Pavlik吊带治疗发育性髋关节发育不良终止时机的选择  

Proper timing for discontinuing Pavlik harness treatment in children with developmental dysplasia of the hip

作　　者：黎艺强 刘雁寒 吴剑平 李敬春 袁哲 周庆和 刘远忠 陈伟东 徐宏文 Li Yiqiang;Liu Yanhan;Wu Jianping;Li Jingchun;Yuan Zhe;Zhou Qinghe;Liu Yuanzhong;Chen Weidong;Xu Hongwen(Department of Pediatric Orthopedics,Municipal Women&Children's Medical Center,Guangzhou 510623,China)

机构地区：[1]广州市妇女儿童医疗中心骨科,广州510623

出　　处：《中华小儿外科杂志》2022年第6期550-555,共6页Chinese Journal of Pediatric Surgery

基　　金：广州市妇女儿童医疗中心/儿科研究所临床研究基金(GWCMC2020-6-005)。

摘　　要：目的探讨运用Pavlik吊带治疗发育性髋关节发育不良(developmental dysplasia of the hip,DDH)的终止时机。方法收集2014年至2019年广州市妇女儿童医疗中心采用Pavlik吊带治疗并达到超声或X线检查痊愈标准的45例(54髋)DDH患儿的临床资料。其中,男6例(9髋),女39例(45髋);年龄为(11.5±5.9)周,范围为1.4~25.7周;患侧为左侧占55.6%(25/45),右侧占24.4%(11/45),双侧占20.0%(9/45);随访时间为(23.9±12.9)个月,范围为12.0~61.5个月,Pavlik吊带治疗时长(3.2±0.7)个月,范围为2~6个月。所有患儿均接受Pavlik吊带治疗,去除吊带时根据其接受的检查结果和达到的痊愈标准情况,将患儿分为A组和B组,A组为Graf法超声检查提示髋关节恢复至Graf-Ⅰ型的患儿,共35例(42髋);B组为X线检查提示髋关节恢复正常的患儿,共10例(12髋)。观察患儿在去除吊带6个月后和末次随访时在髋关节X线正位片上测量的髋臼指数(acetabular index,AI),评估患儿髋关节的恢复情况。采用χ^(2)检验和t检验比较A、B两组残余髋臼发育不良发生率之间的差异。结果本研究45例(54髋)患儿,去除吊带后6个月时有40.7%(22/54)髋存在髋臼发育不良,经过进一步的外展支具治疗后,末次随访时仍有7.4%(4/54)髋残留髋臼发育不良。两组患儿的年龄、性别、DDH侧别、术前α角、Graf分型和随访时间差异均无统计学意义(P>0.05)。A组患儿的吊带治疗时长显著少于B组,(3.1±0.7)个月比(3.6±0.7)个月,差异具有统计学意义(P=0.028)。去除Pavlik吊带6个月后,A组患儿的AI显著高于B组,(27.2±7.0)°比(22.6±3.7)°,差异具有统计学意义(P=0.004)。A组残留髋臼发育不良的患儿数量及年龄均高于B组,分别为21例比1例和(13.4±5.0)周比(7.6±3.9)周,差异均具有统计学意义(P<0.05)。Graf-D型患儿有4髋残留髋臼发育不良,Graf-Ⅲ型患儿和Graf-Ⅳ型患儿分别有13髋和4髋残留髋臼发育不良,差异具有统计学意义(P=0.02)。末次�Objective To explore proper timing of discontinuing Pavlik harness(PH)treatment in children with developmental dislocation of the hip(DDH).Methods Retrospective reviews were conducted for clinical data of 45 DDH children(54 hips)on PH treatment.There were 6 boys and 39 girls with a mean age of(11.5±5.9)(1.4-25.7)weeks from 2014 to 2019.The involved side was left(n=25,55.6%),right(n=11,24.4%)and bilateral(n=9,20.0%).The mean follow-up period was(23.9±12.9)(12.0-61.5)months and the length of PH treatment(3.2±0.7)(2-6)month.According to the recovery criteria of hip achieved,they were divided into two groups of A(Graf typeⅠ,n=35,42 hips)and B(radiographic normalization,n=10,12 hips).At Month 6 after removing PH and during the final follow-up,acetabular index(AI)was measured on pelvic radiograph for evaluating the development of hip.Chisquare and student's t tests were employed for comparing the rates of residual acetabular dysplasia between groups A and B.Results Among 45 cases(54 hips),there were 22 hips(40.7%)had acetabular dysplasia at Month 6 after removing PH while 4 hips(7.4%)had residual acetabular dysplasia during the final follow-up.No inter-group differences existed in age,gender,sideness,preoperative AI,Graf classification or follow-up period(P>0.05).The duration of PH treatment of group A was significantly shorter than that of group B[(3.1±0.7)vs.(3.6±0.7),P=0.028].At Month 6 after removing PH,AI was significantly higher in group A than that in group B[(27.2±7.0)°vs.(22.6±3.7)°,P=0.004];21 hips in group A had hip dysplasia and it was significantly higher than those in group B(1 hip).In group A,age of children with residual hip dysplasia was significantly higher than those without[(13.4±5.0)vs.(7.6±3.9)weeks,P<0.05];Children with Graf-D had 4 hips with residual acetabular dysplasia,and children with Graf-Ⅲand Graf-Ⅳhad 13 and 4 hips with residual acetabular dysplasia,respectively,and the difference was statistically significant(P=0.02).During the final follow-up,no significant differences

关 键 词：发育性髋关节发育不良 Pavlik吊带 Graf法超声检查 髋臼指数 儿童 

分 类 号：R726.8[医药卫生—儿科]