İNSTABİL KALÇAYA SAHİP, 3-6 AYLIK HASTALARIN TEDAVİSİNDE PAVLİK BANDAJI ETKİNLİĞİNİN DEĞERLENDİRİLMESİ
Öz
Amaç: Üç ila altı aylık stabil olmayan kalça teşhisi konulan hastaların tedavisinde pavlik bandajın (PB) etkinliğinin araştırılması. Gereç ve Yöntem: Üç ila altı aylık stabil olmayan kalça teşhisi konulan ve pavlik bandajı ile tedavi edilen hastalar geriye dönük olarak incelendi. Hastaların stabil olmayan kalçaları PB kullanılarak tedavi edildi ve haftalık olarak klinik muayene ile yakından takip edildi. Birincil sonuç kriteri, stabil olmayan kalçaları olan çocuklarda PB tedavisinin başarı oranını değerlendirmekti (Graf’a göre tip IID, III, IV). Başarı kriterleri, Graf’ın kalça ultrasonografisi yöntemine göre tip I kalça veya kalça radyografisinde konsantrik redüksiyon elde edilmesi olarak tanımlandı. Bulgular: Bölümümüze ilk başvuru sırasında Graf yöntemine göre ultrasonografik muayene ile tanı konan 33 hasta ve 34 kalça çalışmaya dahil edildi. Pavlik bandajı tedavisinin başlangıcında çocukların ortalama yaşı 17 hafta (aralık, 14–22); ortalama takip süresi 48 ay (aralık, 24–84) olarak saptandı. Başvuru anında ortalama alfa açısı 46 (aralık, 35–58) olarak ölçüldü. Graf sınıflandırmasına göre GKD, 18 kalça Tip D (%52), 5 kalçada Tip IIIa, 3 (%24) tip IIIB ve 8 (%24) tip IV olarak saptandı. Bu 34 kalçadan 28’i (%82), ortalama 11,24 hafta (aralık, 4–20) uygulama süresi ile PB kullanılarak başarıyla tedavi edildi. PH tedavisinin başarı oranı %82 (28/34 kalça) olarak belirlendi. Sonuç: İnstabil kalçası olan (Graf Tip IID, III, IV) üç ila altı ay arasında tanı konulan hastalarda PB tedavisinden başarılı sonuçlar elde edilebilir.
Anahtar Kelimeler
Gelişimsel kalça displazisi Pavlik bandajı bandaj tedavisi tedavi başarı oranı geç teşhis edilen gelişimsel kalça displazisi
Kaynakça
- 1. Kokavec M, Makai F, Olos M, Bialik V. Pavlik’s method: a retrospective study. Arch Orthop Trauma Surg 2006;126(2):73-6. [CrossRef]
- 2. Pollet V, Pruijs H, Sakkers R, Castelein R. Results of Pavlik harness treatment in children with dislocated hips between the age of six and twenty-four months. J Pediatr Orthop 2010;30(5):437-42. [CrossRef]
- 3. Westacott DJ, Mackay ND, Waton A, Webb MS, Henman P, Cooke SJ. Staged weaning versus immediate cessation of Pavlik harness treatment for developmental dysplasia of the hip. J Pediatr Orthop B 2014;23(2):103-6. [CrossRef]
- 4. Atalar H, Sayli U, Yavuz OY, Uraş I, Dogruel H. Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip. Int Orthop 2007;31(2):145-50. [CrossRef]
- 5. Omeroglu H, Kose N, Akceylan A. Success of Pavlik Harness Treatment Decreases in Patients > 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip. Clin Orthop Relat Res 2016;474(5):1146- 52. [CrossRef]
- 6. Cashman J, Round J, Taylor G, Clarke N. The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. J Bone Joint Surg Br 2002;84(3):418-25. [CrossRef]
- 7. Harding MG, Harcke HT, Bowen JR, Guille JT, Glutting J. Management of dislocated hips with Pavlik harness treatment and ultrasound monitoring. J Pediatr Orthop 1997;17(2):189-98. [CrossRef]
- 8. Viere R, Birch J, Herring J, Roach J, Johnston C. Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment. J Bone Joint Surg Am 1990;72(2):238-44. [CrossRef]
- 9. Lerman JA, Emans JB, Millis MB, Share J, Zurakowski D, Kasser JR. Early failure of Pavlik harness treatment for developmental hip dysplasia: clinical and ultrasound predictors. J Pediatr Orthop 2001;21(3):348-53. [CrossRef]
- 10. Uçar DH, Isklar ZU, Kandemir U, Tümer Y. Treatment of developmental dysplasia of the hip with Pavlik harness: prospective study in Graf type IIc or more severe hips. J Pediatr Orthop B 2004;13(2):70-4. [CrossRef]
