Gharaibeh Ahmad, Sepitka Rastislav, Pobeha Jan, Schreierova Daniela, Habinakova Martina, Vasko Gabriel, Lacko Marek
Orthopaedic Surgeon, Teaching Department of Orthopaedics and Musculoskeletal Trauma, University of Pavol Jozef Šafárik, Kosice, Slovakia.
Orthopaedic Surgeon, Teaching Department of Orthopaedics and Musculoskeletal Trauma, Univerzitná Nemocnica Louisa Pasteura, Kosice, Slovakia.
Adv Orthop. 2022 May 29;2022:8688770. doi: 10.1155/2022/8688770. eCollection 2022.
Hilgenreiner brace (Hb) was developed to improve hip reduction rate and reduce the incidence of femoral head avascular necrosis (AVN). In children under the age of 18 months with unstable hip joints or a dislocated hip joint, the treatment method involves nonsurgical treatment in most cases.
To evaluate the effectiveness and safety of traction, closed reduction, and hip fixation in Hb in patients with severe forms of hip developmental dysplasia (DDH) in follow-up.
Prospective, clinical, cohort observation and retrospective matched-pair analysis. Analysis of medical records was conducted to evaluate the effectiveness of using Hb for treatment of dislocated hip joints in <18-month-old children. The investigated cases were of the dislocated hip joint since DDH was confirmed through clinical and imaging diagnosis and treated by the application of the close reduction method together with Hb, in a nonhuman position (hip joint in 90 degrees of flexion and 80 degrees of abduction). Analysis was carried out using the modified Berkeley's Mckay criteria and hip joint centralization, and evaluation was done using X-ray images according to the basic modified Severin classification system.
The use of Hb applied after overhead traction to (mean 22.8 days, confidence level (95%)) 68 hip joints showed a significant improvement (92%) in the treated hips. In summary, only one brace replacement was performed due to swelling of the thigh and fixation pressure, three cases suffered from hip joint redislocation after removing the Hb (5%), and one patient had bilateral avascular necrosis (2.8%).
The use of Hb reduced avascular necrosis of the femur head, maintained higher hygiene conditions, and lowered both the risk of cast breakage and skin complications over the use of hip spica as compared to Hb. Hb is more cost-effective, and radiolucency is an additional advantage for this technique. Closed reduction and application of Hb after oral administration of a bolus dose of chlorpromazine chloride or phenobarbital resulted in complication avoidance of total anaesthesia.
希尔根赖纳支具（Hb）旨在提高髋关节复位率并降低股骨头缺血性坏死（AVN）的发生率。对于18个月以下髋关节不稳定或髋关节脱位的儿童，大多数情况下治疗方法为非手术治疗。
在随访中评估牵引、闭合复位和使用Hb进行髋关节固定对重度髋关节发育不良（DDH）患者的有效性和安全性。
前瞻性临床队列观察及回顾性配对分析。通过分析病历评估使用Hb治疗18个月以下儿童髋关节脱位的有效性。研究病例为经临床和影像学诊断确诊为DDH且采用闭合复位法并结合Hb在非人体位（髋关节屈曲90度、外展80度）治疗的髋关节脱位病例。采用改良的伯克利麦凯标准和髋关节中心化进行分析，并根据基本改良的塞韦林分类系统使用X线图像进行评估。
对68个髋关节进行头顶牵引（平均22.8天，置信水平（95%））后使用Hb，治疗后的髋关节有显著改善（92%）。总之，因大腿肿胀和固定压力仅进行了1次支具更换，3例在去除Hb后出现髋关节再脱位（5%），1例患者发生双侧缺血性坏死（2.8%）。
与髋人字石膏相比，使用Hb可降低股骨头缺血性坏死，保持更高的卫生条件，并降低石膏断裂和皮肤并发症的风险。Hb更具成本效益，射线可透过性是该技术的另一个优势。口服大剂量氯丙嗪或苯巴比妥后进行闭合复位并应用Hb可避免全身麻醉的并发症。
