Harcke Howard T, Karatas Ali F, Cummings Susan, Bowen James R
Departments of *Medical Imaging †Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
J Pediatr Orthop. 2016 Apr-May;36(3):232-8. doi: 10.1097/BPO.0000000000000446.
The purpose of this single-examination pilot study was to confirm the ability to perform hip sonography while swaddled and to ascertain whether the various swaddling techniques influenced hip position and dynamics.
Dynamic sonography was used to evaluate 30 infants in both swaddled and unswaddled positions who were being seen in clinic for suspected or documented developmental dysplasia of the hip. A "treatment group" of 16 infants (32 hips) treated in a Pavlik harness and a "nontreatment group" of 14 untreated infants (28 hips) were studied.Criteria for comparing sonographic results between swaddled and unswaddled hip positions included femoral head position, instability, and range-of-motion restriction.
Tight swaddling with a blanket was applied in 11 "nontreatment group" cases (20 hips; in 2 cases, only 1 hip studied) and produced limited flexion and abduction. One unstable left hip dislocated when tightly swaddled. Safe swaddling technique in 12 cases (24 hips) showed no limitation of flexion and abduction of the legs and no change in stability by sonography. Commercial swaddling products appeared to mildly restrict leg motion in 14 hips, but there was no change in hip position in the "nontreatment group." However, the commercial swaddling products changed the hip position in 3 Pavlik harness cases.
Swaddling techniques that allow a free range of leg motion may not affect hip stability in normal infants or those being treated with Pavlik harness. Swaddling with restricted leg motion increases potential for hip instability. Tight swaddling dislocated 1 unstable hip, and commercial swaddling products judged to apply only mild restriction of leg motion negatively impacted 3 cases being treated for developmental dysplasia of the hip with Pavlik harness. On the basis of this pilot study, we advise caution when swaddling infants, especially with techniques that restrict leg motion. Further study of the long-term effects of swaddling is warranted.
Level II.
本单检查试点研究的目的是确认在襁褓包裹状态下进行髋关节超声检查的能力，并确定各种襁褓技术是否会影响髋关节位置和动态。
使用动态超声检查对30名因疑似或确诊为发育性髋关节发育不良而前来诊所就诊的婴儿在襁褓包裹状态和未包裹状态下进行评估。研究了16名使用 Pavlik 吊带治疗的婴儿（32个髋关节）组成的“治疗组”和14名未治疗婴儿（28个髋关节）组成的“非治疗组”。比较襁褓包裹状态和未包裹状态下髋关节超声检查结果的标准包括股骨头位置、不稳定性和活动范围受限情况。
“非治疗组”的11例（20个髋关节；2例中仅研究了1个髋关节）使用毯子紧密包裹，导致髋关节屈曲和外展受限。1例不稳定的左侧髋关节在紧密包裹时发生脱位。12例（24个髋关节）采用安全襁褓技术，超声检查显示腿部屈曲和外展无受限，稳定性无变化。商业襁褓产品似乎使14个髋关节的腿部运动受到轻度限制，但“非治疗组”的髋关节位置无变化。然而，商业襁褓产品在3例使用 Pavlik 吊带治疗的病例中改变了髋关节位置。
允许腿部自由活动的襁褓技术可能不会影响正常婴儿或使用 Pavlik 吊带治疗的婴儿的髋关节稳定性。腿部活动受限的襁褓会增加髋关节不稳定的可能性。紧密包裹导致1例不稳定髋关节脱位，被判定仅对腿部运动有轻度限制的商业襁褓产品对3例使用 Pavlik 吊带治疗发育性髋关节发育不良的病例产生了负面影响。基于本试点研究，我们建议在包裹婴儿时要谨慎，尤其是采用限制腿部运动的技术。有必要进一步研究襁褓的长期影响。
二级。
