■发育性髋关节发育不良(DDH)的诊断和治疗在临床实践中是高度可变的。为了获得更统一和循证的治疗途径,我们制定了“1岁以下儿童DDH的荷兰指南”。这项研究描述了不稳定和倾斜臀部的建议。
■应用了研究和评估准则的评估(AGREEII)。对六个预定义的指南问题进行了系统的文献综述。提出了建议,根据文献发现,以及危害/好处,患者/父母偏好,和成本(等级)。
■经系统文献检索,共收录843篇,共11篇。最终的指南建议是(i)Pavlik线束是治疗(亚)脱位髋关节的首选第一步;(ii)在3-4周和6-8周进行超声随访;(iii)如果6-8周后没有出现居中和稳定的髋关节,闭合复位;(iv)如果复位受到有限的髋关节外展的限制,内收肌肌腱切开术;(V)在切开复位的情况下,前部,前外侧,或建议内侧入路,根据手术偏好和经验进行选择;(vi)复位后(闭合/开放),spica演员被建议12周,在残余发育不良的情况下,随后使用外展装置。
■本研究提出了治疗偏心DDH的建议,根据现有文献和专家共识,作为第一个官方和国家基于证据的“1岁以下儿童DDH指南”的第二部分。第1部分在单独的文章中描述了关于居中DDH的指南部分。
UNASSIGNED: Diagnostics and treatment of developmental dysplasia of the hip (DDH) are highly variable in clinical practice. To obtain more uniform and evidence-based treatment pathways, we developed the \'Dutch
guideline for DDH in children < 1 year\'. This study describes recommendations for unstable and decentered hips.
UNASSIGNED: The Appraisal of
Guidelines for Research and Evaluation criteria (AGREE II) were applied. A systematic literature review was performed for six predefined
guideline questions. Recommendations were developed, based on literature findings, as well as harms/benefits, patient/parent preferences, and costs (GRADE).
UNASSIGNED: The systematic literature search resulted in 843 articles and 11 were included. Final guideline recommendations are (i) Pavlik harness is the preferred first step in the treatment of (sub) luxated hips; (ii) follow-up with ultrasound at 3-4 and 6-8 weeks; (iii) if no centered and stable hip after 6-8 weeks is present, closed reduction is indicated; (iv) if reduction is restricted by limited hip abduction, adductor tenotomy is indicated; (v) in case of open reduction, the anterior, anterolateral, or medial approach is advised, with the choice based on surgical preference and experience; (vi) after reduction (closed/open), a spica cast is advised for 12 weeks, followed by an abduction device in case of residual dysplasia.
UNASSIGNED: This study presents recommendations on the treatment of decentered DDH, based on the available literature and expert
consensus, as Part 2 of the first official and national evidence-based \'Guideline for DDH in children < 1 year\'. Part 1 describes the
guideline sections on centered DDH in a separate article.