帕夫利克吊带治疗失败对发育性髋关节发育不良闭合或切开复位术后结局的影响。
Impact of Failed Pavlik Harness Treatment on the Outcomes Following Closed or Open Reduction in Developmental Dysplasia of the Hip.
作者信息
Liu Yong, Kan Lisheng, Sun Jun, Zhang Yapeng
机构信息
Department of Pediatric Orthopedic, The Affiliated Provincial Pediatric Hospital of Anhui Medical University, No 39, Wangjiang Road, Hefei City, China.
No 91126 Military Hospital of Chinese PLA, No 116, Youyi Road, Lvshunkou District, Dalian City, China.
出版信息
Indian J Orthop. 2022 Jun 25;56(9):1634-1639. doi: 10.1007/s43465-022-00680-x. eCollection 2022 Sep.
PURPOSE
To investigate the impact of failed Pavlik harness (PH) treatment on the outcomes following closed reduction (CR) or open reduction (OR) in developmental dysplasia of the hip (DDH).
METHODS
Ninety-three DDH patients treated with CR or OR were enrolled. One group of which received previous PH treatment (F group) and the other (L group) not. The clinical outcomes were evaluated according to McKay's criteria. Radiographs were evaluated for acetabular index (AI) and the degree of dislocation of the hips.
RESULTS
A higher rate of CR was found in F group ( = 0.034). Before CR/OR, the mean AI in F group was significantly lower than that in L group ( = 0.000), while at the last follow-up, the AIs in both groups were all improved. In F group, there were 7 (16.67%), 18 (42.86%) and 17 (40.48%) hips were classified as Graf type II, III and IV pathologic changes, respectively, when PH treatment started, while the corresponding data were 17 (40.48%), 17 (40.48%) and 8 (19.05%) after PH treatment ( = 0.024). At the last follow-up, no significant difference was found concerning the complications between the two groups ( > 0.05).
CONCLUSIONS
PH treatment, even if failed, may have the ability of accelerating the development of the acetabulum and increasing the rate of successful CR. Thus we advocate a trial of PH treatment for all DDH patients less than 6 months of age. Meanwhile, a close monitoring by dynamic ultrasonography is required due to the risk of AVN.
目的
探讨 Pavlik 吊带（PH）治疗失败对发育性髋关节发育不良（DDH）闭合复位（CR）或切开复位（OR）后疗效的影响。
方法
纳入 93 例接受 CR 或 OR 治疗的 DDH 患者。其中一组曾接受过 PH 治疗（F 组），另一组未接受过（L 组）。根据 McKay 标准评估临床疗效。通过 X 线片评估髋臼指数（AI）和髋关节脱位程度。
结果
F 组 CR 率更高（=0.034）。在 CR/OR 之前，F 组的平均 AI 显著低于 L 组（=0.000），而在末次随访时，两组的 AI 均有所改善。在 F 组，开始 PH 治疗时，分别有 7 例（16.67%）、18 例（42.86%）和 17 例（40.48%）髋关节被分类为 Graf II 型、III 型和 IV 型病理改变，而 PH 治疗后相应数据分别为 17 例（40.48%）、17 例（40.48%）和 8 例（19.05%）（=0.024）。在末次随访时，两组之间的并发症无显著差异（>0.05）。
结论
PH 治疗即使失败，但可能具有促进髋臼发育和提高 CR 成功率的能力。因此，我们提倡对所有 6 个月以下 DDH 患者进行 PH 治疗试验。同时由于存在股骨头缺血坏死（AVN）风险，需要通过动态超声进行密切监测。
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