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1.
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。 相似文献
2.
This retrospective study of the early work of Arnold Pavlik in the treatment of developmental dysplasia of the hip proves
the success of his method in eradicating avascular necrosis (AVN) resulting from other modes of treatment. Authors analyzed
some 100 charts of children treated for CDH, as it was known at that time, between 1969 and 1981, and assessed the influence
of gender, clinical stability, severity of X-ray pathology and age at which treatment was started, according to duration,
outcome of treatment and rate of AVN. Of the 100 children with 134 treated pathological hips, 62 children with 86 pathological
hips were treated exclusively by Pavlik’s method. Length of treatment for the 86 hips successfully treated by Pavlik’s method
only was an average of 6 months. No AVN was found for any hip treated by Pavlik’s method only, including dislocated hips.
The 65% of failure rate was for dislocated hips only. Late onset and prolonged duration of treatment using Pavlik’s method
contributed to relative high failure rate followed by AVN. This leads to the conclusion that Pavlik’s method is safe and accurate
for all dysplastic and subluxated hips, along with the vast majority of dislocated hips. 相似文献
3.
Rajiv Merchant Abhinav Singh Benan Dala-Ali Anish P. Sanghrajka Deborah M. Eastwood 《Indian Journal of Orthopaedics》2021,55(6):1417
Bracing is considered a gold standard in treating Developmental Dysplasia of the Hip (DDH) in infants under 6 months of age with reducible hips. A variety of braces are available that work on similar principles of limiting hip adduction and extension. This paper summarises the current evidence regarding bracing in DDH. Most of the literature pertains to the Pavlik harness (PH) and there are few studies for other brace types. Bracing eliminates dislocating forces from the hamstrings, the block to reduction of the psoas and improves the muscle line of pull to stabilise the hip joint. Recent studies have shown no benefit in bracing for stable dysplasia. The rates of PH treatment failure in Ortolani-positive hips have been reported to be high. Barlow positive hips have lower Graf grades and are more amenable to PH treatment. There is consensus that the earlier the diagnosis of DDH and initiation of PH treatment, the better the outcome. Failure rates due to unsuccessful reduction and AVN are higher with treatment initiated after age 4–6 months. Studies have shown no benefits of staged weaning of braces. While there is no maximum time in brace, current consensus suggests a minimum of 6 weeks. The key to successful bracing lies in education and communication with the family. 相似文献
4.
Real-time ultrasonography has been used for diagnosis and screening of developmental dysplasia of the hip for several years. If diagnostic criteria are well established, the use of sonography in follow-up of treated infants remains extremely variable. The aims of this study were (a) to describe the normal sonographic anatomy of the infant abducted hip on an anterior axial view, and (b) to define the role of this approach in the follow-up of developmental dysplasia treated by Pavlik harness. Thirty-eight patients with Pavlik harness had anterior axial sonograms in addition to their usual clinical and sonographic follow-up. Normal anatomy was inferred from the examination of 25 clinically proven normal hips in the same population. The best criterion of a normal positioning of the femoral head appears to be the alignment of the pubic bone and the femoral metaphysis. Pavlik harness was the only treatment in 32 patients. It was directly efficient in 22, after readjustment in 10 patients. Reduction was shown by anterior sonography in all of them. In 6 children, sonography showed no reduction and subsequent treatment by closed or open reduction was carried out. Anterior axial sonogram can show reduction of a dislocated hip in children with Pavlik harness, but it does not evaluate its stability. It helps optimize the settings of the harness, and may predict a poor outcome, but it does not identify the cause of non-reducibility. 相似文献
5.
目的:探讨Pavlik吊带治疗6个月内发育性髋关节发育不良(DDH)的疗效。方法:回顾性研究。纳入2015年7月—2019年7月厦门市妇幼保健院小儿外科DDH患儿66例68髋,其中男4例4髋,女62例64髋;年龄30~180(90.4±38.2)d。患儿治疗前均行髋关节超声检查确诊,依据超声检查Graf分型标准分型:髋... 相似文献
6.
Andrew J. Stevenson Sandeep B. Shewalle Nicholas M. P. Clarke 《Journal of children's orthopaedics》2007,1(5):287-289
Purpose Pseudoparalysis of the leg occurring during use of the Pavlik Harness (PH) is a seldom-reported condition. Three cases of
pseudoparalysis are reported here to illustrate the need for careful assessment of this condition.
Methods A series of patients using the PH and presenting with pseudoparalysis was compiled following a retrospective review of case
notes.
