图宾根夹板对6个月以下儿童发育性髋关节发育不良的疗效：一项系统评价和荟萃分析。
The efficacy of Tübingen splint in developmental dysplasia of the hip in children under 6 months: A systematic review and meta-analysis.
作者信息
Dewa Gde Prema Ananda, Siahaan Deyana Novita, Tandio Luky, Munthe Ronald Vinantius
机构信息
Faculty of Medicine, Christian University of Indonesia, Christian University of Indonesia Hospital, Jakarta, Indonesia.
Department of Orthopedic and Traumatology, Dr. R. Soedjono Selong Hospital, Lombok, Indonesia.
出版信息
Medicine (Baltimore). 2025 Aug 8;104(32):e43753. doi: 10.1097/MD.0000000000043753.
BACKGROUND
Bracing is considered the most effective treatment for developmental dysplasia of the hip (DDH) in infants aged < 6 months with reducible hips. The Tübingen splint was developed as an advancement in abduction brace for managing hip dysplasia, in stable and unstable hip cases. In this systematic review and meta-analysis, the outcomes of the Tübingen splint in treating patients with DDH aged < 6 months were evaluated. The outcomes were categorized according to the Graf classification (IIa, IIb, IIc, IId, III, and IV), based on success and complication rates.
METHODS
The systematic review and meta-analysis were conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was conducted using Scopus, Embase, PubMed, Cochrane Library, and Google Scholar from inception to March 2024. The primary outcomes were the success rate for each Graf type, and the secondary outcome involved evaluating the complication rate through conditional subgroup analysis.
RESULTS
Nine observational studies involving 1456 hip cases were analyzed. Tübingen splint resulted in an overall success rate of 86% (95% confidence interval [CI] [0.80-0.92]; P < .01; χ² = 87%), with 97% (95% CI [0.94-1.00]; P < .01; χ² = 66%) for Graf type II DDH, 94% (95% CI [0.91-0.97]; P = .41; χ² = 2%) for Graf type III DDH, and 48% (95% CI [0.26-0.71]; P < .01; χ² = 86%) for Graf type IV DDH. The overall complication rate was 2% (95% CI [0.00-0.03]; P < .01; χ² = 65%), including 1% (95% CI [0.00-0.01]; P = .47; χ² = 0%) of avascular necrosis and 6% (95% CI [0.03-0.08]; P = .69; χ² = 0%) of residual acetabular dysplasia.
CONCLUSION
These findings support the use of the Tübingen splint as a highly effective first-line conservative treatment option for DDH in infants under 6 months of age, demonstrating notable efficacy, particularly for Graf types II and III cases.
LEVEL OF EVIDENCE
III.
背景
对于髋关节可复位的6个月以下婴儿发育性髋关节发育不良（DDH），支具治疗被认为是最有效的治疗方法。图宾根夹板是作为外展支具的改进型而开发的，用于治疗稳定和不稳定髋关节病例的髋关节发育不良。在本系统评价和荟萃分析中，评估了图宾根夹板治疗6个月以下DDH患者的疗效。根据Graf分类（IIa、IIb、IIc、IId、III和IV），基于成功率和并发症发生率对结果进行分类。
方法
本系统评价和荟萃分析按照系统评价和荟萃分析的首选报告项目指南进行。从创刊至2024年3月，使用Scopus、Embase、PubMed、Cochrane图书馆和谷歌学术进行系统检索。主要结局是每种Graf类型的成功率，次要结局是通过条件亚组分析评估并发症发生率。
结果
分析了9项涉及1456例髋关节病例的观察性研究。图宾根夹板的总体成功率为86%（95%置信区间[CI][0.80 - 0.92]；P <.01；χ² = 87%），其中II型DDH的成功率为97%（95% CI [0.94 - 1.00]；P <.01；χ² = 66%），III型DDH的成功率为94%（95% CI [0.91 - 0.97]；P =.41；χ² = 2%），IV型DDH的成功率为48%（95% CI [0.26 - 0.71]；P <.01；χ² = 86%）。总体并发症发生率为2%（95% CI [0.00 - 0.03]；P <.01；χ² = 65%），包括1%（95% CI [0.00 - 0.01]；P =.47；χ² = 0%）的缺血性坏死和6%（95% CI [0.0
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