Pavlik吊带治疗6个月内婴儿髋关节发育不良

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。     

Gait dynamics when wearing a treadmill safety harness

Nonlinear dynamics quantifies gait variability patterns, which can be useful in evaluating functional ability. A commonly used nonlinear technique is detrended fluctuation analysis (DFA). Safety support structures have previously been shown to alter DFA during gait. However, the effect of a nonweight-supporting treadmill harness on DFA during gait has yet to be determined. The purpose of this study was to determine whether a nonweight-supporting harness influenced the DFA alpha metric (DFA α) of variables typically used to examine gait function. Twenty participants (10 young adults and 10 older adults) were recruited for this study. Each participant completed one testing session on a treadmill consisting of three conditions: (1) no harness, (2) harnessed, but not attached to the support frame, and (3) harnessed and attached to the support frame. Participants walked for 15 min at the same self-selected speed for each condition. The gait variables of stride time, stride length, and step width for each condition were analyzed using DFA α to examine gait function. There were no significant interactions between age group and condition for DFA α of each variable. Additionally, there were no main effects for DFA α for age group or condition. These data indicate that a nonweight-supporting harness can be used for safety without impeding the emergence of natural gait dynamics when stride time, stride length, and step width are the primary variables of interest.     

Anterior dislocation of the shoulder

There is a high incidence of recurrence after traumatic dislocation of the shoulder. In this study of 417 patients, we found that initial dislocation below the age of 30, dislocation with capsular detachment, dislocation without tuberosity fracture and a short period of fixation after reduction were predisposing factors. We have designed a modified clavicular harness and have used it in the treatment of 41 such high risk patients. We found no recurrences during an observation period of one year.

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Résumé La récidive après luxation traumatique de l'épaule est fréquente. Dans cette étude de 417 patients nous avons mis en évidence comme facteurs prédisposants la survenue de la première luxation avant l'âge de 30 ans, l'existence d'une désinsertion capsulaire, l'absence de fracture tubérositaire associée, et une courte période d'immobilisation après réduction.Nous avons mis au point un nouveau système d'immobilisation que nous avons utilisé chez 41 sujets à haut risque. Nous n'avons observé aucune récidive au cours de l'année suivant la luxation.

     

Pavlik’s method: a retrospective study

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.     

充气式肩吊带对偏瘫后肩关节半脱位的疗效

目的观察充气式肩吊带对偏瘫后肩关节半脱位的治疗作用。方法将68例脑卒中偏瘫伴肩关节半脱位的患者分为治疗组和对照组各34例。两组患者均接受常规康复技术治疗肩关节半脱位,治疗组患者在此基础上佩戴充气式肩吊带。治疗前后根据X线片测量双侧肩峰与肱骨头间距(AHI),进行Fugl-Meyer运动功能评定,视觉模拟评分(VAS)评定肩痛。结果治疗8周后,与对照组相比,治疗组的复位率及总有效率无显著性差异(P>0.05);治疗组肩痛发生率、VAS评分、患侧上肢Fugl-Meyer运动功能评分优于对照组(P<0.05)。结论在常规康复治疗的基础上,加用充气式肩吊带治疗偏瘫后肩关节半脱位,可减少肩痛的发生,减轻肩痛程度,有利于提高偏瘫上肢运动功能。     

Principles of Bracing in the Early Management of Developmental Dysplasia of the Hip

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.     

Anterior axial ultrasound in monitoring infants with Pavlik harness

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.     

Pavlik吊带治疗婴幼儿发育性髋关节发育不良的疗效观察

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...     

高原鼢鼠对草场的危害及防治阈值的探讨

本文通过高原鼢鼠对草场形成危害的途径及造成牧草损失的测算,根据投入与产出的价值,建立高原鼢鼠防治的经济阈值模型(Economic threshold mould),进而求得海北高寒草甸上高原鼢鼠的防治阈限为x=4.18。确定地下害鼠经济阈值的方法具有普遍性,本防治阈值模式适用于高寒草甸草场,为我们对该害鼠的综合治理提供了依据。     

The incidence of avascular necrosis following a cohort of treated developmental dysplasia of the hip in a single tertiary centre

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