Department of Orthopaedic Surgery and Trauma, Máxima MC, Veldhoven.
Department of Orthopaedic Surgery, Catharina Hospital, Eindhoven.
J Pediatr Orthop. 2021 Apr 1;41(4):203-208. doi: 10.1097/BPO.0000000000001766.
Worldwide a wide variation exists in duration of Pavlik harness treatment for infants up to 6 months with stable developmental dysplasia of the hip (DDH). The purpose of this study was to evaluate whether shortening the time to first routine follow-up ultrasound after initiation of Pavlik harness treatment would reduce treatment duration and whether this influenced radiologic outcome at 1 year of age. Furthermore, predictors of higher acetabular index (AI) at 1 year of age were investigated.
A retrospective study was conducted in infants with stable DDH (Graf IIb and IIc) diagnosed and treated between 2015 and 2017. Two groups were identified: first routine follow-up ultrasound at 12 weeks after Pavlik harness initiation (group I) and first routine follow-up ultrasound at 6 weeks after Pavlik harness initiation (group II). In both groups, treatment was continued until repeat ultrasound measurements (every 6 wk) showed a normalized hip. Radiologic outcome at 1 year of age was defined as residual dysplasia measured on an anteroposterior hip radiograph according to the Tönnis table.
A total of 222 infants were included. The median time of Pavlik harness treatment was 12 weeks (interquartile range, 11.9 to 12.3) in group I compared with 6.1 weeks (interquartile range, 6.0 to 7.5) in group II (P<0.001). Residual dysplasia at 1 year of age was detected in 20 infants (16.8%) in group I compared with 11 infants (10.7%) in group II (P=0.189). The multivariable prediction model showed that positive family history and lower baseline alpha angle correlate with a higher AI at 1 year of age.
First routine follow-up ultrasound can be safely brought forward from 12 to 6 weeks after Pavlik harness initiation. Furthermore, infants with a positive family history for DDH and an initial low alpha angle are at higher risk to have a higher AI at 1 year of age.
Level III-retrospective study.
全世界范围内，对于 6 个月以下发育性髋关节发育不良（DDH）婴儿的 Pavlik 吊带治疗持续时间存在很大差异。本研究旨在评估在开始 Pavlik 吊带治疗后，将首次常规随访超声检查的时间缩短是否会缩短治疗时间，以及这是否会影响 1 岁时的放射学结果。此外，还研究了 1 岁时髋臼指数（AI）较高的预测因素。
回顾性研究纳入了 2015 年至 2017 年间诊断和治疗的稳定型 DDH（Graf IIb 和 IIc）婴儿。将患儿分为两组：Pavlik 吊带治疗开始后 12 周行首次常规随访超声检查（I 组）和 Pavlik 吊带治疗开始后 6 周行首次常规随访超声检查（II 组）。两组患儿均持续治疗，直至重复超声测量（每 6 周）显示髋关节正常。1 岁时的放射学结果定义为根据 Tönnis 表在前后位髋关节 X 线片上测量的残余发育不良。
共纳入 222 例婴儿。I 组 Pavlik 吊带治疗的中位数时间为 12 周（四分位距，11.9 至 12.3），II 组为 6.1 周（四分位距，6.0 至 7.5）（P<0.001）。I 组有 20 例（16.8%）患儿在 1 岁时发现残余发育不良，II 组有 11 例（10.7%）（P=0.189）。多变量预测模型显示，阳性家族史和较低的基线α角与 1 岁时 AI 较高相关。
在 Pavlik 吊带治疗开始后，首次常规随访超声检查可以安全地提前至 12 周后 6 周进行。此外，DDH 家族史阳性和初始α角较低的婴儿，1 岁时 AI 较高的风险较高。
III 级-回顾性研究。
