Despite the high incidence of developmental dysplasia of the hip (DDH), treatment is very diverse. Therefore, the Dutch Orthopedic Society developed a clinical practice guideline with recommendations for optimal and uniform treatment of DDH. This article summarizes the guideline on centered DDH (i.e. Graf types 2A-C). The guideline development followed the criteria of Appraisal of Guidelines for Research and Evaluation II. A systematic literature review was performed to identify randomized controlled trials and comparative cohort studies including children <1 year with centered DDH. Articles were included that compared (1) treatment with observation, (2) different abduction devices, (3) follow-up frequencies, and (4) discontinuation methods. Recommendations were based on Grading Recommendations Assessment, Development, and Evaluation, which included the literature, clinical experience and consensus, patient and parent comfort, and costs. Out of 430 potentially relevant articles, 5 comparative studies were included. Final guideline recommendations were (1) initially observe 3-month-old patients with centered DDH, start abduction treatment if the hip does not normalize after 6-12 weeks; (2) prescribe a Pavlik harness to children <6 months with persisting DDH on repeated ultrasonography, consider alternative abduction devices for children >6 months; (3) assess patients every 6 weeks; and (4) discontinue the abduction device when the hip has normalized or when the child is 12 months. This paper presents a summary of part 1 of the first evidence-based guideline for treatment of centered DDH in children <1 year. Part 2 presents the guideline on decentered DDH in a separate article.

中文翻译：

---

1 岁以下髋部中心发育性发育不良的治疗：循证临床实践指南 - 第 1 部分。

尽管髋关节发育不良 (DDH) 的发生率很高，但治疗方法非常多样化。因此，荷兰骨科协会制定了临床实践指南，其中包含 DDH 的最佳和统一治疗建议。本文总结了居中 DDH（即 Graf 类型 2A-C）的指南。指南的制定遵循了《研究和评价指南评价 II》的标准。进行了系统的文献回顾，以确定随机对照试验和比较队列研究，包括小于 1 岁的以 DDH 为中心的儿童。包括比较（1）治疗与观察，（2）不同的外展装置，（3）随访频率和（4）停药方法的文章。建议基于评分建议评估、开发和评估，其中包括文献、临床经验和共识、患者和父母的舒适度以及成本。在 430 篇可能相关的文章中，纳入了 5 篇比较研究。最终指南建议是（1）首先观察 3 个月大的 DDH 居中患者，如果 6-12 周后髋关节未恢复正常，则开始外展治疗；(2) 为小于 6 个月且在重复超声检查中持续存在 DDH 的儿童开具 Pavlik 安全带，为大于 6 个月的儿童考虑替代外展装置；(3) 每 6 周对患者进行一次评估；(4) 当髋关节恢复正常或孩子 12 个月时停止外展装置。本文总结了第一个循证指南的第 1 部分，用于治疗小于 1 岁儿童的中心 DDH。