主动监测与立即外展治疗稳定型发育性髋关节发育不良：文献系统评价。
Active monitoring versus immediate abduction as treatment of stable developmental dysplasia of the hip: a systematic review of the literature.
机构信息
Department of Orthopaedic Surgery, Maastricht University, Maastricht, The Netherlands
Department of Orthopaedic Surgery, Maastricht University, Maastricht, The Netherlands.
出版信息
BMJ Open. 2022 Sep 19;12(9):e057906. doi: 10.1136/bmjopen-2021-057906.
OBJECTIVES
This systematic review aims to compare the effects of active monitoring and abduction treatment on the Graf alpha angle, Acetabular Index (AI) and femoral head coverage in infants with stable developmental dysplasia of the hip (DDH).
DESIGN
Systematic review reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
DATA SOURCES
A search of the PubMed, Embase, Cochrane and Web of Science databases was performed in January 2020 and updated in January 2021.
ELIGIBILITY CRITERIA
(Non-)randomised studies comparing active monitoring with abduction treatment in infants younger than 4 months with stable DDH were included.
DATA EXTRACTION AND SYNTHESIS
All eligible articles were methodologically assessed using the Cochrane risk of bias tools. Data were extracted by summarising the study characteristics and results.
RESULTS
Of the six included studies, two randomised studies were of low risk and two of some concerns. Two non-randomised studies were of serious risk. In total, 544 dysplastic hips (439 infants) were investigated, of which 307 were observed and 237 were treated. Two studies reported a faster improvement of the alpha angle and average acetabular coverage in treated hips at 3 months. No differences in AI between the treatment and observation group after 3 months were reported. In total, 38 infants (12%) in the observation group switched to the treatment group. At the final radiograph, 21 observed hips and 32 treated hips were dysplastic.
CONCLUSIONS
There were no differences in AI between the treatment and observation group after 3 months in infants up to 4 months of age with stable DDH hips. The switch of 38 infants (12%) from the observation to the treatment group corroborates that not all infantile DDH hips will spontaneously progress into normal hips. The small study population sizes and methodological heterogeneity warrant a large randomised controlled trial to study this research question.
PROSPERO REGISTRATION NUMBER
CRD4202123300.
目的
本系统评价旨在比较主动监测与外展治疗对稳定型发育性髋关节发育不良（DDH）婴儿 Graf 角、髋臼指数（AI）和股骨头覆盖的影响。
设计
按系统评价和荟萃分析的 Preferred Reporting Items 报告系统综述。
数据来源
2020 年 1 月对 PubMed、Embase、Cochrane 和 Web of Science 数据库进行检索，并于 2021 年 1 月进行了更新。
入选标准
纳入比较小于 4 个月龄且稳定的 DDH 婴儿的主动监测与外展治疗的非随机研究。
数据提取与综合
使用 Cochrane 偏倚风险工具对所有合格文章进行方法学评估。通过总结研究特征和结果提取数据。
结果
6 项纳入研究中，2 项随机研究为低风险，2 项为部分关注风险，2 项非随机研究为严重风险。共纳入 544 个髋关节（439 例婴儿），其中 307 例观察，237 例治疗。有 2 项研究报告治疗组髋关节的 alpha 角和平均髋臼覆盖在 3 个月时更快改善。3 个月后，治疗组与观察组的 AI 无差异。观察组共有 38 例（12%）婴儿转为治疗组。最终 X 线片显示，观察组有 21 个髋关节和治疗组有 32 个髋关节发育不良。
结论
对于 4 个月龄以内且稳定的 DDH 婴儿，3 个月后治疗组与观察组的 AI 无差异。38 例（12%）婴儿从观察组转为治疗组，这表明并非所有婴儿 DDH 髋关节都会自然进展为正常髋关节。小样本量和方法学异质性需要进行大规模的随机对照试验来研究这个问题。
PROSPERO 注册号：CRD4202123300。
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