Lankinen Vilma, Helminen Mika, Bakti Karim, Välipakka Jarmo, Laivuori Hannele, Hyvärinen Anna
Department of Pediatric Surgery, Turku University Hospital, Savitehtaankatu 5, Turku, 20520, Finland.
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
BMC Pediatr. 2025 Aug 4;25(1):596. doi: 10.1186/s12887-025-05940-x.
In the treatment of DDH, stable but dysplastic hips are safe to observe, and these children do not usually need abduction treatment. It has been reported, that also clinically unstable hips have good spontaneous recovery potential, but only a few studies have investigated the observation strategy in clinically mildly unstable (Barlow positive) hips. A conclusion on the safe treatment strategy for these children has not been made.
All early diagnosed mildly unstable (Ortolani negative) hips treated in Tampere University Hospital in 1998-2018 were found, and data was retrospectively collected from the medical records. A total of 510 children were found. There were 222 children with Barlow-positive hips of which 45% were first observed, and 288 children with reported clinically mild hip instability but no reported Barlow-positivity of which 90% were first observed. All the analyses were done separately for these two groups of children.
Girls were more likely to need abduction treatment after observation in Barlow-positive and mildly unstable groups. There were no differences in the six-month alpha angle or treatment failure rates between early-treated and first-observed children in either of the study groups. Duration of the treatment was not increased in observed children in either of the study groups.
Observation for about a month in clinically mildly unstable hips with or without Barlow positive signs seems safe regarding the recovery of alpha angles, treatment duration and treatment failures. More research is needed for longer observation times.
在发育性髋关节发育不良（DDH）的治疗中，髋关节稳定但发育异常的情况可安全观察，这些儿童通常无需外展治疗。据报道，临床上不稳定的髋关节也具有良好的自发恢复潜力，但仅有少数研究探讨了临床轻度不稳定（巴罗试验阳性）髋关节的观察策略。尚未得出针对这些儿童的安全治疗策略的结论。
找出1998年至2018年在坦佩雷大学医院接受治疗的所有早期诊断为轻度不稳定（奥尔托拉尼试验阴性）的髋关节，并从病历中回顾性收集数据。共找到510名儿童。其中有222名巴罗试验阳性的儿童，45%首先接受观察；288名有临床轻度髋关节不稳定报告但无巴罗试验阳性报告的儿童，90%首先接受观察。对这两组儿童分别进行所有分析。
在巴罗试验阳性组和轻度不稳定组中，女孩在观察后更有可能需要外展治疗。在两个研究组中，早期治疗的儿童和首先接受观察的儿童在六个月时的α角或治疗失败率方面均无差异。两个研究组中接受观察的儿童的治疗持续时间均未增加。
对于有或无巴罗试验阳性体征的临床轻度不稳定髋关节，观察约一个月在α角恢复、治疗持续时间和治疗失败方面似乎是安全的。对于更长的观察时间，还需要更多研究。
