小莫雷尔法、过头牵引法与晚期发现的发育性髋关节发育不良即时闭合复位法的长期比较结果：一项系统评价
Comparative long-term outcomes of Petit-Morel versus overhead traction methods versus immediate closed reduction for late-detected developmental dysplasia of the hip: A systematic review.
作者信息
Duan Lian, Canavese Federico, Zhou Weizheng, Chen Yufan, Li Lianyong
机构信息
Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Lille, France.
出版信息
J Child Orthop. 2024 Nov 8;18(6):590-599. doi: 10.1177/18632521241265603. eCollection 2024 Dec.
PURPOSE
This study aimed to compare the clinical and radiographic outcomes of traction to assist reduction in patients with late-detected developmental dislocation of the hip using the Petit-Morel technique versus the Bryant overhead traction technique, and to compare the clinical and radiographic outcomes of these two traction techniques with immediate closed reduction.
METHODS
A comprehensive systematic search of the MEDLINE/PubMed, EMBASE, and Web of Science databases was performed to identify relevant studies. Studies on Petit-Morel and overhead traction techniques and immediate closed reduction were then screened, selected, and data collected; included studies were assessed using the Methodological Index for Non-Randomized Studies criteria.
RESULTS
In total, 22 studies met the inclusion criteria. The Petit-Morel group had a successful reduction rate of 87% while the overhead traction group had a successful reduction rate of 67.1%, and the immediate closed reduction group had a successful reduction rate of 78.4% (Petit-Morel versus overhead traction, p < 0.001; overhead traction versus immediate closed reduction, p < 0.001, Petit-Morel versus immediate closed reduction, p = 0.021). The Petit-Morel group had an overall avascular necrosis rate of 2.7%, compared to 10.6% for overhead traction and 21.5% for immediate closed reduction (Petit-Morel versus overhead traction, p = 0.001; Petit-Morel versus immediate closed reduction, p < 0.001; overhead traction versus immediate closed reduction, p < 0.001). The Petit-Morel group achieved a satisfaction rate of 86.4% according to the Severin classification, as compared to 71.2% in the overhead traction group and 76.4% in the immediate closed reduction group (Petit-Morel versus overhead traction, p < 0.001; Petit-Morel versus immediate closed reduction, p = 0.018; overhead traction versus immediate closed reduction, p = 0.195).
CONCLUSION
Petit-Morel and overhead traction techniques did not outperform immediate closed reduction in terms of redislocation rates, and radiological satisfaction, the Petit-Morel technique, has lower clinically significant avascular necrosis rates than overhead traction and immediate closed reduction.
LEVEL OF EVIDENCE
Level III.
目的
本研究旨在比较采用Petit - Morel技术与Bryant悬吊牵引技术对晚期发现的发育性髋关节脱位患者进行牵引辅助复位的临床和影像学结果，并比较这两种牵引技术与立即闭合复位的临床和影像学结果。
方法
对MEDLINE/PubMed、EMBASE和科学网数据库进行全面系统检索以识别相关研究。然后对关于Petit - Morel和悬吊牵引技术以及立即闭合复位的研究进行筛选、选择并收集数据；采用非随机研究方法学指数标准对纳入研究进行评估。
结果
共有22项研究符合纳入标准。Petit - Morel组的复位成功率为87%，而悬吊牵引组为67.1%，立即闭合复位组为78.4%（Petit - Morel组与悬吊牵引组比较，p < 0.001；悬吊牵引组与立即闭合复位组比较，p < 0.001，Petit - Morel组与立即闭合复位组比较，p = 0.021）。Petit - Morel组的总体无血管坏死率为2.7%，悬吊牵引组为10.6%，立即闭合复位组为21.5%（Petit - Morel组与悬吊牵引组比较，p = 0.001；Petit - Morel组与立即闭合复位组比较，p < 0.001；悬吊牵引组与立即闭合复位组比较，p < 0.001）。根据Severin分类，Petit - Morel组的满意率为86.4%，悬吊牵引组为71.2%，立即闭合复位组为76.4%（Petit - Morel组与悬吊牵引组比较，p < 0.001；Petit - Morel组与立即闭合复位组比较，p = 0.018；悬吊牵引组与立即闭合复位组比较，p = 0.195）。
结论
在再脱位率和放射学满意度方面，Petit - Morel和悬吊牵引技术并不优于立即闭合复位，Petit - Morel技术的具有临床意义的无血管坏死率低于悬吊牵引和立即闭合复位。
证据级别
三级。
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