Establishment and discussion of ultrasonic prediction model for outcome of children with DDH under 6 months treated with Pavlik sling

Establishment and discussion of ultrasonic prediction model for outcome of children with DDH under 6 months treated with Pavlik sling | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Establishment and discussion of ultrasonic prediction model for outcome of children with DDH under 6 months treated with Pavlik sling Jiaju Wang, Qingda Lu, Huan Wang, Chenxin Liu, Shuai Yang, Yating Yang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6463899/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Although Pavlik slings are widely used for the treatment of DDH in children aged 0–6 months, the time point between Pavlik sling and cast treatment is currently debated.This study aims to establish a set of prediction models based on ultrasound indicators and risk factors of children.A total of 102 children, with Pavlik harness failure (n = 22) and Pavlik harness success (n = 80) were included in this study.By comparing the change rate of Pavlik harness treatment between the two groups and establishing a predictive model based on multivariate analysis of follow-up data, 2 months after birth is recommended as the initial age for ultrasound screening of DDH in northwest China. According to the risk factors, the children were divided into 4 grades, and different grades corresponded to different treatment strategies. The end of Pavlik harness treatment was set at 4 months of age.In case the hip joint remained unstable by the time the infant was 4 months old, plaster therapy would then be carried out. Developmental dysplasia of the hip Ultrasound Graf classification Pavlik harness Closed reduction Figures Figure 1 Figure 2 Figure 3 1. INTRODUCTION Childhood developmental dysplasia of the hip (DDH) is a common bone dysplasia disease in children worldwide. Owing to diverse regions and races, the incidence of DDH shows remarkable variation, ranging from 1‰ to 2‰ 1 .At present, there is a consensus that the treatment strategy for young DDH patients is early detection, early diagnosis, and early treatment.If there is no standardized treatment in the early stage or the treatment time is delayed, it can cause serious complications, bringing about a decline in the developmental potential of the hip joint, the aggravation of developmental deformities, abnormal gait, chronic pain, hip arthritis and other serious problems, affecting the quality of life of children 2 .The latest guidelines for the treatment of developmental hip dysplasia in China indicate that the Pavlik sling is generally employed to treat children from 0 to 6 months of age. As for children in the age group of 6–18 months suffering from DDH, closed or open reduction plaster fixation is generally used. Regarding children with an age of more than 18 months, surgical incision osteotomy orthopedic treatment is generally used 3 .As medical technology keeps advancing and medical workers make unceasing efforts, the visiting rate of older DDH children decreases year by year, and the visiting rate of younger DDH children increases year by year 4 , suggesting that the whole society has gradually deepened the understanding of DDH and gradually increased the degree of attention. However, how to achieve early, standardized and accurate screening and treatment of this disease has become the focus of current attention. At present, the ultrasonic examination of DDH at home and abroad mainly includes Graf's method, Harcke's method, Morin's method, Terjesen's method, etc., and it is constantly improving with the progress of medicine and technology. Graf's method is the most representative of many ultrasound examination methods 5 . In 1980, Reinhard Graf 6 , professor of orthopedic surgery in Austria, put forward this concept on the basis of rigorous anatomy. The feasibility and accuracy of Graf's method have been recognized by many scholars 7 . Implementing Graf's morphological approach necessitates a comprehensive knowledge of the hip joint's anatomical traits, the exact acquisition of standard cross-sections, and vigilance towards the subtle morphological variances between diverse types. By measuring the α and β angles in the standard ultrasound section, this method gauges the anatomical abnormality of the hip. Pavlik harness is currently recommended for children aged 0–6 months with DDH. Pavlik harness was invented by Czech orthopaedic surgeon Arnold Pavlik in 1944 8 . The design concept of Pavlik harness is based on the dynamic reduction principle of the hip joint, by holding the hip joint in a natural position of flexion and abduction, it spurs the normal development of the femoral head and acetabulum. A multi-center study by Wada et al 9 in Japan showed that for completely dislocated hips, the Pavlik harness treatment achieved a success rate within the range of 80–82%, and the long-term tracking afterward Severin grade excellent and good rate was approximately 72 to 78%. But Pavlik slings have their limitations. First of all, it is a soft, comfortable and safe band, which allows the hip joint to maintain a specific limited range of motion during the treatment. However, it is inconvenient to dress and care during the treatment process. There are also certain complications during the treatment process, including skin abrasion, femoral nerve palsy, residual acetabular dysplasia, and AVN 10 . In general, because of its high success rates and a small number of complications, the Pavlik harness is the preferred treatment for children younger than 6 months with hip issues. Only when the Pavlik harness application proves unsuccessful in these young children are