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Pavlik-Bandage zur Therapie der kongenitalen Hüftdysplasie Typ D, III und IV

Pavlik harness for the treatment of congenital hip dysplasia types D III and IV

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Zusammenfassung

Hintergrund

Bis zu 4 % aller Neugeborenen in Mitteleuropa kommen mit einer kongenitalen Hüftdysplasie (KHD) auf die Welt, die somit die häufigste angeborene Erkrankung des Bewegungsapparats ist. Im Rahmen der hier vorgestellten retrospektiven Erhebung wurden die Therapieergebnisse von Neugeborenen mit KHD Typ D, III oder IV nach Graf nachuntersucht, die mit einer Pavlik-Bandage behandelt wurden und deren Therapiebeginn innerhalb der ersten 12 Lebenswochen lag. Beurteilt wurden Zusammenhänge zwischen dem Zeitpunkt des Therapiebeginns bzw. dem Ausgangsbefund nach Graf und dem erzielten sonographischen Ergebnis sowie den Röntgenbildern nach einem und 2 Jahren. Es wurden ausbleibende Repositionen durch die Pavlik-Bandage und Nebenwirkungen ausgewertet sowie deren Relevanz beurteilt, insbesondere in Bezug auf die avaskuläre Hüftkopfnekrose.

Material und Methodik

Es wurden alle Neugeborenen ermittelt, die von 2010 bis 2012 in unserer Klinik aufgrund einer KHD mit einer Pavlik-Bandage behandlungspflichtig waren. Es konnten insgesamt 62 Patienten mit insgesamt 79 pathologischen Hüften ermittelt werden. Um den Einfluss des Therapiebeginns auf das Ergebnis zu evaluieren, wurden die Kinder in 3 Gruppen eingeteilt: Gruppe I: Erstuntersuchung und Beginn der Pavlik-Bandagenbehandlung innerhalb der ersten 10 Lebenstage (U1 und U2), Gruppe II ab 11. Lebenstag bis 4. Lebenswoche, Gruppe III ab der 4. Lebenswoche (U3 und später). Klinische und sonographische Nachuntersuchungen wurden befundabhängig durchschnittlich nach 1, 3 und 6 Monaten durchgeführt. Weiterhin erfolgten klinische und radiologische Kontrolluntersuchungen nach dem 1. und 2. Lebensjahr sowie befundabhängige weitere Nachuntersuchungen.

Ergebnisse und

Eine ausbleibende Reposition durch die Pavlik-Bandage trat in der Gruppe I in einem Fall (2,2 %), in Gruppe II in einem Fall (7,1 %) und in Gruppe III in 2 Fällen (10 %) auf. Bei Hüften vom Typ D und Typ III traten ausbleibende Repositionen jeweils in einem Fall (3,3 %) und bei Typ IV in 2 Fällen (10,5 %) auf. Hüftkopfnekrosen wurden in Gruppe I in 2 Fällen (4,4 %), in Gruppe II mit 0 % und in Gruppe III in einem Fall (5 %) nachgewiesen. Initial handelte es sich bei allen Patienten mit einer Hüftkopfnekrose um Typ-IV-Hüften. Alle Nekrosen waren zu den Verlaufskontrollen nach spätestens 2 Jahren nicht mehr nachweisbar.

Schlussfolgerungen

Zusammenfassend zeigt die Untersuchung, dass auch bei späterem Therapiebeginn sehr gute Ergebnisse erzielt werden können; allerdings steigen die Raten von ausbleibenden Repositionen und Hüftkopfnekrosen an. Ein Hüftultraschallscreening zur U3 scheint somit ausreichend, wobei sich insbesondere bei Risikogruppen ein zusätzliches Screening bis zur U2 empfiehlt, was bei normalen Befunden jedoch eine erneute Evaluation zur U3 nicht ersetzt.

