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发育性髋关节发育不良:过去20年有哪些变化?

Developmental dysplasia of the hip: What has changed in the last 20 years?

作者信息

Kotlarsky Pavel, Haber Reuben, Bialik Victor, Eidelman Mark

机构信息

Pavel Kotlarsky, Reuben Haber, Victor Bialik, Mark Eidelman, Pediatric Orthopedic Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa 3109601, Israel.

出版信息

World J Orthop. 2015 Dec 18;6(11):886-901. doi: 10.5312/wjo.v6.i11.886.

Abstract

Developmental dysplasia of the hip (DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Different screening programs for DDH were implicated. The suspicion is raised based on a physical examination soon after birth. Radiography and ultrasonography are used to confirm the diagnosis. The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined; however, extensive research is underway on this subject. Treatment depends on the age of the patient and the reducibility of the hip joint. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. If this fails, closed reduction and spica casting is usually done. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades.

摘要

发育性髋关节发育不良(DDH)描述了涉及生长中的髋关节的一系列结构异常。早期诊断和治疗对于获得最佳功能结果至关重要。髋关节发育不良持续至青少年期和成年期可能导致步态异常、力量下降以及髋关节和膝关节退行性疾病发生率增加。尽管努力在出生后不久识别和治疗所有DDH病例,但仍有一些儿童的诊断被延迟,且随着就诊延迟的增加,治疗结果会恶化。不同的DDH筛查项目也受到牵连。出生后不久通过体格检查引发怀疑。X线摄影和超声检查用于确诊。其他成像方式,如磁共振成像的作用仍未确定;然而,关于这个主题的广泛研究正在进行中。治疗取决于患者年龄和髋关节的可复性。在早期至6个月大时,主要治疗方法是使用如 Pavlik 吊带之类的外展支具。如果失败,通常进行闭合复位和髋人字石膏固定。18个月大之后,治疗通常包括切开复位和髋关节重建手术。已经提出了各种治疗方案。我们总结了当前DDH检测和治疗的实践,重点强调过去二十年筛查和治疗方面的进展。

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