The Outcomes Of Different Treatments Of 409 Screened Cases With Graf Type? DDH: A Retrospective Multicenter Study

Objective: To compare the effect of different intervention methods including abduction embrace,Pavlik hardness,wide diapers flexion and passive hips abduction exercises on children with Graf type ? DDH(?a??b??c??d)and to explore the treatment of Graf type ? DDH.To investigate the possible evaluation criterion difference between ultrasound and X-ray during the follow-up.Methods: This was a multicenter observational registry and there were 409 screened cases with Graf type ? DDH from January 2011 to December 2015 from 7 hospitals in 7 cities across China.All the patients did not receive any treatment previously and had no neuromuscular disorders.Their clinical features,intervention methods,diagnosis and treatment options,imaging results and so on were analyzed retrospectively.One-way analysis of variance was used to assess the treatment outcome of Graf type?a DDH screened cases with different intervention methods.One-way analysis was used to compare Pavlik hardness to others intervention methods in the treatment outcome of Graf type?b DDH screened cases.For those cases followed up by ultrasound and X-ray,the difference of positive rate between ultrasonography and X-ray examination was compared by Fisher's exact test with paired four-grid data.Results: Among the 409 cases,124 were male and 285 were female,including 292 Graf type ? a,102 Graf type ? b,14 Graf type ? c,1 Graf type ? d.There were significant differences in the average treatment durations between the each two of three intervention methods(56 days by abduction embrace,38 days by Pavlik hardness,46 days by wide diapers flexion and passive hips abduction exercises)(F=9.422,P=0.0001).Of Graf type?b DDH screened cases,there were significant differences in the average treatment durations between Pavlik hardness(32 days)to other's intervention methods(45 days)(F=5.556,P=0.001).During the followed-up,the positive rate of ultrasonography and X-ray examination were 9.05%(18/199)and 0.50%(1/199).There was no significant difference of positive rate between ultrasonography and X-ray examination(c2=10.106,P=0.09).Conclusion: All Graf type?DDH cases can be cured with the Pavlik harnesses.(1)For Graf type?a DDH and Graf type?b DDH cases,the average treatment durations of using the Pavlik harnesses is shorter than those using wide diapers flexion and passive hip abduction exercises and abduction embrace.(2)No abnormal hip is found in all cases with different intervention methods including abduction embrace,Pavlik hardness,wide diapers flexion and passive hip abduction exercises.(3)The ultrasonography is a good method to assess the Graf type ? DDH cases.