婴儿髋关节不稳定（无半脱位或脱位）的自然病史：三年随访

Natural history of hip instability in infants (without subluxation or dislocation): a three year follow-up.

作者信息

Pruszczynski Blazej, Harcke H Theodore, Holmes Laurens, Bowen J Richard

机构信息

Department of Orthopedics, Nemours/Alfred I, duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA.

出版信息

BMC Musculoskelet Disord. 2014 Oct 28;15:355. doi: 10.1186/1471-2474-15-355.

DOI:10.1186/1471-2474-15-355

PMID:25348031

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4236482/

Abstract

BACKGROUND

The natural history of hip instability (without subluxation or dislocation) and treatment in infants remain controversial. We performed a retrospective cohort case-only study with blinded, prospectively collected data to assess normalization of the acetabular index in consecutive untreated infant hips with sonography instability.

METHODS

Consecutive hips meeting inclusion criteria were followed by sonography/radiography and data analyzed using tabular and regression models.

RESULTS

In 48 hips, acetabular index measured by radiography normalized within 3 years of age without treatment. Normalization by age occurred: 7 months in 35%, 12 months in 67%, 18 months in 75%, 24 months in 81%, and 36 months in 100%. Two patterns of normalization of the acetabular index were observed: group I showed ossification in a physiological range of normal by 7 months of age, and group II had delayed ossification with later normalization of the acetabular index measurement. Breech presentation (p =0.013) and cesarean delivery (p =0.004) statistically directly correlated with a later normalization.

CONCLUSIONS

The natural history of infant hip instability (without subluxation or dislocation), which is reduced at rest and unstable with stress as diagnosed by the Harcke method of sonography, has spontaneous normalization of the acetabular index within 3 years of age. We suggest three patterns of acetabular ossification in unstable infants' hips: (I) normal ossification, (II) delayed ossification with normalization of the acetabular index by age 3 years, and (III) defective secondary centers of ossification with an upward tilt of the lateral acetabular rim in adolescence.

摘要

背景

婴儿髋关节不稳定（无半脱位或脱位）的自然病程及治疗仍存在争议。我们进行了一项回顾性队列单病例研究，采用前瞻性收集的盲法数据，以评估连续未经治疗的超声检查显示不稳定的婴儿髋关节髋臼指数的正常化情况。

方法

对符合纳入标准的连续髋关节进行超声/放射摄影随访，并使用表格和回归模型分析数据。

结果

在48例髋关节中，未经治疗的情况下，放射摄影测量的髋臼指数在3岁内实现正常化。按年龄实现正常化的比例为：7个月时35%，12个月时67%，18个月时75%，24个月时第八十一%，36个月时100%。观察到髋臼指数正常化的两种模式：第一组在7个月大时在正常生理范围内出现骨化，第二组骨化延迟，髋臼指数测量随后实现正常化。臀位分娩（p = 0.013）和剖宫产（p = 0.004）与较晚的正常化在统计学上直接相关。