Pavlik吊带治疗6个月内婴儿髋关节发育不良

Pavlik Harness Treatment for Baby Aged in 6 Months with Development Dysplasia of the Hip

目的 探讨Pavlik吊带治疗6个月内婴儿髋关节发育不良的方法和疗效以及高频超声在诊断治疗中的价值.方法 回顾性总结我院2004年1月至2012年1月收治的102例（124髋）6个月内发育性髋关节异常的婴儿,其中男性14例,女性88例,单侧80例,双侧22例,年龄3～24周.据Graf超声波髋关节分型,20髋为Ⅱa（-）型,50髋为Ⅱb型,34髋为Ⅱc型,18髋为Ⅲ型,2髋为Ⅳ型.常规新生儿体检均发现有双侧臀纹不对称,或伴有髋关节屈曲外展受限,经Garf静态超声技术确认.均采用Pavlik吊带治疗,平均间隔2～3周超声监测髋关节发育变化.吊带治疗时间4 ～ 20周,随访时间15 ～ 30个月,平均24个月.结果 92例（112髋）经Pavlik吊带治疗后,复查超声和X线片指标恢复正常,确认治愈.4例（5髋）治疗过程中超声指标改善明显,58°＜α角＜60°,年龄超过8个月后,改用髋外展矫形器固定,4周后X线片指标恢复正常.6例（7髋）年龄超过6个月,指标未恢复正常,且伴有内收肌紧张,予以内收长肌松解后石膏固定.在此6例患儿中,3例（3髋）随访至18个月,髋臼指数大于25°,Sheton氏线不连续,行Salter骨盆截骨术.所有患儿均无股骨头无菌性坏死等并发症.结论 Pavlik吊带对于GrafⅡ型患儿治愈率高,而对于GrafⅢ、Ⅳ型患儿,Pavlik吊带治愈率降低,部分患儿需后续进一步治疗.超声检查可动态观察Pavlik吊带治疗效果.早期超声检查为及时应用Pavlik吊带治疗提供了可能,对减轻患儿晚期畸形和并发症有重要意义.

Objective To investigate the effective treatment method of the Pavlik harness for aged in 6 month baby with developmental dysplasia of the hip（DDH）,the value on high frequency ultrasound in the diagnosis and treatment of DDH.Methods From 2004 to 2012,102（124 hips）affected baby aged in 6 months were treated,male in 14,female in 88,one side in 80,two sides in 22.The patients were 3 ～ 24 weeks old,according to Graf ultrasound hip type,20 patients with type Ⅱ a （-）,50 patients with type Ⅱ b,34 patients with type Ⅱ c,18 patients with type Ⅲ,2 patients with type Ⅳ.The patients were found to have bilateral hip pattern asymmetry or limited adduction by routine newborn physical examination,recognized by Garf static ultrasound technology.All were treated with Pavlik harness ;ultrasound monitored the hip development with an average interval of 2 to 3 weeks.The treatment time was 4 to 20 weeks;the follow-up time was 15 to 30 months,an average of 24 months.Results Of them,92 cases （112 hips） were cured by Pavlik harness ; alpha angle of 4 cases （5 hips） was 58 ° ～ 60°,they were switched to braces when they were over eight months old,X-ray indexes returned to normal after 4 weeks ;6 cases （7 hips） were over six months old,indicators were not back to normal,and accompanied adductor muscle tension,they were fixated with plaster casts after adductor longus release operation.Of the 6 cases （7 hips）,3 case（3 hips）were followed up to 18 months,each of them,AI was greater than 25°,Sheton＇s line was not continuous,they were operated with Salter pelvic osteotomy.All patients had no complications such as avascular necrosis of the femoral head.Conclusion Pavlik harness has high cure rate for affected children of Graf type Ⅱ,has lower cure rate for Graf type Ⅲ、Ⅳ,some patients required further treatment.Ultrasound can dynamically observe the effective treatment of the Pavlik harness.Early ultrasound provides the possibility to use Pavlik harness in time.It is important for decreasing the late deformity and complications.