6个月以下诊断为发育性髋关节发育不良的婴儿不可复位性髋关节脱位的治疗
Management of Irreducible Hip Dislocations in Infants With Developmental Dysplasia of the Hip Diagnosed Below 6 Months of Age.
作者信息
Aarvold Alex, Schaeffer Emily K, Kelley Simon, Clarke Nicholas M P, Herrera-Soto Jose A, Price Charles T, Mulpuri Kishore
机构信息
Department of Orthopaedic Surgery, University of Southampton, Southampton, UK.
Department of Orthopaedics, University of British Columbia.
出版信息
J Pediatr Orthop. 2019 Jan;39(1):e39-e43. doi: 10.1097/BPO.0000000000001205.
BACKGROUND
Infants with dislocated irreducible (D/I) hips can be substantially harder to treat than infants with dislocated but reducible hips. The purpose of this study was to compare treatment methods and outcomes for infants with D/I hips in order to optimize management of this difficult patient cohort.
METHODS
A multicenter prospective hip dysplasia study database was analyzed from 2010 to 2016. Infants aged below 6 months with clinically and radiologically confirmed D/I hips were included in the study. Teratological hips (syndromic/neuromuscular) were excluded.
RESULTS
In total, 59 hips in 52 patients were included. All hips were clinically Ortolani negative and radiologically dislocated but irreducible on presentation and had at least 20 months of follow-up. Mean age at diagnosis was 1.9 months (range, 0.1 to 5.9 mo). There were 33 left hips, 12 right hips, and 14 bilateral hips (7 patients). In total, 48 of 59 hips were treated in Pavlik harness. The remainder were treated by alternative braces or primary closed or open reductions. Pavlik treatment was successful in 27 of 48 hips. Pavlik treatment was abandoned in 21 D/I hips, 3 due to femoral nerve palsy and the remainder due to failure to achieve reduction. There was no statistical correlation between Pavlik success and age at diagnosis (P=0.22), patient sex (P=0.61), or bilateral compared with unilateral D/I hips (P=0.07). Left hips were more likely to be successfully reduced in Pavlik harness than right hips (P=0.01). Five complications occurred: 3 patients developed femoral nerve palsy in Pavlik harness, while 2 patients developed avascular necrosis, both after failed Pavlik treatment and subsequent surgery.
CONCLUSIONS
Pavlik harness treatment has been demonstrated to be a safe and sensible first-line treatment for infants with D/I hips. Left hips were more likely to be successfully reduced in Pavlik harness than right hips, but age, sex, and bilaterality were not correlated. The outcomes demonstrated from this multicentre prospective database inform management of this complex patient cohort.
LEVEL OF EVIDENCE
Level II-prognostic study: less-quality prospective study.
背景
与髋关节脱位但可复位的婴儿相比，髋关节脱位且不可复位（D/I）的婴儿治疗难度可能大得多。本研究的目的是比较D/I髋关节婴儿的治疗方法和结果，以优化对这一困难患者群体的管理。
方法
分析了2010年至2016年的多中心前瞻性髋关节发育不良研究数据库。纳入临床和放射学确诊为D/I髋关节的6个月以下婴儿。排除畸形髋关节（综合征性/神经肌肉性）。
结果
共纳入52例患者的59个髋关节。所有髋关节临床奥氏征均为阴性，放射学检查显示脱位且就诊时不可复位，且至少随访20个月。诊断时的平均年龄为1.9个月（范围0.1至5.9个月）。有33个左髋关节、12个右髋关节和14个双侧髋关节（7例患者）。59个髋关节中共有48个采用 Pavlik 吊带治疗。其余采用其他支具或一期闭合或切开复位治疗。48个髋关节中有27个采用Pavlik治疗成功。21个D/I髋关节放弃了Pavlik治疗，3个因股神经麻痹，其余因未能复位。Pavlik治疗成功与诊断时年龄（P=0.22）、患者性别（P=0.61）或双侧与单侧D/I髋关节（P=0.07）之间无统计学相关性。左髋关节在Pavlik吊带中比右髋关节更有可能成功复位（P=0.01）。发生了5例并发症：3例患者在Pavlik吊带治疗中出现股神经麻痹，2例患者在Pavlik治疗失败及随后手术之后出现股骨头缺血性坏死。
结论
已证明Pavlik吊带治疗是D/I髋关节婴儿安全且合理的一线治疗方法。左髋关节在Pavlik吊带中比右髋关节更有可能成功复位，但年龄、性别和双侧性无相关性。该多中心前瞻性数据库显示的结果为管理这一复杂患者群体提供了依据。
证据水平
二级预后研究：质量较低的前瞻性研究。
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