摘要
目的比较3种干预方式（蛙式抱、Pavlik挽具，宽尿不湿及屈髋外展被动操）对发育性髋关节脱位（DDH）GrafⅡ型患儿的疗效，探讨超声随访与X线随访的关系。方法多中心、观察性临床研究，纳人中国7个城市7家儿童医院2011年1月至2015年12月409例GrafⅡ型DDH患儿的资料，对其临床表现、干预方式、诊治经过、影像结果等进行回顾性分析。采用单因素方差分析两两比较，评估3种不同干预方式对GrafⅡa型DDH患儿的转归。采用单因素方差分析，评估Pavlik挽具及非Pavlik挽具（蛙式抱、宽尿不湿以及屈髋外展被动操）对GraflIb型DDH患儿的转归。采用配对四格表Fisher确切概率法，比较超声检查发现异常的阳性率和X线检查的差异。结果409例中，男124例，女285例；Graf Ⅱa型292例，Ⅱb型102例，ⅡC型14例，Ⅱd型1例。GrafⅡa型DDH患儿分别采用3种干预方式干预后，正常转归时间分别为：Pavlik挽具，平均38d；宽尿不湿及屈髋外展被动操，平均46d；蛙式抱，平均56d，差异有统计学意义（F=9．422，P：0．0001）。Graf Ⅱb型DDH患儿采用Pavlik挽具与非Pavlik挽具干预正常转归时间分别为32d和45d，差异有统计学意义（F=5．566，P=0．001）。超声检查和x线随访检查发现异常结果的阳性率分别为9．05％（18／199）和0．50％（1／199），差异无统计学意义（x2=10．106，P=0．09）。结论GrafⅡ型DDH均能用Pavlik挽具治愈。对GrafⅡa型、Ⅱb型DDH患儿，Pavlik挽具干预与宽尿不湿及屈髋外展被动操干预、单纯蛙式抱干预比较，治愈所需时间最短。所有409例临床随访均未发现髋关节异常；超声是随访评价GrafⅡ型DDH患儿有效的工具。
Objective To compare the effieacies of different interventions of abduction embrace, Pavlik hardness, wide diaper flexion and passive hips abduction exercises for children with Oraf Ⅱ DDH （ Ⅱ a, Ⅱ b, Ⅱ c ＆ Ⅱ d） and examine the possible differences of evaluation criteria between ultrasound and radiography during follow-ups. Methods For this multi-center observational registry, 409 screened eases with Graf Ⅱ DDH from January 2011 to December 2015 from 7 hospitals in 7 Chinese cities. Their clinical features, intervention methods, diagnosis and treatment options and imaging findings were analyzed retrospectively. One-way analysis of variance was used for assessing the outcome of Graf Ⅱ a DDH screened cases with different intervention methods. One-way analysis was performed for comparing Pavlik hardness to others interventions in the outcomes of Graf Ⅱb DDH screened cases. The difference of positive rate between ultrasonography and radiography was compared by Fisher＇s exact test with paired four-grid data. Results Among 409 cases, there were 124 boys and 285 girls. The clinical types were Ⅱa （n = 292）, Ⅱ b （n = 102）, Ⅱ c （n = 14） and Ⅱ d （n = 1）. Significant differences existed in average treatment duration between each two of three interventions （56 days by abduction embrace, 38 days by Pavlik hardness, 46 days by wide diaper flexion ＆ passive hip abduction） （F= 9. 422, P = 0. 0001）. For Graf Ⅱ b DDH screened cases, significant differences existed in average treatment duration between Pavlik hardness and other interventions （32 vs 45 days） （F= 5. 556, P = 0. 001）. The positive rates of uttrasonography and radiography were 9. 05% （18/ 199） and 0. 50% respectively （1/199）. No significant difference existed in positive rate between ultrasonography and radiography （x2 = 10. 106, P = 0. 09）. Conclusions All Graf Ⅱ DDH cases may be cured with Pavlik harnesses. For Graf Ⅱ a and Ⅱ b DDH cases, the average duration of using Pavlik harnesses is shorter than that using wide diaper flexion, passive hip abduction exercises and abduction embrace. No abnormal hip is found after different interventions of abduction embrace, Pavlik hardness, wide diaper flexion and passive hip abduction exercises. Ultrasonography is ideal for assessing Graf Ⅱ DDH.
出处
《中华小儿外科杂志》
CSCD
2016年第12期893-897,共5页
Chinese Journal of Pediatric Surgery
基金
2015年广东省深圳市知识创新计划项目（JCYJ20150403100317060）
关键词
髋关节脱位
治疗结果
对比研究
Hip dislocation
Treatment outcome
Comparative study
