位的髋关节均未发生股骨头缺血性坏死（AVN）。在 Pavlik 吊带治疗失败的髋关节中，3髋出现 AVN 迹象，1例在闭合复位后出现，2例在开放复位后出现。
对于年龄较大的婴儿，在晚期诊断的 Graf 3型髋关节脱位中使用 Pavlik 吊带可能是一种成功的治疗选择。我们注意到这些患者的并发症较少，这可能是由于外展和屈曲逐渐轻柔增加，无论是否临时使用外展夹板。如果6周后髋关节未复位，则应放弃该治疗。Pavlik 吊带无法成功复位 Graf 4型髋关节中的任何一例。这与 Graf 3型髋关节的成功率有显著差异。
治疗性研究，临床病例系列：IV级。
