Xu Guang-Wei, Yang Yan-Cai, Xu Zhen-Hua, Liu Yun-Long
Department of Pediatric Orthopedics, Ningbo Women & Children's Hospital, Ningbo 315012, China.
Ann Palliat Med. 2020 May;9(3):1020-1029. doi: 10.21037/apm-20-889. Epub 2020 May 8.
The treatment protocol for children with developmental dysplasia of the hip (DDH) is routinely adjusted by assessing the hip reduction after 3 weeks of Pavlik harness treatment. However, there is a high risk of failure and complications in the treatment adjustment. The aim of this study was to explore the value of ultrasound features in predicting the treatment outcome of Pavlik harness after 3 weeks in DDH children.
A total of 215 DDH children were recruited and the demographics and the changes of ultrasound features [α and β angle and femoral head coverage (FHC)] during the Pavlik harness treatment were recorded. The children were divided into the success group and the failure group according to the reduction outcome after 3 weeks. Univariate and multivariate analyses were performed to analyze the independent predictors for the treatment outcome. Repeated-measures analysis of variance was used to compare the changes of ultrasound features between the two groups during the treatment. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive accuracy of the ultrasound features.
Graf type III (P=0.036), bilateral dislocation (P=0.031), and age at diagnosis (P=0.021) were associated with an increased risk of Pavlik harness failure in the multivariate analysis. The changes in α and β angle and FHC were generally greater in the success group than in the failure group. The α angle and FHC were larger in the success group, while the β angle was larger in the failure group (P<0.05). Each ultrasound parameter (α and β angle and FHC) alone could not accurately predict the treatment outcome within 3 weeks. However, the combined ultrasonic features at the second week could accurately predict the outcome of Pavlik harness treatment after the third week. The combination of the ultrasound features at the first week and the influencing factors (Graf classification, age at diagnosis, and side of pathology) could accurately predict the outcome at the first week [area under curve (AUC) =0.931, sensitivity =82.14%, specificity =97.86%].
The combined model of ultrasonic features at the second week could accurately predict the reduction outcome of Pavlik harness after the third week. The combined model including independent predictors and ultrasonic features could accurately predict the reduction outcome at the first week.
发育性髋关节发育不良（DDH）患儿的治疗方案通常在 Pavlik 吊带治疗 3 周后通过评估髋关节复位情况进行调整。然而，治疗调整存在较高的失败风险和并发症风险。本研究的目的是探讨超声特征在预测 DDH 患儿 Pavlik 吊带治疗 3 周后治疗效果方面的价值。
共招募 215 例 DDH 患儿，记录其人口统计学资料以及 Pavlik 吊带治疗期间超声特征[α角、β角和股骨头覆盖率（FHC）]的变化。根据 3 周后的复位结果将患儿分为成功组和失败组。进行单因素和多因素分析以分析治疗效果的独立预测因素。采用重复测量方差分析比较两组治疗期间超声特征的变化。绘制受试者工作特征（ROC）曲线以分析超声特征的预测准确性。
多因素分析中，Graf III 型（P = 0.036）、双侧脱位（P = 0.031）和诊断时年龄（P = 0.021）与 Pavlik 吊带治疗失败风险增加相关。成功组α角、β角和 FHC 的变化通常大于失败组。成功组α角和 FHC 较大，而失败组β角较大（P < 0.05）。单独的每个超声参数（α角、β角和 FHC）均不能准确预测 3 周内的治疗效果。然而，第二周的联合超声特征能够准确预测第三周后 Pavlik 吊带治疗的结果。第一周的超声特征与影响因素（Graf 分类、诊断时年龄和病变侧别）的组合能够准确预测第一周的结果[曲线下面积（AUC）= 0.931，灵敏度 = 82.14%，特异度 = 97.86%]。
第二周的联合超声特征模型能够准确预测第三周后 Pavlik 吊带的复位结果。包括独立预测因素和超声特征的联合模型能够准确预测第一周的复位结果。
