RESOLVING RESIDUAL ACETABULAR DYSPLASIA FOLLOWING SUCCESSFUL BRACE TREATMENT FOR DEVELOPMENTAL DYSPLASIA OF THE HIP IN INFANTS
Notice bibliographique
Résumé
Successful bracing for DDH in infancy is characterized by normal clinical examination and hip ultrasound at the end of treatment. However, radiographic residual acetabular dysplasia (RAD) has been reported in up to 30% of children who had DDH treated in infancy. It is important to predict those that will resolve and those that may need corrective surgery to optimize efficient follow-up protocols. We therefore aimed to identify the prevalence and predictors of RAD at two-years and five-years post bracing and identify factors that predicted spontaneous resolution. This was a single centre, prospective longitudinal cohort study of infants with DDH managed using a published, standardized Pavlik harness protocol between 2012-2016. RAD was measured at two-years mean follow-up using acetabular index-lateral edge (AI-L) and acetabular index-sourcil (AI-S). At five-years, RAD was measured using AI-L, AI-S, centre-edge angle (CEA) and acetabular depth ratio (ADR). At both timepoints, each hip was classified based on published normative values for normal, borderline (1-2 SD), or dysplastic (>2 SD) based on sex, age, and laterality. Of 202 infants that completed the protocol, 181 (90%) had two- and five-years follow-up radiographs. At two-years, in 304 initially pathologic hips, the prevalence of RAD (dysplastic) was 10% and RAD (borderline) was 30%. At five-years, RAD (dysplastic) decreased to 1-3% and RAD (borderline) decreased to < 1 -2%. On logistic regression, no variables were predictive of RAD at two-years. Only AI-L at two-years was predictive of RAD at five-years (p < 0 .001). If both hips were normal at two-years follow-up (n=96), all remained normal at five-years. In those with bilateral borderline hips at two-years (n=21), only two were borderline at five-years, none were dysplastic. In those with either borderline-dysplastic or bilateral dysplasia at two-years (n=26), three (12%) were dysplastic at five-years. The vast majority of RAD at two-years post brace treatment spontaneously resolved by five-years follow-up without surgical intervention. Children with normal radiographs at two-years post brace treatment can be discharged from care. Targeted follow-up for those with abnormal AI-L at two-years will identify those few that may benefit from surgical correction at five-years follow-up. Our evidence-based pragmatic approach to DDH follow-up will inform efficient follow-up protocols and reduce unnecessary exposure to radiography.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».