发育性髋关节发育不良帕夫利克吊带治疗中股神经麻痹。
Femoral nerve palsy in Pavlik harness treatment for developmental dysplasia of the hip.
机构信息
Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA.
出版信息
J Bone Joint Surg Am. 2011 Mar 2;93(5):493-9. doi: 10.2106/JBJS.J.01210.
BACKGROUND
Transient femoral nerve palsy is a potential complication of the use of a Pavlik harness to treat developmental dysplasia of the hip. Our hypothesis was that patients who develop a femoral nerve palsy while undergoing Pavlik harness treatment for developmental dysplasia of the hip are more likely to have unsuccessful orthotic treatment and to require closed or open hip reduction.
METHODS
We performed a retrospective review of all patients who underwent Pavlik harness treatment for developmental dysplasia of the hip within a seventeen-year period (1992 to 2008). All cases of femoral nerve palsy were identified and reviewed. Thirty infants met the study criteria and formed the palsy group. A control group of seventy-nine infants who did not develop femoral nerve palsy during treatment was randomly selected.
RESULTS
Thirty cases of femoral nerve palsy were identified from a group of 1218 patients for an incidence of 2.5%. Eighty-seven percent of femoral nerve palsies presented within one week of application of the Pavlik harness. Femoral nerve palsy was more likely in older, larger patients in whom the developmental dysplasia of the hip was of higher severity. Patients whose femoral nerve palsy resolved within three days had a 70% chance of having successful treatment with the Pavlik harness, whereas those who had not recovered by ten days had a 70% chance of having treatment failure with the Pavlik harness. The success rate associated with treatment with a Pavlik harness was 94% in our control group and 47% in our palsy group.
CONCLUSIONS
Femoral nerve palsy is an uncommon yet clinically important complication of Pavlik harness treatment for developmental dysplasia of the hip. This complication is strongly predictive of failure of treatment, and its impact is greatest when the developmental dysplasia of the hip is higher in severity. Early recognition and management of femoral nerve palsies may improve the success of treatment.
背景
暂时性股神经麻痹是使用 Pavlik 吊带治疗发育性髋关节发育不良的潜在并发症。我们的假设是，在接受 Pavlik 吊带治疗发育性髋关节发育不良时发生股神经麻痹的患者更有可能治疗失败，需要闭合或开放髋关节复位。
方法
我们对 17 年内（1992 年至 2008 年）接受 Pavlik 吊带治疗发育性髋关节发育不良的所有患者进行了回顾性研究。所有股神经麻痹的病例均被识别并进行了回顾。30 名婴儿符合研究标准，形成麻痹组。随机选择了 79 名在治疗过程中未发生股神经麻痹的婴儿作为对照组。
结果
在 1218 名患者中，有 30 例股神经麻痹，发生率为 2.5%。87%的股神经麻痹发生在 Pavlik 吊带应用后一周内。股神经麻痹更可能发生在年龄较大、体型较大的患者中，髋关节发育不良的严重程度也较高。股神经麻痹在三天内缓解的患者，使用 Pavlik 吊带治疗的成功率为 70%，而十天内未恢复的患者，使用 Pavlik 吊带治疗失败的可能性为 70%。我们的对照组治疗成功率为 94%，而我们的麻痹组为 47%。
结论
股神经麻痹是 Pavlik 吊带治疗发育性髋关节发育不良的一种罕见但具有重要临床意义的并发症。这种并发症是治疗失败的强烈预测因素，当髋关节发育不良的严重程度较高时，其影响最大。早期识别和处理股神经麻痹可能会提高治疗成功率。
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