Vaidya Sandeep, Aroojis Alaric, Mehta Rujuta
Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Mumbai, 40012 Maharashtra India.
Indian J Orthop. 2021 Sep 25;55(6):1410-1416. doi: 10.1007/s43465-021-00513-3. eCollection 2021 Dec.
Traditional swaddling, which implies restrictive immobilisation of the infant's lower limbs with the hips in forced extension and adduction, has been shown to be a risk factor for Developmental Dysplasia of Hip (DDH).
We reviewed the literature regarding the correlation between DDH and post-natal positioning by swaddling and baby-wearing, to draw awareness of healthcare professionals towards an important risk factor for DDH that has often been overlooked.
There is overwhelming evidence in the literature by both experimental and clinical studies, that proves the close association between improper post-natal positioning of the baby's hips in extension-adduction and an increased incidence of DDH. On the other hand, "hip safe" swaddling which allows unrestricted flexion-abduction movements of the infants' hips, and the use of baby-wearing devices which keep the lower limbs in an attitude of hip flexion-abduction and knee flexion, is optimal for hip development. Populations which practice these "hip-safe" techniques of infant immobilisation have a lower incidence of DDH as compared to those which practice restrictive immobilisation. Furthermore, populations which have adopted "hip-safe" positioning have demonstrated a significant decrease in the incidence of DDH. Understanding this association is vital, since this is a modifiable risk factor, rectification of which can decrease the incidence of DDH.
Policy makers and governments must design educational campaigns tailored to their respective populations to increase awareness regarding the benefits of "hip-safe" techniques of infant positioning, since this simple intervention has the potential of decreasing the incidence of DDH.
传统襁褓包裹法，即意味着对婴儿下肢进行限制性固定，使髋关节处于强迫伸展和内收状态，已被证明是髋关节发育不良（DDH）的一个危险因素。
我们回顾了关于DDH与通过襁褓包裹和使用婴儿背带进行产后体位摆放之间相关性的文献，以提高医疗保健专业人员对这一经常被忽视的DDH重要危险因素的认识。
文献中的实验和临床研究都有压倒性的证据，证明婴儿髋关节伸展 - 内收的不当产后体位与DDH发病率增加之间存在密切关联。另一方面，允许婴儿髋关节进行无限制屈伸 - 外展运动的“髋关节安全”襁褓包裹法，以及使用能使下肢保持髋关节屈伸 - 外展和膝关节屈曲姿势的婴儿背带，对髋关节发育最为有利。与采用限制性固定方法的人群相比，采用这些“髋关节安全”婴儿固定技术的人群DDH发病率较低。此外，采用“髋关节安全”体位的人群DDH发病率已显著下降。了解这种关联至关重要，因为这是一个可改变的危险因素，纠正这一因素可降低DDH的发病率。
政策制定者和政府必须针对各自的人群设计教育活动，以提高对“髋关节安全”婴儿体位摆放技术益处的认识，因为这种简单的干预措施有可能降低DDH的发病率。
