特贝丁根髋关节弯曲夹板比帕夫利克吊带在三个月大后治疗髋关节偏心更有效。
Tübingen hip flexion splint more successful than Pavlik harness for decentred hips after the age of three months.
机构信息
Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China.
Ultrasound Department, Beijing Jishuitan Hospital, Beijing, China.
出版信息
Bone Joint J. 2021 May;103-B(5):991-998. doi: 10.1302/0301-620X.103B5.BJJ-2020-1946.R1.
AIMS
The objective of this study was to evaluate the clinical and radiological outcomes of patients younger than six months of age with developmental dysplasia of the hip (DDH) managed by either a Pavlik harness or Tübingen hip flexion splint.
METHODS
Records of 251 consecutive infants with a mean age of 89 days (SD 47), diagnosed with DDH between January 2015 and December 2018, were retrospectively reviewed. Inclusion criteria for patients with DDH were: younger than 180 days at the time of diagnosis; ultrasound Graf classification of IIc or greater; treatment by Pavlik harness or Tübingen splint; and no prior treatment history. All patients underwent hip ultrasound every seven days during the first three weeks of treatment and subsequently every three to four weeks until completion of treatment. If no signs of improvement were found after three weeks, the Pavlik harness or Tübingen splint was discontinued. Statistical analysis was performed.
RESULTS
The study included 251 patients with Graf grades IIc to IV in 18 males and 233 females with DDH. Mean follow-up time was 22 months (SD 10). A total of 116 hips were graded as Graf IIc (39.1%), nine as grade D (3.0%), 100 as grade III (33.7%), and 72 as grade IV (24.2%). There were 109 patients (128 hips) in the Pavlik group and 142 patients (169 hips) in the Tübingen group (p = 0.227). The Tübingen group showed a 69.8% success rate in Graf III and Graf IV hips while the success rate was significantly lower in the Pavlik group, 53.9% (p = 0.033). For infants older than three months of age, the Tübingen group showed a 71.4% success rate, and the Pavlik group a 54.4% success rate (p = 0.047).
CONCLUSION
The Tübingen splint should be the preferred treatment option for children older than three months, and for those with severe forms of DDH such as Graf grade III and IV, who are younger than six months at time of diagnosis. The Tübingen hip flexion splint is a valid alternative to the Pavlik harness for older infants and those with more severe DDH. Cite this article: 2021;103-B(5):991-998.
目的
本研究旨在评估 6 个月以下发育性髋关节发育不良（DDH）患儿接受帕夫利克吊带或图宾根髋关节弯曲夹板治疗的临床和影像学结果。
方法
回顾性分析了 2015 年 1 月至 2018 年 12 月期间诊断为 DDH 的 251 例连续婴儿的记录，这些婴儿的平均年龄为 89 天（标准差 47）。DDH 患者的纳入标准为：诊断时年龄小于 180 天；超声 Graf 分类 IIc 或更高；接受帕夫利克吊带或图宾根夹板治疗；无既往治疗史。所有患者在治疗的前 3 周内每 7 天进行一次髋关节超声检查，随后每 3-4 周检查一次，直到治疗结束。如果 3 周后没有发现改善迹象，就停止使用帕夫利克吊带或图宾根夹板。进行了统计学分析。
结果
本研究纳入了 18 名男性和 233 名女性共 251 例 DDH 患儿，Graf 分级为 IIc-IV。平均随访时间为 22 个月（标准差 10）。116 髋为 Graf IIc（39.1%），9 髋为 D 型（3.0%），100 髋为 III 型（33.7%），72 髋为 IV 型（24.2%）。帕夫利克组 109 例（128 髋），图宾根组 142 例（169 髋）（p=0.227）。图宾根组 Graf III 和 Graf IV 髋关节的成功率为 69.8%，而帕夫利克组的成功率明显较低，为 53.9%（p=0.033）。对于 3 个月以上的婴儿，图宾根组的成功率为 71.4%，而帕夫利克组为 54.4%（p=0.047）。
结论
对于 3 个月以上的儿童，以及诊断时年龄小于 6 个月且髋关节发育不良程度较重（如 Graf 分级 III 和 IV）的儿童，图宾根支具应作为首选治疗方法。对于较大的婴儿和髋关节发育不良程度较重的婴儿，图宾根髋关节弯曲夹板是帕夫利克吊带的有效替代方法。
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