外展支具早期治疗髋关节发育不良疗效的回顾性分析

Adverse effect of abduction brace in early treatment for developmental dysplasia of the hip: a retrospective analysis

目的探讨外展支具早期治疗髋关节发育不良(developmental dysplasia of the hip,DDH)的疗效,并分析影响疗效的因素。方法回顾性分析我院2013年10月至2015年6月收治的223例(270髋)髋关节发育不良患儿资料,其中男性53例,女性170例;年龄1~183(62.41±23.82)d,中位年龄58 d;左侧151髋,右侧119髋,单侧142髋,双侧64髋;超声Graf分型:Ⅱa型143髋,Ⅱb型75髋,Ⅱc型11髋,D型13髋,Ⅲ型19髋,Ⅳ型9髋,均采用外展支具治疗,每隔3~4周超声监测髋关节形态变化,>6个月行X线摄片,支具治疗时间3~20周,随访时间12~24个月,平均16.4个月。结果 206例(250髋)经外展支具治疗后恢复正常形态,且无一例发生股骨头坏死;17例(20髋)治疗失败,其中17髋改行石膏固定术治疗,3髋行Salter骨盆截骨手术治疗。结论外展支具是早期治疗髋关节发育不良安全、有效的方法之一,对GrafⅡ型髋关节治愈率高,对Ⅲ型及Ⅳ型治愈率低,但可尝试作为初始治疗的方法;超声检查对于早期诊治髋关节发育不良具有重要意义。

Objective To investigate the efficacy of abduction brace in the early treatment of developmental dysplasia of the hip（DDH） and analyze the influencing factors. Methods A retrospective analysis was conducted on 223 DDH children（270 hips） receiving abduction brace in our hospital from August 2013 to June 2015. They were 53 boys and 170 girls,and at an average age of 62. 41 ± 23. 82 d（1 ~183 d,median age 58 d）. There were 151 hips in the left and 119 in the right,and 142 hips of single-sided and 64 of double-sided. According to Graf method for ultrasound classification system,143 patients was identified with typeⅡa,75 with typeⅡb,11 with typeⅡc,13 with type D,19 with type Ⅲ,and 9 with typeⅣ. After abduction brace was applied to these children,all of them were monitored by ultrasound evaluation（X-ray was taken when age 6 months） at an average interval of 3 to 4 weeks. The treatment time ranged from 3 to 20 weeks,and all cases were followed up for 12 to 24 months（mean 16. 4 months）. Results Ultrasound examination and X-ray filming confirmed 206 children（250 hips） were cured without femoral head necrosis after using abduction brace. Seventeen subjects（20 hips） were failed,and 17 hips were changed to the cast and the other 3 hips were operated with Salter pelvic osteotomy. Conclusion Abduction brace is one of the effective and safe methods in early treatment of DDH,with a high curative rate for Graf Type Ⅱ hips.Though it has a low success rate for Graf TypeⅢ or Graf Type IV hips,it can be used as an initial treatment approach. Ultrasound examination is of significant values in the early diagnosis and treatment of the disease.