Hospital for Special Surgery, New York, New York, USA.
Curr Opin Pediatr. 2018 Feb;30(1):84-92. doi: 10.1097/MOP.0000000000000574.
Our understanding of the epidemiology, diagnosis, and management of developmental dysplasia of the hip (DDH) is evolving. This review focuses on the most up-to-date literature on DDH in patients from birth to six months of age.
Well known risk factors for DDH include family history, female sex, and breech positioning. Recent evidence suggests higher birth weight is a risk, whereas prematurity may be protective. Screening includes physical examination of all infant hips and imaging when abnormal findings or risk factors are present. Treatment in the first six months consists of a harness, with 70-95% success. Failure risk factors include femoral nerve palsy, static bracing, irreducible hips, initiation after seven weeks of age, right hip dislocation, Graf-IV hips, and male sex. Rigid bracing may be trialed if reduction with a harness fails and closed reduction is indicated after failed bracing. If the hip is still irreducible, nonconcentric, or unstable, open reduction may be required following closed reduction. Evidence does not support delaying hip reduction until the ossific nucleus is present.
DDH affects 1-7% of infants. All infants should be examined and selective screening with imaging should be performed for abnormal physical exams or risk factors. Early treatment is associated with optimal outcomes.
我们对发育性髋关节发育不良（DDH）的流行病学、诊断和治疗的理解正在不断发展。本篇综述重点关注了从出生到六个月大的 DDH 患者的最新文献。
DDH 的已知危险因素包括家族史、女性、臀位等。最近的证据表明，较高的出生体重是一个危险因素，而早产可能具有保护作用。筛查包括对所有婴儿髋关节的体格检查，以及当存在异常发现或危险因素时进行影像学检查。在最初的六个月内，治疗方法包括使用吊带，成功率为 70-95%。治疗失败的危险因素包括股神经麻痹、静态支具、不可复位的髋关节、7 周后开始治疗、右侧髋关节脱位、Graf-IV 型髋关节、男性等。如果使用吊带复位失败，可以尝试使用刚性支具，如果刚性支具治疗失败并需要闭合复位，则可以进行闭合复位。如果髋关节仍然不可复位、非同心或不稳定，则可能需要在闭合复位后进行切开复位。目前的证据并不支持等到骨化核出现后再进行髋关节复位。
DDH 影响 1-7%的婴儿。所有婴儿都应进行检查，对于体格检查异常或存在危险因素的婴儿，应选择性地进行影像学筛查。早期治疗与最佳结果相关。
