Choudry Qaisar, Paton Robin W
aDepartment of Orthopaedics, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn bSchool of Medicine, University of Central Lancashire, Preston cUniversity of Manchester, Manchester, UK.
J Pediatr Orthop B. 2017 Jul;26(4):293-297. doi: 10.1097/BPB.0000000000000413.
In the UK, the Pavlik harness is generally the accepted treatment technique for the treatment of neonatal and infant pathological developmental dysplasia of the hip. In 2013, the success rate of the Pavlik harness became an outcome measure from the British Society of Children's Orthopaedic Surgery for appraisal and revalidation with the GMC for paediatric orthopaedic surgery. The standard set requires an 80% success rate, with less than 20% requiring surgery. This study evaluated the outcomes of Pavlik harness treatment in neonates/infants with 'pathological hips' diagnosed by ultrasound imaging in a district general hospital setting. In a 10-year prospective observational longitudinal cohort study, modified Graf type III and IV hips (excluding those presenting with irreducible hip dislocation) were classified as pathological and splinted. A total of 2826 neonates/infants underwent ultrasound assessment in the paediatric orthopaedic 'screening clinic'. Neonates and infants were referred as 'at-risk' or as clinically unstable by the Paediatric Department and by general practitioners. Thirty-one Graf type III and 95 Graf type IV hips were identified and treated with a Pavlik harness. One Graf type III (30/31=success rate 96.8%) and three clinically unstable Graf type IV hips progressed to irreducible hip dislocations (92/95=96.8%). The success rate of the Pavlik harness in Graf type III and IV dysplasia was 96.8%, with 3.2% requiring surgery because of progression of the condition, confirming acceptable results for this technique in a district general hospital setting.
在英国，帕夫利克吊带通常是治疗新生儿及婴儿病理性髋关节发育不良被广泛认可的治疗技术。2013年，帕夫利克吊带的成功率成为英国儿童骨科学会用于评估以及向英国医学总会进行小儿骨外科再认证的一项结果指标。设定的标准要求成功率达到80%，手术率低于20%。本研究评估了在一家地区综合医院中，对经超声成像诊断为“病理性髋关节”的新生儿/婴儿采用帕夫利克吊带治疗的效果。在一项为期10年的前瞻性观察性纵向队列研究中，改良Graf III型和IV型髋关节（不包括那些存在不可复位髋关节脱位的病例）被归类为病理性髋关节并予以固定。共有2826名新生儿/婴儿在小儿骨科“筛查门诊”接受了超声评估。新生儿和婴儿由儿科及全科医生作为“高危”或临床不稳定病例转诊而来。共识别出31例Graf III型和95例Graf IV型髋关节，并采用帕夫利克吊带进行治疗。1例Graf III型髋关节（30/31 =成功率96.8%）和3例临床不稳定的Graf IV型髋关节进展为不可复位髋关节脱位（92/95 = 96.8%）。帕夫利克吊带治疗Graf III型和IV型发育不良的成功率为96.8%，3.2%的病例因病情进展需要手术，这证实了在地区综合医院环境中该技术能取得可接受的结果。
