409例Graf Ⅱ型发育性髋关节脱位不同干预后转归的回顾性多中心研究

发布时间：2018-04-28 07:24

本文选题：发育性髋关节发育不良 + GrafⅡ型　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:比较3种干预方式(蛙式抱、Pavlik挽具,宽尿布湿以及屈髋外展被动操)对GrafⅡ(Ⅱa、Ⅱb、Ⅱc、Ⅱd)型发育性髋关节发育不良(DDH)患儿的疗效,从而探讨GrafⅡ型DDH的治疗方案。探讨超声随访与X线随访的关系。方法:本研究为多中心、回顾性临床研究。从2011年1月至2015年12月,纳入我国7个城市7家儿童医院,既往无治疗史、且不合并神经肌肉疾患的GrafⅡ型DDH患儿的资料,共409例。对其临床表现、干预方式、诊治经过、影像结果等进行回顾性分析。采用单因素方差分析两两比较,评估3种不同干预方式对GrafⅡa型DDH患儿的转归;采用单因素方差分析,评估Pavlik挽具及非Pavlik挽具(蛙式抱、宽尿布湿以及屈髋外展被动操)对GrafⅡb型DDH患儿的转归。采用配对四格表Fisher确切概率法,比较超声检查发现异常的阳性率和X线检查的差异。结果:409例中,男124例,女285例;GrafⅡa型292例,Ⅱb型102例,Ⅱc型14例,Ⅱd型1例。GrafⅡa型DDH患儿分别采用3种干预方式干预后,正常转归时间分别为:Pavlik挽具,平均38 d;宽尿布湿以及屈髋外展被动操,平均46 d;蛙式抱,平均56 d,差异有统计学意义(F=9.422,P=0.0001)。GrafⅡb型DDH患儿采用Pavlik挽具与非Pavlik挽具干预正常转归时间分别为32 d和45 d,差异有统计学意义(F=5.566,P=0.001)。超声检查和X线随访检查发现异常结果的阳性率分别为9.05%(18/199)和0.50%(1/199),差异无统计学意义(c2=10.106,P=0.09)。结论:GrafⅡ型DDH均能用Pavlik挽具治愈。(1)对GrafⅡa型、Ⅱb型DDH患儿,Pavlik挽具干预与宽尿布湿以及屈髋外展被动操干预、蛙式抱干预比较,治愈所需时间最短。(2)所有409例临床随访均未发现髋关节异常。(3)超声是随访评价GrafⅡ型DDH患儿有效的工具。
[Abstract]:Objective: To compare the effect of 3 kinds of intervention methods (breaststroke, Pavlik harness, wetness of wide diaper and flexion of hip abduction) to Graf II (II A, II B, II C, d) developmental dysplasia of the hip (DDH), and discuss the therapeutic scheme of Graf type II DDH. The relationship between the follow-up and the follow-up of the ultra sound follow-up. Methods: This study was a multicenter and retrospective study. From January 2011 to December 2015, 7 children's hospitals in 7 cities of China were included in 409 cases of Graf II DDH children without history of treatment and no neuromuscular disorders. The clinical manifestations, intervention methods, diagnosis and treatment, and image results were retrospectively analyzed. The comparison of single factor analysis of variance 22 was used. The outcome of 3 different intervention methods for children with Graf II a DDH was evaluated. By single factor analysis of variance, the prognosis of children with Graf II B DDH was evaluated by Pavlik harness and non Pavlik harness (breaststroke, wide diaper wetness and flexion of hip abduction). A paired four lattice Fisher exact probability method was used to compare the positive rate and X-ray findings of abnormal ultrasound. Results: among the 409 cases, there were 124 males and 285 females, 292 cases of Graf II A, 102 cases of type II B, 14 cases of type II C, 1 children of type.Graf II a DDH in type II d, respectively: Pavlik harness, average 38 D, wide diaper wetness and flexion hip abduction passive exercise, average 46 D, frog type, average 56 D, the difference, the difference, the difference, the mean of 56 D, the difference, the difference, the difference, the difference, the mean of 56 D, the difference, the difference, the difference, the difference, the difference, the difference, the difference, the difference, the difference, the difference, the mean, the difference, the mean 56 D, difference, the difference The statistical significance (F=9.422, P=0.0001).Graf II B DDH children with Pavlik harness and non Pavlik harness intervention were 32 D and 45 D, respectively. The difference was statistically significant (F=5.566, P=0.001). The positive rates of abnormal results were 9.05% (18/199) and 0.50% (1/199), respectively, with no statistical difference. Significance (c2=10.106, P=0.09). Conclusion: Graf II type DDH can be cured with Pavlik harness. (1) Graf II A, type II B DDH children, Pavlik harness intervention and wide diaper wetness and flexion hip abduction passive intervention, breaststroke intervention comparison, the shortest cure time. (2) all 409 cases of clinical follow-up did not find hip abnormality. (3) ultrasound is followed up and evaluation An effective tool for children with type Graf type II DDH.

【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.8

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