A espessura da cartilagem acetabular como medida complementar ao método de Graf para a displasia do desenvolvimento do quadril
Data
2024-11-08
Autores
Motta, Giovanna Galvão Braga 
Orientadores
Iared, Wagner
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A Displasia do desenvolvimento do quadril (DDQ) se caracteriza por uma alteração do desenvolvimento do acetábulo, usualmente presente ao nascimento ou nos primeiros meses de vida e cursa com diferentes graus de incongruência articular. O tempo de tratamento não cirúrgico é variável e é realizado até a normalização do quadril. Alguns estudos buscando a causa dos casos que evoluem com displasia residual apontaram alterações na área do teto cartilaginoso associadas a esses casos. Objetivo: Avaliar a acurácia da medida da espessura da cartilagem acetabular (ECA) avaliada pela ultrassonografia no diagnóstico da DDQ; sua relação com os tipos sonográficos de Graf; e como fator influenciador do tempo de tratamento não cirúrgico. Métodos: Este trabalho foi subdividido em três estudos sequenciais e interdependentes. O estudo 1, foi um estudo de acurácia da ECA para diagnóstico da DDQ tendo como padrão referência o método de Graf. O estudo 2 foi uma coorte prospectiva que avaliou se a medida da ECA tem relação com a evolução do quadril durante o tratamento não cirúrgico. Um estudo adicional foi realizado para avaliar a reprodutibilidade da medida da ECA pelo método ultrassonográfico. Os participantes foram crianças de zero a seis meses de vida encaminhados por pediatras, ortopedistas ou ortopedistas pediátricos com suspeita de DDQ, para avaliação ultrassonográfica dos quadris pelo método de Graf, incluídos no trabalho de forma consecutiva. Resultados: Foram avaliados 2.738 quadris de 1.369 pacientes. Desses 877 eram do sexo feminino (64%) e 492 do sexo masculino (36%), com média de idade de seis semanas de vida. A ECA foi medida em todos os quadris, e avaliada sua relação com os tipos sonográficos de Graf. Todos os valores tiveram significância estatística, mais evidente nos quadris tipo III, no entanto não há valor de corte suficientemente acurado para o diagnóstico de DDQ. O aumento da ECA durante o tratamento se correlacionou com maior necessidade de tempo de uso da órtese para atingir o quadril tipo I de Graf. Conclusão: A ECA tem significância estatística comparada a classificação de Graf, principalmente no quadril do tipo III, porém não pode ser utilizada para diagnóstico da DDQ. Quando a ECA aumenta durante o tratamento não cirúrgico, a resolução da DDQ tende a ser mais lenta, com necessidade de um tempo maior do uso da órtese.
Introduction: Developmental Dysplasia of the Hip (DDH) is characterized by an alteration in the development of the acetabulum, usually present at birth or in the first months of life, presenting different degrees of joint incongruence. The non-surgical treatment time is variable and is performed up to a time when the hip stabilizes itself. Some studies seeking the cause of cases which evolve to residual dysplasia have pointed to changes in the area of the cartilaginous roof associated with such cases. Goal: To evaluate the accuracy of acetabular cartilage thickness (ACT) measurements evaluated by ultrasonography in the diagnosis of DDH; its relationship with Graf's sonographic types; and as an influencing factor of the non-surgical treatment time. Method: This study was subdivided into three sequential and interdependent studies. Study 1 was a study of ACT accuracy for the diagnosis of DDH using the Graf method as the reference standard. Study 2 was a prospective cohort that evaluated whether ACT measurement holds any correlation to hip evolution during non-surgical treatment. An additional study was carried out to evaluate the reproducibility of ACT measurements by ultrasound. Patients included children from zero to six months of age referred by pediatricians, orthopedists or pediatric orthopedists with or without suspicion of Developmental Dysplasia of the Hip (DDH), for ultrasound evaluation of the hips under the Graf Method. They have been included in the study in a consecutive approach. Results: A total of 2,738 hips from 1,369 patients were evaluated. Out of those, 877 were female (64%) and 492 were male (36%), with a median age of six weeks of life. ACT was measured in all hips, and its relationship with Graf's sonographic types was evaluated. All values were statistically significant and more evident in type III hips, although there is no sufficiently accurate cut-off value for the diagnosis of DDH. The increase in ACT during treatment was correlated with the need for a longer period using the orthosis to reach a type-1 Graf hip. Conclusion: ACT accuracy is statistically significant when compared to the Graf method, especially in type III hips. However, it should not be used for the diagnosis of DDH. When ACT increases during non-surgical treatment, DDH resolution tends to be slower, requiring longer periods using an orthosis.
Introduction: Developmental Dysplasia of the Hip (DDH) is characterized by an alteration in the development of the acetabulum, usually present at birth or in the first months of life, presenting different degrees of joint incongruence. The non-surgical treatment time is variable and is performed up to a time when the hip stabilizes itself. Some studies seeking the cause of cases which evolve to residual dysplasia have pointed to changes in the area of the cartilaginous roof associated with such cases. Goal: To evaluate the accuracy of acetabular cartilage thickness (ACT) measurements evaluated by ultrasonography in the diagnosis of DDH; its relationship with Graf's sonographic types; and as an influencing factor of the non-surgical treatment time. Method: This study was subdivided into three sequential and interdependent studies. Study 1 was a study of ACT accuracy for the diagnosis of DDH using the Graf method as the reference standard. Study 2 was a prospective cohort that evaluated whether ACT measurement holds any correlation to hip evolution during non-surgical treatment. An additional study was carried out to evaluate the reproducibility of ACT measurements by ultrasound. Patients included children from zero to six months of age referred by pediatricians, orthopedists or pediatric orthopedists with or without suspicion of Developmental Dysplasia of the Hip (DDH), for ultrasound evaluation of the hips under the Graf Method. They have been included in the study in a consecutive approach. Results: A total of 2,738 hips from 1,369 patients were evaluated. Out of those, 877 were female (64%) and 492 were male (36%), with a median age of six weeks of life. ACT was measured in all hips, and its relationship with Graf's sonographic types was evaluated. All values were statistically significant and more evident in type III hips, although there is no sufficiently accurate cut-off value for the diagnosis of DDH. The increase in ACT during treatment was correlated with the need for a longer period using the orthosis to reach a type-1 Graf hip. Conclusion: ACT accuracy is statistically significant when compared to the Graf method, especially in type III hips. However, it should not be used for the diagnosis of DDH. When ACT increases during non-surgical treatment, DDH resolution tends to be slower, requiring longer periods using an orthosis.
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Citação
MOTTA, Giovanna Galvão Braga. A espessura da cartilagem acetabular como medida complementar ao método de Graf para a displasia do desenvolvimento do quadril. 2024. 117 f. Tese (Doutorado em Saúde Baseada em Evidências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.