Predictive Factors for Unsuccessful Treatment of Developmental Dysplasia of the Hip by the Pavlik Harness
Predictive Factors for Unsuccessful Treatment of Developmental Dysplasia of the Hip by the Pavlik Harness
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DOI：
10.1097/bpo.0b013e3181b2f200
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发表时间：
2009-09-01
影响因子：
1.7
通讯作者：
Ishiguro, Naoki
中科院分区：
文献类型：
--
作者：
Kitoh, Hiroshi;Kawasumi, Motoaki;Ishiguro, Naoki
背景资料：Pavlik吊带是髋关节发育不良（DDH）初始治疗的一种广泛使用和有效的方法，但使用吊带时某些髋关节无法稳定，可能发生股骨头缺血性坏死（AVN）。不成功的帕弗里克线束治疗的预测因素，应确定适当的治疗和预防AVN.Methods的适应症：帕弗里克线束治疗DDH的结果进行了回顾性研究，在221髋210例最初在我们的机构治疗，并随访至少1年后的应用线束。进行单变量分析，以确定复位失败和AVN发生率的预测因素，连续变量采用Mann-Whitney U检验，分类变量采用Fisher精确检验或Pearson检验。其次，采用Logistic回归分析确定复位失败和AVN发生率的独立多变量预测因子。结果：181个髋关节复位，总复位率为81.9%。根据Salter等的诊断标准，181个髋关节中有16个髋关节发生了AVN，发生率为8.8%。Yamamuro和Chene定义的双侧和距离“a”减小是复位失败的统计学显著单变量和多变量风险因素。在它们之间，距离a是最有力的预测因素。髋关节内收挛缩（髋关节外展至90度< 60度）是AVN发生率的唯一重要单变量和多变量预测因素。结论：距离a和髋关节内收挛缩是Pavlik治疗结果的重要预测因素。我们得出结论，Pavlik吊带是治疗髋关节外展>= 60 °和距离a >= 6 mm的DDH的一种非常安全有效的方法。
Background: The Pavlik harness is a widely used and effective means of initial treatment of developmental dysplasia of the hip (DDH), but some hips fail to stabilize with the use of harness and avascular necrosis (AVN) of the femoral head can occur. Predictive factors for unsuccessful Pavlik harness treatment should be determined for appropriate indication of the treatment and prevention of AVN.Methods: The outcome of Pavlik harness treatment for DDH was retrospectively examined in 221 hips of 210 patients who were treated initially at our institution and followed up for at least 1 year after the application of the harness. Univariate analysis was performed to determine predictors for failure of reduction and for the incidence of AVN by using the Mann-Whitney U test for continuous variables and the Fisher exact test or the Pearson test for categorical variables. Next, independent multivariate predictors for the failure of reduction and the incidence of AVN were identified using logistic regression analysis.Results: One hundred and eighty-one hips were reduced and the overall rate of reduction was 81.9%. AVN that was diagnosed according to the criteria of Salter et al was identified in 16 of the 181 reduced hips and the rate of incidence of AVN was 8.8%. Bilaterality and decreased distance "a,'' as defined by Yamamuro and Chene, were statistically significant univariate and multivariate risk factors for the failure of reduction. Between them, distance a was the most powerful predictor. Adduction contracture of the hip (abduction with the hips flexed to 90 degrees < 60 degrees) was the only significant univariate and multivariate predictor for the incidence of AVN.Conclusions: Distance a and adduction contracture of the hip were important predictors for the outcome of Pavlik harness treatment. We concluded that the Pavlik harness is a very safe and effective means of DDH treatment for the hips with abduction >= 60 degrees and distance a >= 6 mm.