Abstract

Background

Up to 4 % of all neonates in Central Europe are born with congenital hip dysplasia (CHD), the most common congenital disease of the musculoskeletal system. However, in this retrospective analysis the outcomes of infants with CHD (type D, III or IV according to Graf) have been considered, with Pavlik therapy starting within the first 12 weeks of life. Connections between the start of therapy or the first finding according to Graf`s classification and the ultrasound result achieved, as well as the X-rays taken after 1 and 2 years, were evaluated. No repositioning under Pavlik treatment or side effects and their relevance have been evaluated, especially with regard to avascular necrosis (AVN) of the femoral head.

Materials and methods

All infants treated using Pavlik treatment for CHD between 2010 and 2012 in our clinic were determined. A total of 62 patients with 79 pathological hips were included. The infants were classified into three groups to evaluate the influence of the start of therapy on the result: group I with the first investigation and start of treatment within the first 10 days of life, group II between the 11th day and the end of week 3, group III within preventive general examinations (U3) after the 4th week. Clinical examinations and the usual ultrasound scans were performed at an average of 1, 3, and 6 months. Furthermore, after 1 and 2 years clinical and radiological investigations were carried out, as well as further examinations depending on the findings.

Results

A failure of repositioning of the Pavlik treatment occurred in group I in 1 case (2.2 %), in group II in 1 case (7.1 %), and in group III in 2 cases (10 %). This occurs in hips type D and type III in 1 case each (3.3 %) and type IV in 2 cases (10.5 %). Maturation disorders of the hips were found in 1 case (2.2 %) in group I, 1 case (7.1 %) in group II, and 3 cases (15 %) in group III. Avascular necrosis of the femoral head was proven in 2 cases (4.4 %) in group I, 0 % in group II, and in 1 case (5 %) in group III. All patients initially had femoral head necrosis of Graf type IV . All necrosis and maturation disorders were no longer visible on subsequent examinations after 2 years at the most.

Conclusions

In summary, the study shows that even with a late treatment start (U3) good results could be achieved, but with a rising number of repositioning failures and femoral necroses. Ultrasound screening on U3 seems to be sufficient; however, for high-risk groups an additional screening in the first week of life should be performed, which does not replace a second evaluation at U3 if there are normal findings.

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Literatur

  1. Cooper AP, Doddabasappa SN, Mulpuri K (2014) Evidence-based management of developmental dysplasia of the hip. Orthop Clin North Am 45(3):341–354

    Article  PubMed  Google Scholar 

  2. Dornacher D, Cakir B, Reichel H, Nelitz M (2010) Early radiological outcome of ultrasound monitoring in infants with developmental dysplasia of the hips. J Pediatr Orthop B 19(1):27–31

    Article  PubMed  Google Scholar 

  3. Farr S, Grill F, Muller D (2008) When is the optimal time for hip ultrasound screening? Orthopäde 37(6):532, 534–536, 538–540

    Article  Google Scholar 

  4. Finlay HVL, Maudsley RH, Busfield PI (1967) Dislocatable hip and dislocated hip in the newborn infant. Br Med J 4(5576):377–381

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  5. Gabuzda GM, Renshaw TS (1992) Reduction of congenital dislocation of the hip. J Bone Joint Surg Am 74:624–631

    PubMed  CAS  Google Scholar 

  6. Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg 97:117–133

    Article  PubMed  CAS  Google Scholar 

  7. Graf R (1987) Sonographic diagnosis of hip dysplasia. Principles, sources of error and consequences. Ultraschall Med 8(1):2–8

    Article  PubMed  CAS  Google Scholar 

  8. Graf R (2002) Ultrasound examination of the hip. An update. Orthopäde 31(2):181–189

    Article  PubMed  CAS  Google Scholar 

  9. Gulati V, Eseonu K, Sayani J, Ismail N, Uzoigwe C, Choudhury MZ, Gulati P, Aqil A, Tibrewal S (2013) Developmental dysplasia of the hip in the newborn: a systematic review. World J Orthop 4(2):32–41

