Bradley Catharine S, Verma Yashvi, Maddock Connor L, Wedge John H, Gargan Martin F, Kelley Simon P
Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada.
Department of Surgery, University of Toronto, Toronto, Canada.
Bone Joint J. 2023 Aug 1;105-B(8):935-942. doi: 10.1302/0301-620X.105B8.BJJ-2023-0149.R1.
Brace treatment is the cornerstone of managing developmental dysplasia of the hip (DDH), yet there is a lack of evidence-based treatment protocols, which results in wide variations in practice. To resolve this, we have developed a comprehensive nonoperative treatment protocol conforming to published consensus principles, with well-defined a priori criteria for inclusion and successful treatment.
This was a single-centre, prospective, longitudinal cohort study of a consecutive series of infants with ultrasound-confirmed DDH who underwent a comprehensive nonoperative brace management protocol in a unified multidisciplinary clinic between January 2012 and December 2016 with five-year follow-up radiographs. The radiological outcomes were acetabular index-lateral edge (AI-L), acetabular index-sourcil (AI-S), centre-edge angle (CEA), acetabular depth ratio (ADR), International Hip Dysplasia Institute (IHDI) grade, and evidence of avascular necrosis (AVN). At five years, each hip was classified as normal (< 1 SD), borderline dysplastic (1 to 2 SDs), or dysplastic (> 2 SDs) based on validated radiological norm-referenced values.
Of 993 infants assessed clinically and sonographically, 21% (212 infants, 354 abnormal hips) had DDH and were included. Of these, 95% (202 infants, 335 hips) successfully completed bracing, and 5% (ten infants, 19 hips) failed bracing due to irreducible hip(s). The success rate of bracing for unilateral dislocations was 88% (45/51 infants) and for bilateral dislocations 83% (20/24 infants). The femoral nerve palsy rate was 1% (2/212 infants). At five-year follow-up (mean 63 months (SD 5.9; 49 to 83)) the prevalence of residual dysplasia after successful brace treatment was 1.6% (5/312 hips). All hips were IHDI grade I and none had AVN. Four children (4/186; 2%) subsequently underwent surgery for residual dysplasia.
Our comprehensive protocol for nonoperative treatment of infant DDH has shown high rates of success and extremely low rates of residual dysplasia at a mean age of five years.
支具治疗是发育性髋关节发育不良（DDH）治疗的基石，但缺乏循证治疗方案，导致实际治疗差异很大。为解决这一问题，我们制定了一项全面的非手术治疗方案，该方案符合已发表的共识原则，具有明确的纳入和成功治疗的先验标准。
这是一项单中心、前瞻性、纵向队列研究，对一系列经超声确诊为DDH的婴儿进行研究。这些婴儿于2012年1月至2016年12月在一家统一的多学科诊所接受了全面的非手术支具治疗方案，并进行了五年随访X光片检查。放射学结果包括髋臼指数-外侧边缘（AI-L）、髋臼指数-眉弓（AI-S）、中心边缘角（CEA）、髋臼深度比（ADR）、国际髋关节发育不良协会（IHDI）分级以及股骨头缺血性坏死（AVN）的证据。在五年时，根据经过验证的放射学标准参考值，将每个髋关节分为正常（<1个标准差）、临界发育不良（1至2个标准差）或发育不良（>2个标准差）。
在993例接受临床和超声评估的婴儿中，21%（212例婴儿，354个异常髋关节）患有DDH并被纳入研究。其中，95%（202例婴儿，335个髋关节）成功完成支具治疗，5%（10例婴儿，19个髋关节）因髋关节不可复位而支具治疗失败。单侧脱位支具治疗成功率为88%（45/51例婴儿），双侧脱位为83%（20/24例婴儿）。股神经麻痹发生率为1%（2/212例婴儿）。在五年随访时（平均63个月（标准差5.9；49至83））成功支具治疗后残留发育不良的患病率为1.6%（5/312个髋关节）。所有髋关节均为IHDI I级，无AVN。4名儿童（4/186；2%）随后因残留发育不良接受了手术。
我们针对婴儿DDH的全面非手术治疗方案显示出高成功率，且在平均五岁时残留发育不良率极低。
