髋关节矫形器的年龄和佩戴时机对发育性髋关节发育不良婴儿治疗效果的影响：一项系统评价和荟萃分析。
Impact of age and timing of hip orthosis on treatment outcomes in infants with developmental dysplasia of the hip: A systematic review and meta-analysis.
作者信息
Marletta Daniela Alessia, Zampogna Biagio, Giuca Gabriele, Nanni Matteo, Ilaria Sanzarello, Leonetti Danilo
机构信息
Section of Orthopaedics and Traumatology, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, 98122, Messina, (ME), Italy.
Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy.
出版信息
J Clin Orthop Trauma. 2025 Feb 19;64:102944. doi: 10.1016/j.jcot.2025.102944. eCollection 2025 May.
BACKGROUND
Developmental Dysplasia of the Hip (DDH) is a prevalent pediatric condition affecting 1-3% of newborns worldwide. Early treatment is crucial to prevent long-term complications such as residual dysplasia, avascular necrosis (AVN), and osteoarthritis. Despite the widespread use of the Pavlik harness, the optimal timing of hip orthosis initiation remains a topic of debate. This systematic review and meta-analysis evaluate the impact of age and timing of hip orthosis application on treatment outcomes in infants with DDH.
METHODS
This systematic review was registered on PROSPERO (Registration No. CRD42025638433). A comprehensive literature search was conducted in PubMed, Scopus, and Cochrane Library for studies published between 2000 and 2024. Twenty-two studies meeting inclusion criteria were analyzed, focusing on success rates, healing times, and complications such as AVN and residual dysplasia. Data were pooled for meta-analysis, and statistical analyses were performed using a random-effects model to assess the impact of treatment timing.
RESULTS
Infants treated before 3 months of age achieved a pooled success rate of 88.79 % (SE: 0.57 %), with lower complication rates, including AVN (0.89 %, SE: 0.18 %) and residual dysplasia (1.80 %, SE: 0.25 %). In contrast, treatment initiation between 3 and 6 months had a slightly lower success rate of 87.78 % (SE: 0.34 %), but with higher AVN (9.66 %, SE: 0.30 %) and residual dysplasia (20.27 %, SE: 0.40 %) rates. The Pavlik harness and Tübingen hip flexion splint were most effective in early-treated cases, whereas later treatment initiation or severe presentations resulted in less favorable outcomes.
CONCLUSION
Early treatment initiation, particularly before 3 months of age, significantly improves treatment success and reduces long-term complications. These findings emphasize the necessity of early screening and timely intervention to optimize outcomes. Future research should focus on refining treatment protocols for delayed presentations and improving management strategies for severe dysplasia.
LEVEL OF EVIDENCE
Level IV.
背景
发育性髋关节发育不良（DDH）是一种常见的儿科疾病，全球1% - 3%的新生儿受其影响。早期治疗对于预防诸如残余发育不良、缺血性坏死（AVN）和骨关节炎等长期并发症至关重要。尽管帕夫利克吊带被广泛使用，但开始使用髋关节矫形器的最佳时机仍是一个有争议的话题。本系统评价和荟萃分析评估了髋关节矫形器应用的年龄和时机对DDH婴儿治疗结果的影响。
方法
本系统评价在PROSPERO上注册（注册号CRD42025638433）。在PubMed、Scopus和Cochrane图书馆中对2000年至2024年发表的研究进行了全面的文献检索。分析了22项符合纳入标准的研究，重点关注成功率、愈合时间以及诸如AVN和残余发育不良等并发症。对数据进行汇总以进行荟萃分析，并使用随机效应模型进行统计分析，以评估治疗时机的影响。
结果
3个月龄前接受治疗的婴儿汇总成功率为88.79%（标准误：0.57%），并发症发生率较低，包括AVN（0.89%，标准误：0.18%）和残余发育不良（1.80%，标准误：0.25%）。相比之下，3至6个月开始治疗的成功率略低，为87.78%（标准误：0.34%），但AVN（9.66%，标准误：0.30%）和残余发育不良（20.27%，标准误：0.40%）发生率较高。帕夫利克吊带和图宾根髋关节屈曲夹板在早期治疗的病例中最有效，而较晚开始治疗或病情严重则导致预后较差。
结论
早期开始治疗，尤其是在3个月龄前，可显著提高治疗成功率并减少长期并发症。这些发现强调了早期筛查和及时干预以优化治疗结果的必要性。未来的研究应专注于完善延迟就诊的治疗方案，并改善严重发育不良的管理策略。
证据水平
四级。
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