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ihme N, Altenhofen L, von Kries R, Niethard FU (2008) Hip ultrasound screening in Germany. Results and comparison with other screening procedures. Orthopäde 37(6):541–546, 548–549

    Article  PubMed  CAS  Google Scholar 

  11. Johnson AH, Aadalen RJ, Eilers VE, Winter RB (1981) Treatment of congenital hip dislocation and dysplasia with the Pavlik harness. Clin Orthop Relat Res 155:25–29

    PubMed  Google Scholar 

  12. Jones DHA (2010) Shenton’s line. J Bone Joint Surg 92-B:1312–1315

    Article  Google Scholar 

  13. Kalamchi A, MacFarlane R 3rd (1982) The Pavlik harness: results in patients over three months of age. J Pediatr Orthop 2(1):3–8

    Article  PubMed  CAS  Google Scholar 

  14. Kokavec M, Makai F, Olos M, Bialik V (2006) Pavlik’s method: a retrospective study Arch Orthop Trauma Surg 126(2):73–76

    Article  PubMed  Google Scholar 

  15. Liu Q, Wang Y, Liu Y, Zhang M, Gao J, Chang J, Tian P, Zhang Y, He X, Chen X, Qin P, Fan Y, Meng C, Jia X, Liu X, Fan Y, Wang J (2014) Early screening of developmental dysplasia of the hip among hospitalized children. Zhonghua Yi Xue Za Zhi 94(20):1567–1569

    PubMed  Google Scholar 

  16. Mubarak SJ, Bialik V (2003) Pavlik: the man and his method. J Pediatr Orthop 23:342–346

    PubMed  Google Scholar 

  17. Nelitz M, Reichel H (2008) Nonsurgical treatment of developmental dysplasia of the hip. Orthopäde 37(6):550, 552–555

    Article  Google Scholar 

  18. Pavlik A (1957) Method of functional therapy with strap braces as a principle of conservative therapy of congenital dislocation of the hip in infants. Z Orthop 89:341–352

    PubMed  CAS  Google Scholar 

  19. Pavlik A (1989) Stirrups as an aid in the treatment of congenital dysplasias of the hip in children. J Pediatr Orthop 9:157–159

    Article  PubMed  CAS  Google Scholar 

  20. Pavlik A (1992) The functional method of treatment using a harness with stirrups as the primary method of conservative therapy for infants with congenital dislocation of the hip. Clin Orthop Relat Res 281:4–10

    PubMed  Google Scholar 

  21. Peled E, Bialik V, Katzman A, Eidelman M, Norman D (2008) Treatment of Graf’s ultrasound class III and IV hips using Pavlik’s method. Clin Orthop Relat Res 466(4):825–829

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pollet V, Pruijs H, Sakkers R, Castelein R (2010) Results of Pavlik harness treatment in children with dislocated hips between the age of six and twenty-four months. J Pediatr Orthop 30(5):437–442

    Article  PubMed  Google Scholar 

  23. Roposch A, Liu LQ, Hefti F, Clarke NMP, Wedge JH (2011) Standardized diagnostic criteria for developmental dysplasia of the hip in early infancy. Clin Orthop Relat Res 469(12):3451–3461

    Article  PubMed  PubMed Central  Google Scholar 

  24. van de Sande MAJ, Melisie F (2012) Successful Pavlik treatment in late-diagnosed developmental dysplasia of the hip. Int Orthop 36:1661–1668

    Article  PubMed  PubMed Central  Google Scholar 

  25. Shorter D, Hong T, Osborn DA (2013) Cochrane Review: screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health 8(1):11–54

    Article  PubMed  Google Scholar 

  26. Sink EL, Ricciardi BF, Torre KD, Price CT (2014) Selective ultrasound screening is inadequate to identify patients who present with symptomatic adult acetabular dysplasia. J Child Orthop 8(6):451–455