- 11. Thieme WT, Thiersch JB. Translation: Hilgenreiner on congenital hip dislocation. J Pediatr Orthop 1986;6(2):202- 14. [CrossRef]
- 12. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980;62(6):876-88. [CrossRef]
- 13. Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 1976;119:39-47. [CrossRef]
- 14. Westacott DJ, Mackay ND, Waton A, Webb MS, Henman P, Cooke SJ. Staged weaning versus immediate cessation of Pavlik harness treatment for developmental dysplasia of the hip. J Pediatr Orthop B 2014;23(2):103-6. [CrossRef]
- 15. Nakamura J, Kamegaya M, Saisu T, Someya M, Koizumi W, Moriya H. Treatment for developmental dysplasia of the hip using the Pavlik harness. J Bone Joint Surg Br 2007;89(2):230-5. [CrossRef]
- 16. Ramsey P, Lasser S, MacEwen G. Congenital dislocation of the hip. Use of the Pavlik harness in the child during the first six months of life. J Bone Joint Surg Am 1976;58(7):1000-4. [CrossRef]
- 17. Larson JE, Patel AR, Weatherford B, Janicki JA. Timing of Pavlik Harness Initiation: Can We Wait? J Pediatr Orthop 2019;39(7):335-8. [CrossRef]
- 18. Tiruveedhula M, Reading IC, Clarke NM. Failed Pavlik harness treatment for DDH as a risk factor for avascular necrosis. J Pediatr Orthop 2015;35(2):140-3. [CrossRef]
- 19. Kitoh H, Kawasumi M, Ishiguro N. Predictive factors for unsuccessful treatment of developmental dysplasia of the hip by the Pavlik harness. J Pediatr Orthop 2009;29(6):552-7. [CrossRef]
- 20. Suzuki SG, Yamamuro T. Avascular necrosis in patients treated with the Pavlik harness for congenital dislocation of the hip. J Bone Joint Surg Am 1990;72(7):1048-55. [CrossRef]
- 21. Fujioka F, Terayama K, Sugimoto N, Tanikawa H. Longterm results of congenital dislocation of the hip treated with the Pavlik harness. J Pediatr Orthop 1995;15(6):747-52. [CrossRef]
- 22. Tucci JJ, Kumar SJ, Guille JT, Rubbo ER. Late acetabular dysplasia following early successful Pavlik harness treatment of congenital dislocation of the hip. J Pediatr Orthop 1991;3(4):502-5. [CrossRef]
- 23. Carsi B, Al-Hallao S, Wahed K, Page J, Clarke NM. Incomplete periacetabular acetabuloplasty. Acta Orthop 2014;85(1):66-70. [CrossRef]
Öz
Objective: To investigate the effectiveness of the Pavlik harness (PH) in the treatment of patients who were diagnosed with unstable hips aged between three and six months. Material and Method: We retrospectively reviewed patients aged three to six months who were diagnosed with unstable hips and treated with the PH. The patients were treated using PH and were closely followed by a weekly clinical examination. The primary outcome was to assess the success rate of PH treatment in children with unstable hips (Graf Type IID, III, IV). A successful outcome as a result of PH treatment was defined as either obtaining a Type I hip based on Graf’s method of hip ultrasonography or a concentric reduction based on hip radiography. Results: Thirty-three patients’ 34 hips were included in this study with a diagnosis of DDH based on hip sonography performed according to the Graf’s method at the time of initial admission to our department. The mean age of the children in the beginning of the PH treatment was 17 weeks (range, 14–22); the mean follow- up was 48 months (range, 24–84). On admission, the mean alpha angle was 46 (range, 35–58). According to the Graf classification, DDH was determined as Type D in 18 hips (52%), Type IIIa in 5 hips, Type IIIB in 3 (24%) and Type IV in 8 (24%). Of these 34 hips, 28 (82%) were treated successfully using PH, with a mean application time of 11.24 weeks (range, 4–20). The success rate of PH treatment was determined as 82% (28/34 hips). Conclusions: Favorable outcomes can be expected from PH treatment in patients with unstable hips (Graf Type IID, III, IV) who are diagnosed between the age of three and six months.
