尽管发育性髋关节发育不良(DDH)的发病率很高,治疗非常多样化。因此,荷兰骨科协会制定了一项临床实践指南,建议对DDH进行最佳和统一的治疗.本文总结了有关居中DDH(即Graf类型2A-C)的指南。准则的制定遵循了《研究与评估准则II》的评估标准。进行了系统的文献综述,以确定随机对照试验和比较队列研究,包括患有中心DDH的<1岁儿童。包括比较(1)治疗与观察的文章,(2)不同的外展装置,(3)跟踪频率,和(4)中止方法。建议基于分级建议评估,发展,和评估,其中包括文学,临床经验和共识,患者和父母的安慰,和成本。在430篇潜在相关文章中,纳入5项比较研究。最终的指南建议是:(1)最初观察3个月大的中心DDH患者,如果髋关节在6-12周后未恢复正常,则开始外展治疗;(2)对6个月以下且持续进行DDH的儿童进行Pavlik线束重复超声检查,为6个月以上的儿童考虑替代外展装置;(3)每6周对患者进行一次评估;(4)当髋关节恢复正常或儿童12个月时停止外展装置.本文总结了第一个循证指南的第1部分,该指南用于治疗<1岁的儿童中的DDH。第2部分在另一篇文章中介绍了关于decentrateDDH的指南。
Despite the high incidence of developmental dysplasia of the hip (DDH), treatment is very diverse. Therefore, the Dutch Orthopedic Society developed a clinical practice guideline with recommendations for optimal and uniform treatment of DDH. This article summarizes the
guideline on centered
DDH (i.e. Graf types 2A-C). The
guideline development followed the criteria of Appraisal of
Guidelines for Research and Evaluation II. A systematic literature review was performed to identify randomized controlled trials and comparative cohort studies including children <1 year with centered DDH. Articles were included that compared (1) treatment with observation, (2) different abduction devices, (3) follow-up frequencies, and (4) discontinuation methods. Recommendations were based on Grading Recommendations Assessment, Development, and Evaluation, which included the literature, clinical experience and
consensus, patient and parent comfort, and costs. Out of 430 potentially relevant articles, 5 comparative studies were included. Final
guideline recommendations were (1) initially observe 3-month-old patients with centered
DDH, start abduction treatment if the hip does not normalize after 6-12 weeks; (2) prescribe a Pavlik harness to children <6 months with persisting DDH on repeated ultrasonography, consider alternative abduction devices for children >6 months; (3) assess patients every 6 weeks; and (4) discontinue the abduction device when the hip has normalized or when the child is 12 months. This paper presents a summary of part 1 of the first evidence-based guideline for treatment of centered DDH in children <1 year. Part 2 presents the
guideline on decentered
DDH in a separate article.