髋臼盂唇反折预测发育性髋关节发育不良儿童使用吊带治疗失败。

An Inverted Acetabular Labrum Is Predictive of Pavlik Harness Treatment Failure in Children With Developmental Hip Dysplasia.

机构信息

Children's Orthopaedic Center.

Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA.

出版信息

J Pediatr Orthop. 2021 Sep 1;41(8):479-482. doi: 10.1097/BPO.0000000000001916.

DOI:10.1097/BPO.0000000000001916

PMID:34267151

Abstract

INTRODUCTION

The failure rate of Pavlik harness treatment for developmental dysplasia of the hip (DDH) has been reported as high as 55%. The purpose of this study is to investigate the effect of an inverted acetabular labrum on outcomes of Pavlik harness treatment for DDH.

METHODS

A retrospective review was conducted on DDH patients at a tertiary care pediatric hospital from 2004 to 2016. DDH patients that underwent index treatment with Pavlik harness and had minimum 12 months follow-up were included. Medical charts were reviewed for demographics, treatment, and outcomes. Outcomes were compared between patients with an inverted labrum versus those without an inverted labrum.

RESULTS

A total of 156 patients with 229 dysplastic hips were included. The mean age at initiation of Pavlik harness treatment was 1.9±1.4 months and mean follow-up was 37.7±23.0 months. Bilateral DDH was diagnosed in 46% (73/156) of patients. In all, 37% (75/229) of hips failed Pavlik harness index treatment. Second-line treatment was rigid hip abduction bracing in 91% (68/75) of hips, closed reduction in 5% (4/75) of hips, and open reduction in 4% (3/75) of hips. An inverted labrum was present in 10% (22/229) of all hips. The incidence of Pavlik harness treatment failure was 91% (20/22) in the inverted labrum group compared with 27% (55/207) in the control group (P<0.001). Closed or open reduction was required in 86% (15/22) of the inverted labrum group compared with 3% (7/207) of hips in the control group (P<0.001). The incidence of avascular necrosis was 18% (4/22) in hips with an inverted labrum compared with 0.4% (1/207) in the control group (P<0.001).

CONCLUSIONS

In children with DDH undergoing index treatment in a Pavlik harness, the presence of an inverted acetabular labrum is strongly predictive of treatment failure. Dysplastic hips with an inverted labrum also have a significantly higher risk of requiring closed or open reduction and developing avascular necrosis compared with those without an inverted labrum.

LEVEL OF EVIDENCE

Level III.

摘要

介绍

发育性髋关节发育不良（DDH）的 Pavlik 吊带治疗失败率高达 55%。本研究旨在探讨髋臼盂唇倒置对 Pavlik 吊带治疗 DDH 结局的影响。

方法

对 2004 年至 2016 年在一家三级儿童保健医院接受治疗的 DDH 患者进行回顾性研究。纳入接受 Pavlik 吊带指数治疗且随访时间至少 12 个月的 DDH 患者。对病历进行回顾，以获取人口统计学、治疗和结局等信息。比较有髋臼盂唇倒置和无髋臼盂唇倒置的患者之间的结局。

结果

共纳入 156 例 229 髋发育不良的患者。Pavlik 吊带治疗起始时的平均年龄为 1.9±1.4 个月，平均随访 37.7±23.0 个月。46%（73/156）的患者为双侧 DDH。229 髋中，37%（75/229）的髋关节 Pavlik 吊带指数治疗失败。91%（68/75）的髋关节采用刚性髋关节外展支具进行二线治疗，5%（4/75）的髋关节行闭合复位，4%（3/75）的髋关节行切开复位。所有髋关节中，髋臼盂唇倒置的发生率为 10%（22/229）。髋臼盂唇倒置组 Pavlik 吊带治疗失败率为 91%（20/22），对照组为 27%（55/207）（P<0.001）。髋臼盂唇倒置组中，86%（15/22）的髋关节需要闭合或切开复位，而对照组中仅有 3%（7/207）（P<0.001）。髋臼盂唇倒置组中发生缺血性坏死的比例为 18%（4/22），而对照组为 0.4%（1/207）（P<0.001）。