稳定型发育性髋关节发育不良的超声复查时间。
Timing of Repeat Ultrasound Examination in Treatment of Stable Developmental Dysplasia of the Hip.
机构信息
Department of Orthopaedic Surgery and Trauma, Máxima MC, Veldhoven.
Department of Orthopaedic Surgery, Catharina Hospital, Eindhoven.
出版信息
J Pediatr Orthop. 2021 Apr 1;41(4):203-208. doi: 10.1097/BPO.0000000000001766.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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 OF EVIDENCE
Level III-retrospective study.
背景
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。
方法
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。
结果
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。
结论
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。
证据等级
III 级-回顾性研究。
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