Pavlik吊带治疗婴幼儿发育性髋关节发育不良的经验

Pavlik harness treatment for developmental dysplasia of the hip in neonates and infants within 6 months

目的探讨Pavlik吊带治疗6个月内婴幼儿发育性髋关节发育不良(DDH)的治疗效果。方法 2015年8月至2017年8月,Graf超声对广州市新生儿及小于6月婴儿进行DDH普查,检出异常髋关节(DDH)18个,其中女婴DDH髋检出13个,男性5个。根据Graf超声诊断发育性髋关节发育不良(DDH)的病理分型,9髋为Ⅱb型,6髋为Ⅱc型,2髋为Ⅲ型,1髋为Ⅳ型。均采用Pavlik吊带治疗,间隔2周复诊1次,超声检查观察髋关节发育变化。吊带治疗时间6~20周,随访时间3~18个月,平均8个月。结果 17髋经Pavlik吊带治疗后,经超声和X线片检查,相关指标达到正常,确认治愈。1髋在经Pavlik治疗过程中,经超声检查后,相关指标改善明显,58°<α角<60°。全部患儿均无股骨头无菌性坏死等并发症。结论 Pavlik吊带对于Graf II型患儿治愈率高,而对于GrafⅢ、Ⅳ型患儿,Pavlik吊带治愈率降低,部分患儿需要进一步的后续治疗。超声检查可达到动态观察Pavlik吊带治疗效果的目的。早期超声检查为发育性髋关节发育不良(DDH)能早期得到Pavlik吊带治疗提供了可能,对减少患儿远期遗留畸形和降低治疗过程中并发症发生率有重要意义。

Objective To investigate the treatment effect of the Pavlik harness for developmental dysplasia of the hip(DDH)in neonates and infants less than six months old. Methods From August2015 to August 2017,18 cases with DDH of hips were detected and confirmed,with 13 cases of female and 5 cases of male. According to Graf ultrasound hip type,9 patients with type IIb,6 patients with type IIc,2 patients with type III,one patients with type IV. All of the DDH hips were treated with Pavlik harness. The ultrasound was used to monitor the hip development one time in two weeks. The treatment time was 6 to 20 weeks;the follow-up time was 3 to 18 months,an average of 8 months. Results Of them,17 cases of type II hips were cured by Pavlik harness,one case got better by ultrasound examination which alpha angle of which was 59°. All patients had no complications such as avascular necrosis of the femoral head. Conclusion Pavlik harness had high cure rate for affected children. Early ultrasound provides the possibility to use Pavlik harness treatment.