    Article  PubMed  PubMed Central  Google Scholar 

  27. Sochart DH, Paton RW (1996) Role of ultrasound assessment and harness treatment in the management of developmental dysplasia of the hip. Ann R Coll Surg Engl 78:505–508

    PubMed  CAS  PubMed Central  Google Scholar 

  28. Thallinger C, Pospischill R, Ganger R, Radler C, Krall C, Grill F (2014) Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program. J Child Orthop 8(1):3–10

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tönnis D (2001) Protective influence of the ossific femoral nucleus with regard to avascular necrosis in the treatment of developmental hip dislocation was doubted. J Pediatr Orthop 21(1):135–136

    Article  PubMed  Google Scholar 

  30. Tönnis D, Kuhlmann GP (1969) Studies on the frequency of femur head necroses following the use of braces and various conservative therapeutic technics in congenital hip displasia and hip luxation. Z Orthop Ihre Grenzgeb 106(4):651–672

    PubMed  Google Scholar 

  31. Tiruveedhula M, Reading IC, Clarke NM (2014) Failed Pavlik harness treatment for DDH as a risk factor for avascular necrosis. J Pediatr Orthop 35(2):140-143

  32. Tschauner C, Klapsch W, Graf R (1993) The effect of ultrasonography screening of hips in newborn infants on femur head necrosis and the rate of surgical interventions. Orthopäde 22(5):268–276

    PubMed  CAS  Google Scholar 

  33. Wada I, Sakuma E, Otsuka T, Wakabayashi K, Ito K, Horiuchi O, Asagai Y, Kamegaya M, Goto E, Satsuma S, Kobayashi D, Saito S, Taketa M, Takikawa K, Nakashima Y, Hattori T, Mitani S, Wada A (2013) The Pavlik harness in the treatment of developmentally dislocated hips: results of Japanese multicenter studies in 1994 and 2008. J Orthop Sci 18(5):749–753

    Article  PubMed  PubMed Central  Google Scholar 

  34. Woodacre T, Dhadwal A, Ball T, Edwards C, Cox PJA (2014) The costs of late detection of developmental dysplasia of the hip. J Child Orthop 8:325–332

    Article  PubMed  PubMed Central  Google Scholar 

  35. Woolacott NF, Puhan MA, Steurer J, Kleijnen J (2005) Ultrasonography in screening for developmental dysplasia of the hip in newborns: systematic review. Br Med J 330:1413

    Article  Google Scholar 

  36. Ying GY, Jia Y, Pei FX, Zhou ZK, Luan RS, Yu HT, Yang J, Shen B, Feng W, Chen ZY, Zheng YC, Liu WG, Tang SG, Song ZY (2007) One family investigation and risk factors analysis of developmental dysplasia of the hip. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 24(1):84–87

    PubMed  Google Scholar 

  37. Ziegler J, Thielemann F, Mayer-Athenstaedt C, Günther KP (2008) The natural history of developmental dysplasia of the hip. A meta-analysis of the published literature. Orthopade 37(6):515–516, 518–524

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    D. Zajonz, S. Strobel, M. Wojan, N. von der Höh, C. Josten, E. Schumann &  C.-E. Heyde

  2. Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    P. Brandmaier

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  1. D. Zajonz
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  2. S. Strobel
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Correspondence to C.-E. Heyde.

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Interessenkonflikt

D. Zajonz, S. Strobel, M. Wojan, N. von der Höh, P. Brandmaier, C. Josten, E. Schumann und C.-E. Heyde geben an, dass kein Interessenkonflikt besteht.

Für die in dieser Arbeit retrospektiv analysierten Patientendaten war ein Votum einer Ethikkommission nicht erforderlich.

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Zajonz, D., Strobel, S., Wojan, M. et al. Pavlik-Bandage zur Therapie der kongenitalen Hüftdysplasie Typ D, III und IV. Orthopäde 45, 72–80 (2016). https://doi.org/10.1007/s00132-015-3171-3

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