Ghanem Ismat, Karam Geoffrey, Ghanem Diane, Saliba Ibrahim
Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
J Child Orthop. 2023 May 9;17(3):205-211. doi: 10.1177/18632521231172986. eCollection 2023 Jun.
The aim of this study was to report the incidence of femoral nerve palsy in developmental dysplasia of the hip children treated with Pavlik harness, to identify any possible associated risk factors, and to evaluate its outcome without any specific strap release.
A retrospective chart review was conducted on all cases of femoral nerve palsy in a consecutive series of children who underwent Pavlik harness treatment for developmental dysplasia of the hip. In unilateral cases, the developmental dysplasia of the hip was compared to the contralateral side. All hips with femoral nerve palsy were compared to the remaining hips of the series and any possible risk factor for paralysis was recorded.
In total, 53 cases of femoral nerve palsy of various severity were identified from a group of 473 children with 527 hips treated for developmental dysplasia of the hip at an average age of 3.9 months. However, 93% occurred during the first 2 weeks of treatment. Femoral nerve palsy was more common in older and larger children with the most severe Tonnis type, and a hip flexion angle in the harness above 90° (p < 0.03 for all). All of them resolved spontaneously before completion of treatment without any specific measures. We found no correlation between the presence of femoral nerve palsy or the time taken for spontaneous resolution and treatment failure using the harness.
Femoral nerve palsy is most observed with higher Tonnis types and high hip flexion angles in the harness, but its presence by itself is not predictive of treatment failure. It resolves spontaneously before completion of treatment and does not require any strap release or harness discontinuation.
Level III.
本研究旨在报告使用 Pavlik 吊带治疗的发育性髋关节发育不良患儿股神经麻痹的发生率，确定任何可能的相关危险因素，并评估在不进行任何特定吊带松解的情况下其预后。
对一系列连续接受 Pavlik 吊带治疗发育性髋关节发育不良的患儿中所有股神经麻痹病例进行回顾性病历审查。在单侧病例中，将患侧髋关节发育不良与对侧进行比较。将所有发生股神经麻痹的髋关节与该系列中的其余髋关节进行比较，并记录任何可能的麻痹危险因素。
在平均年龄为 3.9 个月的 473 名接受发育性髋关节发育不良治疗的 527 个髋关节患儿中，共识别出 53 例不同严重程度的股神经麻痹病例。然而，93%发生在治疗的前 2 周内。股神经麻痹在年龄较大、体型较大且 Tonnis 类型最严重的患儿中更常见，吊带中的髋关节屈曲角度大于 90°（所有 p < 0.03）。所有病例均在治疗完成前自发缓解，无需任何特殊措施。我们发现股神经麻痹的存在或自发缓解所需时间与使用吊带治疗失败之间没有相关性。
股神经麻痹在较高的 Tonnis 类型和吊带中较高的髋关节屈曲角度时最常观察到，但其本身的存在并不能预测治疗失败。它在治疗完成前自发缓解，不需要任何吊带松解或停止使用吊带。
三级。
