Seidl T, Lohmaier J, Hölker T, Funk J, Placzek R, Trouillier H H
Centrum für Muskuloskeletale Chirurgie, Sektion Kinder- und Neuroorthopädie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin.
Orthopade. 2012 Mar;41(3):195-9. doi: 10.1007/s00132-011-1873-8.
The indication for the use of the Tübingen hip flexion splint is a dysplastic hip without instability. According to current knowledge dysplastic unstable or dislocated hips should be treated with a stable retention device such as a modified Fettweis cast. The aim of this study was to evaluate the treatment effect of the Tübingen hip flexion splint when applied to dysplastic unstable hips (type IIc unstable according to the classification of Graf) and dislocated hips (types D, III and IV according to the classification of Graf) within the first week of life.
All newborns with an unstable hip type IIc or worse detected by ultrasound in the first week of life were treated with a Tübingen hip flexion splint. A prospective cohort trial was performed between November 2007 and December 2010. The initial hip type according to the ultrasound classification of Graf, the start and the duration of treatment with the Tübingen hip flexion splint as well as the rate of success were evaluated. Due to the small number of patients non-parametric tests were used for statistical analysis.
A total of 50 dysplastic unstable or dislocated hips in 42 newborns were treated with the Tübingen hip flexion splint. The distribution of pathological hip types was 6 type IIc unstable, 33 type D, 10 type III and 1 type IV. Therapy was started on average on day 3.5 (range 1-8 days) of life and 49 out of 50 hips were successfully treated with the Tübingen hip flexion splint. Solely the type IV hip could not be reduced in the Tübingen hip flexion splint. Thus 98% of the dysplastic unstable or dislocated hips were successfully converted into type I hips with an α-angle of more than 64° in the splint. The mean time for achieving an α-angle ≥ 64° was 51.6 ± 18.9 days (range 21-87 days). No statistically significant relationship was found between the duration of therapy and the time when treatment was started, early or late within the first week of life (p = 0.152). Furthermore, no correlation was detected between the duration of therapy and the initial hip type determined by ultrasound (p = 0.886). In all successfully treated cases therapy could be discontinued during the exponential part of Tschauner's maturation curve of hip development.
When recognized within the first week of life dysplastic unstable hips (type IIc unstable according to the classification of Graf) and dislocated hips with a cranially dislocated cartilage roof (types D and III according to the classification of Graf) can be successfully treated with the Tübingen hip flexion splint provided that the parents show good compliance concerning the treatment regimen.
图宾根髋关节屈曲夹板的使用指征是发育不良但无不稳定的髋关节。根据目前的知识，发育不良、不稳定或脱位的髋关节应使用稳定的固定装置进行治疗，如改良的费特魏斯石膏。本研究的目的是评估图宾根髋关节屈曲夹板应用于出生后第一周内发育不良的不稳定髋关节（根据格拉夫分类为IIc型不稳定）和脱位髋关节（根据格拉夫分类为D、III和IV型）的治疗效果。
所有在出生后第一周经超声检测为IIc型或更严重不稳定髋关节的新生儿均采用图宾根髋关节屈曲夹板治疗。2007年11月至2010年12月进行了一项前瞻性队列试验。评估了根据格拉夫超声分类的初始髋关节类型、图宾根髋关节屈曲夹板的治疗开始时间和持续时间以及成功率。由于患者数量较少，采用非参数检验进行统计分析。
42例新生儿共50个发育不良的不稳定或脱位髋关节接受了图宾根髋关节屈曲夹板治疗。病理性髋关节类型分布为：IIc型不稳定6个，D型33个，III型10个，IV型1个。平均在出生后3.5天（范围1 - 8天）开始治疗，50个髋关节中有49个通过图宾根髋关节屈曲夹板成功治疗。只有IV型髋关节在图宾根髋关节屈曲夹板中未能复位。因此，98%的发育不良的不稳定或脱位髋关节在夹板中成功转变为α角大于64°的I型髋关节。达到α角≥64°的平均时间为51.6±18.9天（范围21 - 87天）。治疗持续时间与出生后第一周内治疗开始的早晚之间未发现统计学上的显著关系（p = 0.152）。此外，治疗持续时间与超声确定的初始髋关节类型之间也未检测到相关性（p = 0.886）。在所有成功治疗的病例中，治疗可在髋关节发育的绍纳成熟曲线的指数期停止。
如果在出生后第一周内识别出发育不良的不稳定髋关节（根据格拉夫分类为IIc型不稳定）和伴有颅骨脱位软骨顶的脱位髋关节（根据格拉夫分类为D和III型），并且父母对治疗方案有良好的依从性，那么使用图宾根髋关节屈曲夹板可以成功治疗。
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