ЛЕЧЕНИЕ ВРОЖДЁННОГО ВЫВИХА БЕДРА ДИНАМИЧЕСКИМИ ШИНАМИ У ДЕТЕЙ ДО ОДНОГО ГОДА

Abstract

Objective: To enhance the outcomes of conservative treatment for developmental dysplasia of the hip (DDH) with congenital hip dislocation (CHD) in infants under one year by using dynamic splinting (DS). Methods: The study examined the treatment of CHD in 206 infants during their first year of life. There were 164 girls (79.6%) and 42 boys (20.4%). Patient age distribution: up to 3 months – 17.0%, 4-6 months – 28.6%, 7-9 months – 40.3%, and 10-12 months – 14.1%. 151 (73.3%) had unilateral dislocation, and 55 (26.7%) had bilateral dislocation. The control group (n=101) used splints with rigid fixation of the limb in 67 (66.3%) and in 34 (33.7%) patients, the CITO splint and the Vilensky splint were used, respectively. In the main group, 105 patients (51.0%) used two DS types developed by study authors. Results: The study showed that traditional splints used in the control group had disadvantages associated with the rigid fixation of limbs, i.e., lack of mobility leading to hip joint (HJ) contracture and aseptic necrosis of the femoral head. Two types of dynamic hip abduction splints were developed to overcome these shortcomings. The first is called the DS, which is used to treat CHD in children without aseptic necrosis or in the absence of the threat of such a complication. The second is called dynamic distraction splint (DDS), which was developed to treat CHD with avascular necrosis or in the presence of a risk of such a complication. The implementation of these approaches resulted in a statistically significant reduction in the frequency of aseptic necrosis (from 15.8% to 1.9%, p<0.05), HJ contracture (from 18.8% to 3.8%, p<0.05), residual phenomena (from 14.9% to 4.7%, p<0.05), and a decrease in the frequency of unsatisfactory results compared to traditional approaches (7.6% versus 22.8%, p<0.05). Conclusion: The DS technique enables achieving maximum mobility in the HJ while maintaining the abduction and preserving the function of the structure during the actual treatment process at different ages. This, in turn, assists in enhancing the treatment outcomes for the patients. Keywords: Congenital hip dislocation, conservative treatment, abduction splints, dynamic distraction splints.