Results In 3 cases, infants treated for developmental dysplasia of the hip using the PH were found to have developed a pseudoparalysis
of the affected limb. All presented with similar signs, with the infant being systemically irritable and reluctant to move
the limb. In 2 of the cases, this was related to the harness—its removal resulted in recovery of the affected limb. The third
case was proven to be septic arthritis, unrelated to the harness, and treatment by means of arthrotomy, intravenous antibiotics
and use of the PH for hip stabilisation was used successfully. In the first two cases, the pseudoparalysis was noticed at
routine review clinic, and clinical assessment, ultrasound scan and blood tests were performed. The case of septic arthritis
was similarly assessed, following referral by paediatric physicians.
Conclusion Pseudoparalysis in the PH is a rare event and requires careful investigation. 相似文献
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8.
Pablo Vadillo Carlos Alberto Encinas-Ullan Luis Moraleda Javier Albi?ana 《Journal of children's orthopaedics》2015,9(4):249-253
Background
Predictors of failure of the Pavlik harness in reducing and stabilizing an Ortolani-positive hip remain ‘unclear’. The purpose of this study is to investigate the success of the Pavlik harness when treating Ortolani-positive hips, to look for predictors of failure of the harness and to analyze the arthrographic findings among these failures.Materials and methods
The medical records of 39 consecutive patients with an Ortolani-positive hip treated initially with a Pavlik harness were reviewed. Data regarding birth order, problems during pregnancy, presentation at birth, delivery, family history of DDH, gender, side involved, bilaterality, onset of treatment, problems related to use of the harness, and time until the harness reduced and stabilized the hip or was abandoned because of a failure were recorded. The presence of plagiocephaly, torticollis or foot deformity was also noted. We looked for predictors of failure among these aspects and report the arthrographic findings of the failures.Results
The mean age when the harness was started was 16.7 days. The mean time until success or failure of the harness in reducing and stabilize the hip was 18.5 days. There were 8 (20.5 %) failures. Multigravida (p = 0.026) and foot deformity (p = 0.023) were associated with failure of the harness. On the other hand, problems during pregnancy (p = 1), presentation at birth (p = 0.078), c-section (p = 0.394), family history of DDH (p = 1), gender (0.313), torticollis (p = 1), bilaterality (p = 1) and onset of treatment (p = 0.485) were not associated. Arthrographic abnormalities were found in all failures.Conclusion
The Pavlik harness failed to reduce and stabilize the hip in 20.5 % of the newborns with an Ortolani-positive hip. Multigravida and foot deformity were statistically associated with failure of the harness. An anatomical obstacle for reduction was found in all hips with a harness failure. A more teratological than mechanical hip dislocation could be the reason for failure of the Pavlik harness.Level of evidence
IV, Retrospective case series. 相似文献9.
Rahim Nawaz Hussain Darius Rad William John Watkins Clare Carpenter 《Journal of children's orthopaedics》2021,15(3):232
PurposeAvascular necrosis (AVN) may occur following treatment for developmental dysplasia of the hip (DDH). The primary aim of this study was to identify the incidence of AVN in a cohort of patients treated for DDH. Secondary aims were to classify AVN using available classification systems, analyze the correlation between the systems and investigate their relationship with the age at diagnosis of DDH.MethodsAn 11-year retrospective study was carried out at a single tertiary centre, using data from the clinical portal (patient records database) and IMPAX (system used to store plain radiographic images). Clinical details (patient demographics and outcomes) and plain radiographic images were used to identify cases of DDH and categorize cases of AVN using available classification systems: Tonnis and Kuhlmann, Kalamchi and McEwen, Bucholz and Ogden and Salter. Severin was used to assess final clinical outcome.ResultsIn total, 405 (522 hips) cases of DDH were identified, of which 213 resolved without treatment, 93 were treated conservatively and 99 surgically. Only treated cases were included in the analysis (n = 192). AVN (45/99; 45.5%) was found to occur only postoperatively. A positive correlation was present between age at presentation and severity of AVN as classified according to Salter’s criteria (chi-squared p value < 0.01).ConclusionAVN incidence was 23.4% (45/192) and only occurred in surgically treated patients. Older age at diagnosis was associated with a higher incidence of AVN, as defined according to Salter’s criteria. The classification systems appeared to show no correlation amongst each other (p-value < 0.01).Level of evidence:III - Retrospective cohort study 相似文献
10.