Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Orthopedic Surgery, NYU Langone Health Orthopedic Hospital, New York, NY.
J Pediatr Orthop. 2021 Mar 1;41(3):143-148. doi: 10.1097/BPO.0000000000001753.
Following successful treatment of developmental hip dysplasia with a Pavlik harness, controversy exists over the benefit of continued harness use for an additional "weaning" period beyond ultrasonographic normalization versus simply terminating treatment. Although practitioners are often dogmatic in their beliefs, there is little literature to support the superiority of 1 protocol over the other. The purpose of this study was to compare the radiographic outcomes of 2 cohorts of infants with developmental hip dysplasia treated with Pavlik harness, 1 with a weaning protocol and 1 without.
This was a comparative review of patients with dislocated/reducible hips and stable dysplasia from 2 centers. All patients had pretreatment ultrasounds, and all started harness treatment before 3 months of age. On the basis of power analysis, a sufficient cohort of hips were matched based on clinical examination, age at initiation, initial α angle, and initial percent femoral head coverage. Patients from institution W (weaned) were weaned following ultrasonographic normalization, whereas those from institution NW (not weaned) immediately ceased treatment. The primary outcome was the acetabular index at 1 year of age.
In total, 16 dislocated/reducible and 16 stable dysplastic hips were matched at each center (64 total hips in 53 patients). Initial α angle and initial femoral head coverage were not different between cohorts for either stable dysplasia (P=0.59, 0.81) or dislocated/reducible hips (P=0.67, 0.70), respectively. As expected, weaned hips were treated for significantly longer in both the stable dysplasia (1540.4 vs. 1066.3 h, P<0.01), and dislocated/reducible cohorts (1596.6 vs. 1362.5 h, P=0.01). Despite this, we found no significant difference in the acetabular index at 1 year in either cohort (22.8 vs. 23.1 degrees, P=0.84 for stable dysplasia; 23.9 vs. 24.8 degrees, P=0.32 for Ortolani positive).
Despite greater total harness time, infants treated with additional Pavlik weaning did not demonstrate significantly different radiographic results at 1 year of age compared with those who were not weaned. However, differences in follow-up protocols between centers support the need for a more rigorous randomized controlled trial.
Level III.
经过 Pavlik 吊带成功治疗发育性髋关节发育不良后，对于在超声正常化后是否继续使用吊带进行额外的“断奶”期，还是简单地终止治疗，存在争议。尽管从业者在他们的信念上往往是教条主义的，但很少有文献支持一种方案优于另一种方案。本研究的目的是比较两组接受 Pavlik 吊带治疗的发育性髋关节发育不良婴儿的影像学结果，一组有断奶方案，一组没有。
这是对来自两个中心的脱位/可复位髋关节和稳定型发育不良的患者进行的比较性回顾。所有患者均有术前超声检查，所有患者均在 3 个月龄前开始吊带治疗。根据功效分析，根据临床检查、开始年龄、初始α角和初始股骨头覆盖率，对足够数量的髋关节进行匹配。来自机构 W（断奶）的患者在超声正常化后进行断奶，而来自机构 NW（未断奶）的患者立即停止治疗。主要结果是 1 岁时的髋臼指数。
在每个中心，16 个脱位/可复位和 16 个稳定发育不良髋关节被匹配（53 名患者共 64 个髋关节）。对于稳定型发育不良（P=0.59，0.81）或脱位/可复位髋关节（P=0.67，0.70），稳定型发育不良和脱位/可复位髋关节的初始α角和初始股骨头覆盖率在两组之间均无差异。正如预期的那样，在稳定型发育不良（1540.4 小时对 1066.3 小时，P<0.01）和脱位/可复位组（1596.6 小时对 1362.5 小时，P=0.01），断奶的髋关节接受治疗的时间明显更长。尽管如此，我们发现两组的髋臼指数在 1 年时均无显著差异（22.8 度对 23.1 度，P=0.84 用于稳定型发育不良；23.9 度对 24.8 度，P=0.32 用于 Ortolani 阳性）。
尽管使用 Pavlik 吊带的总时间更长，但接受额外的 Pavlik 断奶治疗的婴儿在 1 岁时的影像学结果与未断奶的婴儿相比，没有显著差异。然而，由于中心之间的随访方案存在差异，因此需要进行更严格的随机对照试验。
3 级。
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