Displasia del desarrollo de la cadera: tamizaje y manejo en el lactante / Developmental dysplasia of the hip: screening and management in the infant

La displasia del desarrollo de la cadera comprende un conjunto de anormalidades que afectan la articulación coxofemoral: la displasia, subluxación y luxación de la cadera. El concepto de "displasia" describe anormalidades en la estructura femoral, acetabular o ambas. Corresponde a la patología ortopédica más frecuente del recién nacido y lactante, lo que genera mucha preocupación e intranquilidad entre los padres, en los primeros controles sanos de sus hijos. Es una patología en la que un diagnóstico oportuno y precoz son la clave para poder realizar un tratamiento efectivo, obteniendo como resultado una cadera clínica y radiológicamente normal al finalizar el desarrollo esquelético. Para esto es fundamental conocer la patología e ir activamente en su búsqueda. Actualmente existe mucha discusión sobre la manera de pesquisar esta patología. En Chile, se realiza tamizaje universal con imagen -radiografía de pelvis- a todos los niños a los 3 meses de edad. El objetivo de la siguiente revisión, es traer a la práctica clínica actual de todos aquellos profesionales que se enfrentan en distintos escenarios a esta patología: médicos de atención primaria, enfermeras, médicos en etapas de destinación y formación en distintas regiones del país, pediatras y ortopedistas, aquellas características y signos de sospecha propios de esta enfermedad y detallar las herramientas para un correcto diagnóstico y oportuno tratamiento.

Developmental dysplasia of the hip (DDH) comprises a set of abnormalities that affect the hip joint: hip dysplasia, subluxation, and dislocation. It is the most frequent orthopedic pathology of the newborn and infant, and it generates great concern among parents during the first health check-ups of their children. It is a condition in which a timely and early diagnosis is key to be able to carry out an effective treatment, obtaining as a result of a clinically and radiologically normal hip at the end of skeletal development. For this, it is essential to know this orthopedic condition and actively search for it. Currently, there is much discussion about how to screen DDH. In Chile, universal screening with imaging - pelvic radiography - is performed on all children at 3 months of age. The objective of the following review is to bring to the current clinical practice of all those professionals who face this pathology in different scenarios: primary care physicians, nurses, physicians in training stages in different regions of the country, pediatricians and orthopedic surgeons, signs of suspicion typical of the disease and detail the assessment tools for a correct diagnosis and timely treatment.

Clinical research of bilateral sacrospinous ligament fixation by Pavlik harness method in treating the pelvic organ prolapse / 中国医师进修杂志

Objective To investigate the effect of bilateral sacrospinous ligament fixation by Pavlik harness method in the treatment of pelvic organ prolapse (POP). Methods Sixty patients with POP received operation were divided into bilateral sacrospinous ligament fixation by Pavlik harness method group (study group,30 cases),posterior intravaginal sling plasty group (P-IVS group, 15 cases) and sacrospinous ligament fixation group (SSLF group, 15 cases) by random digits table. The data of the three groups, such as operation time, bleeding during the operation, indwelling urinary catheter time, duration out of bed after operation, cure rate, recurrence rate and the quality of sexual life were observed. Results The operation time in study group [( 30.5 ± 5.3 ) min] was significantly shorter than that in SSLF group [(43.5 ± 10.6) min](P ＜ 0.05 ), and the duration out of bed in study group [( 1.5 ± 0.6) d] was earlier than that in SSLF group [(3.1 ±0.7) d] and P-IVS group [(3.3 ±0.8) d](P＜0.05). The POP-Q stage of all the patients being hospital was 0 or Ⅰ , approached the cure standard. Patients were followed up for 3-16 months after operation, the recurrence rate and the decrease of the quality of sexual life in study group [0,3.3%(1/30)]were lower than those in P-IVS group [20.0%(3/15),13.3%(2/15)] and SSLF group[6.7%(1/15),26.7%(4/15)] (P ＜ 0.05). Conclusion Bilateral sacrospinous ligament fixation by Pavlik harness method is a simple, firm operation, and the position of vagina does not axialitily change and suits the anatomy, so it is effective and worth spreading clinically to treat the POP.

The Usefulness of Dynamic Ultrasound Assessment for the Diagnosis of Developmental Dysplasia of the Hip and for Pavlik Harness Treatment Monitoring / 대한정형외과학회잡지

PURPOSE: To evaluate the usefulness of dynamic ultrasound assessment for the diagnosis of DDH and for Pavlik harness treatment monitoring. MATERIALS AND METHODS: Dynamic ultrasound examination was performed on 35 infants (average age: 3 months) having possible hip dysplasia. Based on ultrasonographic findings (normal, laxity with stress, subluxated, dislocated), the indication and duration of Pavlik harness treatment was determined. Radiographic examinations were performed at regular intervals (after 6 months) to assess hip development. RESULTS: All hips showing normal ultrasonographic findings developed well. In 20 infants treated with the Pavlik harness, 2 infants failed to maintain the harness application, 16 infants among 18 were successfully weaned from the harness, and 2 infants required additional treatment. Of the 16 successfully treated patients, 3 showed hip dysplasia, and one showed mild avascular necrosis of the femoral head. CONCLUSIONS: Dynamic ultrasound monitoring is an effective method for the accurate diagnosis of various degrees of hip dysplasia, the assessment of reduction quality, and for the assessment of hip stability during Pavlik harness treatment, and provides a reliable guide during the weaning from the harness process.