Anahtar Kelimeler
Developmental dysplasia of the hip Pavlik harness harness treatment treatment success rate late-diagnosed hip dysplasia
Kaynakça
- 1. Kokavec M, Makai F, Olos M, Bialik V. Pavlik’s method: a retrospective study. Arch Orthop Trauma Surg 2006;126(2):73-6. [CrossRef]
- 2. Pollet V, Pruijs H, Sakkers R, Castelein R. Results of Pavlik harness treatment in children with dislocated hips between the age of six and twenty-four months. J Pediatr Orthop 2010;30(5):437-42. [CrossRef]
- 3. Westacott DJ, Mackay ND, Waton A, Webb MS, Henman P, Cooke SJ. Staged weaning versus immediate cessation of Pavlik harness treatment for developmental dysplasia of the hip. J Pediatr Orthop B 2014;23(2):103-6. [CrossRef]
- 4. Atalar H, Sayli U, Yavuz OY, Uraş I, Dogruel H. Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip. Int Orthop 2007;31(2):145-50. [CrossRef]
- 5. Omeroglu H, Kose N, Akceylan A. Success of Pavlik Harness Treatment Decreases in Patients > 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip. Clin Orthop Relat Res 2016;474(5):1146- 52. [CrossRef]
- 6. Cashman J, Round J, Taylor G, Clarke N. The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. J Bone Joint Surg Br 2002;84(3):418-25. [CrossRef]
- 7. Harding MG, Harcke HT, Bowen JR, Guille JT, Glutting J. Management of dislocated hips with Pavlik harness treatment and ultrasound monitoring. J Pediatr Orthop 1997;17(2):189-98. [CrossRef]
- 8. Viere R, Birch J, Herring J, Roach J, Johnston C. Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment. J Bone Joint Surg Am 1990;72(2):238-44. [CrossRef]
- 9. Lerman JA, Emans JB, Millis MB, Share J, Zurakowski D, Kasser JR. Early failure of Pavlik harness treatment for developmental hip dysplasia: clinical and ultrasound predictors. J Pediatr Orthop 2001;21(3):348-53. [CrossRef]
- 10. Uçar DH, Isklar ZU, Kandemir U, Tümer Y. Treatment of developmental dysplasia of the hip with Pavlik harness: prospective study in Graf type IIc or more severe hips. J Pediatr Orthop B 2004;13(2):70-4. [CrossRef]
- 11. Thieme WT, Thiersch JB. Translation: Hilgenreiner on congenital hip dislocation. J Pediatr Orthop 1986;6(2):202- 14. [CrossRef]
- 12. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980;62(6):876-88. [CrossRef]
- 13. Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 1976;119:39-47. [CrossRef]
- 14. Westacott DJ, Mackay ND, Waton A, Webb MS, Henman P, Cooke SJ. Staged weaning versus immediate cessation of Pavlik harness treatment for developmental dysplasia of the hip. J Pediatr Orthop B 2014;23(2):103-6. [CrossRef]
- 15. Nakamura J, Kamegaya M, Saisu T, Someya M, Koizumi W, Moriya H. Treatment for developmental dysplasia of the hip using the Pavlik harness. J Bone Joint Surg Br 2007;89(2):230-5. [CrossRef]
- 16. Ramsey P, Lasser S, MacEwen G. Congenital dislocation of the hip. Use of the Pavlik harness in the child during the first six months of life. J Bone Joint Surg Am 1976;58(7):1000-4. [CrossRef]
- 17. Larson JE, Patel AR, Weatherford B, Janicki JA. Timing of Pavlik Harness Initiation: Can We Wait? J Pediatr Orthop 2019;39(7):335-8. [CrossRef]
- 18. Tiruveedhula M, Reading IC, Clarke NM. Failed Pavlik harness treatment for DDH as a risk factor for avascular necrosis. J Pediatr Orthop 2015;35(2):140-3. [CrossRef]
- 19. Kitoh H, Kawasumi M, Ishiguro N. Predictive factors for unsuccessful treatment of developmental dysplasia of the hip by the Pavlik harness. J Pediatr Orthop 2009;29(6):552-7. [CrossRef]
- 20. Suzuki SG, Yamamuro T. Avascular necrosis in patients treated with the Pavlik harness for congenital dislocation of the hip. J Bone Joint Surg Am 1990;72(7):1048-55. [CrossRef]
- 21. Fujioka F, Terayama K, Sugimoto N, Tanikawa H. Longterm results of congenital dislocation of the hip treated with the Pavlik harness. J Pediatr Orthop 1995;15(6):747-52. [CrossRef]
- 22. Tucci JJ, Kumar SJ, Guille JT, Rubbo ER. Late acetabular dysplasia following early successful Pavlik harness treatment of congenital dislocation of the hip. J Pediatr Orthop 1991;3(4):502-5. [CrossRef]
- 23. Carsi B, Al-Hallao S, Wahed K, Page J, Clarke NM. Incomplete periacetabular acetabuloplasty. Acta Orthop 2014;85(1):66-70. [CrossRef]
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | ARAŞTIRMA |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Temmuz 2021 |
| Gönderilme Tarihi | 24 Şubat 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 84 Sayı: 3 |
Kaynak Göster
Contact information and address
Addressi: İ.Ü. İstanbul Tıp Fakültesi Dekanlığı, Turgut Özal Cad. 34093 Çapa, Fatih, İstanbul, TÜRKİYE
Email: itfdergisi@istanbul.edu.tr
Phone: +90 212 414 21 61