Medical Faculty, Department of Orthopaedics and Trauma Surgery, University of Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
Orthopaedicum Munich, Charles-de-Gaulle-Str. 4, 81737, Munich, Germany.
Arch Orthop Trauma Surg. 2023 Aug;143(8):4871-4878. doi: 10.1007/s00402-023-04807-z. Epub 2023 Feb 21.
The treatment of ultrasound unstable hips with the Tübingen splint is currently under discussion. However, there is a lack of long-term follow-up data. This study presents to the best of our knowledge first radiological mid-term to long-term data of the successful initial treatment with the Tübingen splint of ultrasound unstable hips.
From 2002 to 2022 the treatment of ultrasound unstable hips type D, III and IV (age ≤ 6 weeks, no severe limitation of abduction) with the Tübingen splint worn as a plaster is evaluated. Based on data derived from routine X-rays during the follow-up period, a radiological follow-up (FU) analysis until the age of 12 years was performed. The acetabular index (ACI) and center-edge angle (CEA) were measured and classified according to Tönnis as normal findings (NF), slightly (sliD) or severely dysplastic (sevD).
193 of 201 (95.5%) unstable hips could be successfully treated showing normal findings with an alpha angle > 65°. The few patients showing treatment failures were successfully treated applying a Fettweis plaster (human position) under anesthesia. The radiological FU of 38 hips showed a favorable trend with increase of normal findings from 52.8% to 81.1% and decrease of 38.9% to 19.9% of sliD respectively 8.3% to 0% of sevD hips. The analysis of avascular necrosis of the femoral head showed 2 cases (5.3%) of grade 1 according to Kalamchi and McEwen, which were improving over time in the further course.
The Tübingen splint as alternative to replace a plaster has proven a successful therapeutic option for ultrasound unstable hips type D, III and IV with favorable and over time improving radiological parameter up to the age of 12 years.
目前，对于超声不稳定型髋关节，Tübingen 夹板的治疗方法存在争议。然而，缺乏长期随访数据。本研究首次提供了我们所知的最佳的、关于超声不稳定型髋关节经 Tübingen 夹板初始治疗的放射学中期至长期数据。
从 2002 年至 2022 年，我们对超声不稳定型髋关节 D、III 和 IV 型（年龄≤6 周，外展无严重受限）采用 Tübingen 夹板（石膏型）进行治疗。根据随访期间的常规 X 射线数据，进行放射学随访（FU）分析，直至 12 岁。测量髋臼指数（ACI）和中心边缘角（CEA），并根据 Tönnis 进行分类，分为正常发现（NF）、轻度（sliD）或重度发育不良（sevD）。
201 例不稳定型髋关节中，193 例（95.5%）治疗成功，表现为正常发现，阿尔法角>65°。少数治疗失败的患者，在全身麻醉下应用 Fettweis 石膏（仰卧位）成功治疗。38 髋的放射学 FU 显示出良好的趋势，正常发现的比例从 52.8%增加到 81.1%，轻度发育不良的比例从 38.9%减少到 19.9%，而重度发育不良的比例从 8.3%减少到 0%。股骨头缺血性坏死的分析显示，2 例（5.3%）为 Kalamchi 和 McEwen 分级 1，在随后的病程中逐渐改善。
与石膏替代相比，Tübingen 夹板已被证明是超声不稳定型髋关节 D、III 和 IV 型的成功治疗选择，放射学参数在 12 岁前具有良好的改善趋势。