Dynamic ultrasonography in developmental dysplasia of the hip treated with Pavlik harness / 대한정형외과학회잡지

To evaluate the usefulness of dynamic ultrasonography in documenting treatment efficacy and expecting prognosis in developmental dysplasia of the hip (DDH), 49 DDH hips in 32 patients, who had serial dynamic ultrasonographic examinations by Harcke's method during Pavlik harness treatment, were studied as for the progression of ultrasound findings. Grafs alpha and beta angle were measured in coronal flexion view of dynamic ultrasonography. Among 49 hips, on follow-up radiographs, 44 hips showed normal hip development and 5 hips showed dysplasia. In 44 normal hips, 43 hips had alpha angle of more than 50 degrees and stability on dynamic sonogram at the time of weaning of harness. In contrast, all five hips with residual dysplasia exhibited instability on dynamic stress with comparable alpha angle to that of normal hips. This finding suggests that when the hip matures beyond "delayed ossification"(alpha angle more than 50 degrees) with stability on dynamic sonogram, normal hip development can be expected. But if the hip is continuously unstable, regardless of alpha angle, there can be a possibility of residual dysplasia.

Treatment of Congenital Dislocation of Hip in Children Under the Age of 2 Years / 대한정형외과학회잡지

The authors report a clinical experience of 95 patients (98 hips) with congenital dislocation of hip under the age of 2 years who were followed up at least 1 year at Chonnam University Hospital between 1979 and 1988. The result of clinical analysis are as follows; 1. The most patients were girls, comprising 87 girls (89 hips) and 8 boys (9 hips). 2. The age at treatment were under the age of 6 months in 49 hips, 7 to 12 months in 5, 13 to 18 months in 30 and 19 to 24 months in 14. 3. The initial treatment of the 98 hips were Pavlik harness in 49 hips, closed reduction in 18, and open reduction in 31. 4. Pavlik harness was applied to the patients under the age of 7 months and the results were acceptable in 37 hips (76%), uncertain in 4 (8%) and unacceptable in 8 (16%). The 8 unacceptable hips were retreated by closed reduction in 6 hips and open reduction in 2. 5. Closed reduction was applied to the patients ranging from the age of 4 months to 21 months and the results were acceptable in 14 hips(78%), unacceptable in 4 (22%). The 4 unacceptable hips were retreated by open reduction in 3 hips and Salter innominate osteotomy in l. 6. Open reduction was applied to the patients ranging from the age of 7 months to 20 months, and the results were acceptable in 26 hips (84%), uncertain in 3 (10%) and unacceptable in 2 (6%). The one of 2 unacceptable hips was retreated by Salter innominate osteotomy. 7. The overall results of 98 hips following initial treatment were acceptable in 77 hips (79%), uncertain in 7 (7%), and unacceptable in 14 (14%). The final results after secondary treatment were acceptable in 89 hips (91%), uncertain in 7 (7%), and unacceptable in 2 (2%).

Treatment of Congenital Dislocation of the Hip with the Pavlik Harness / 대한정형외과학회잡지

The congenital dislocation. of the hip is a common congenital disease in the orthopedic field. It is well known that the early diagnosis and effective treatment is very important for the patient to provide a favorable function in the whole life. The Pavlik harness made an important contribution to the treatment of children before standing age. The authors report a clinical experience of 34 patients(35 hips) with congenital dislocation of hip who were treated with Pavlik harness at the Department of Orthopedic Surgery of Chonnam University Hospital. There were total 230 patients(237 hips) diagnosed as congenital dislocation of hip for 10 years from 1978 to 1987. Fifty-one patients(52 hips) of them were treated with Pavlik harness. Only 34 patients(35 hips) were included in this study excluding 17 patients(17 hips) because of inappropriate records or follow-up. The follow-up period ranged from 1 year to 6 years with an average of 2 years and 5 months. The results are as follows ; 1. The most patients were girls, comprising 33 girls and 1 boy. 2. The age of children was 124.6days in average ranging from 13 to 201 days. 3. Of the 35 hips treated with Pavlik harness, satisfactory reduction was obtsined in 30 hips(85.7%). For 5 failed cases, the authors performed closed reduction under the general anesthesia in 3 cases and open reduction in 2 cases. 4. The causes of reduction failure were impossible reduction in 3 cases, nonconcentric reduction in 1 case and repeated redislocation in 1 case. 5. The acetabular and metaphyseal-edge angle improved from the average 33 and 5.8 degrees at the first visit to the average 19.9 and 30.6 degree at the final follow-up (20.7 and 29.2 degrees in normal side). 6. When compared with the value of the 30 hips which were reduced successfully, the initial acetabular angle of 5 failed cases was similar but the metaphyseal-edge angle of them was very low. 7. There was no reduction failure in 27 hips which had metaphyseal-edge angle above 10 degrees. But 5 reduction failures were observed in 8 hips with below −11 degrees. 8. An avascular necrosis was observed in only one patient. In conclusion, the Pavlik harness proved to be a successful means in treating patients with congenital dislocation of hip under 7 months of age with particularly above −10 degrees in metaphyseal-edge angle.