rigid braces used as a secondary treatment option. For children older than 6 months, in cases where an early harness application has failed, closed reduction along with cast fixation is likely to be a more suitable approach compared to other methods 11 . Previous studies have found that there are risk factors that may lead to treatment failure, including older age at initial treatment, Graf III/IV 12 , male 13 , combined with other deformities, bilateral dislocation, hip adduction contracture 14 , etc. It is suggested that if the Pavilik sling cannot be reattached after 3 weeks of treatment, the treatment should be terminated in time 15 . However, there are still many problems to be clarified in the study of the correlation between these phenomena. In view of the above problems, the objective of this study was to discover a secure and reliable method or a reference index that could accurately forecast the results of Pavlik harness treatment administered to young children (under 6 months of age) who have DDH, filter out those children who have a significant probability of Pavlik harness treatment not being successful, and guide the early intervention of closed reduction and plaster external fixation to reduce the occurrence of subsequent AVN. Whether it is possible to treat children with plaster in advance through some predictive indicators in the clinic, so as to reduce the incidence of AVN. The aim of this study is to screen out the risk factors for failure of Pavliv harness treatment and establish a prediction model to provide theoretical support for early plaster intervention and reduce the occurrence of AVN, and to provide evidence for clinical decision-making. 2. METHODS 2.1 General information The ultrasound data of children with DDH aged 0–6 months who were treated with Pavlik harness in Xi 'an Honghui Hospital of Children's Disease from December 2019 to December 2024 were collected and analyzed.Inclusion criteria: ① The initial ultrasound examination was conducted in our hospital, and the outcome led to a diagnosis of developmental dysplasia of the hip, the ultrasound findings were classified as Graf type Ⅱ or above; ② age ≤ 6 months; ③ The children and their families cooperated with the treatment plan and were regularly reviewed and followed up. Exclusion criteria: ① DDH caused by neurogenic, trauma or other factors; ② Patients whose family members did not agree and signed the informed consent; ③ cases with missing ultrasound results during follow-up; ④ the ultrasound examination image is not clearly distinguished. In accordance with the established inclusion and exclusion criteria, a total of 102 patients were recruited, there were 7 male patients and 95 female patients among them, and the ratio of males to females was 1:13.6. The patients' ages ranged from 27 days at the youngest to 6 months at the oldest. There were 51 cases of left hip, 22 cases of right hip and 29 cases of bilateral DDH. The patients were divided into a failure group (n = 22) and a success group (n = 80) according to whether Pavlik harness treatment was successful. In the failure group, 22 patients received closed reduction and plaster immobilization under anesthesia or surgery after failure regarding the Pavlik harness treatment. The age of the youngest patient was 3.1 months, while that of the oldest patient was 12 months. On average, the patients were 7.2 months old. In the success group, 80 patients were followed up for 2 weeks after Pavlik harness treatment. Ultrasound examination of bilateral hips showed bilateral Graf type Ⅰ. 2.2 Indicator Measurement The ultrasound examination of the children was performed in the outpatient department accompanied by their family members. Keep the child in a quiet and comfortable supine position, and the hip joint is naturally relaxed and lightly abducted. A thin pillow can be placed under the hip of the child to make the hip joint naturally flech slightly. The examiner stood at the foot of the child, and the high-frequency 5–10 MHZ linear array probe was selected. The probe was positioned at a right angle to the longitudinal axis of the child's body. It was placed on the upper part of the lateral greater trochanter of the child's hip joint. In this way, the ultrasound beam was made to be perpendicular to the longitudinal axis of the child's femoral neck. The position and orientation of the probe were modified in order to acquire a distinct coronal cross-section of the hip joint. The standard section should simultaneously display the acetabular fossa, acetabular roof, acetabular lip, femoral head, femoral neck and other structures. After the relevant structures were clearly displayed, The measurements of the α angle, β angle, FHC, and Graf classification were carried out. The angle α represents the angular measurement formed between the line that extends from the deepest point of the acetabular fossa to the uppermost part of the acetabulum, and a horizontal line that lies within the plane of the pelvis. The angle β is defined as the angular separation between the line connecting the most lateral position of the acetabular lip and the deepest location of the acetabular fossa, and a horizontal line that is in the plane of the pelvis. According to the α Angle and β Angle, the Graf classification of children can be determined. Type Ⅰ : normal hip joint, which can be divided into type Ⅰa: α Angle greater than or equal to 60°, β Angle less than 55°, excellent contour of acetabular parietal bone, sharp and angular outer edge of bone crest. Type Ⅰb: the α Angle was 50°-59°, the contour of the acetabular parietal bone was slightly blunted. Type Ⅱ : immature or slightly abnormal hip development, divided into type Ⅱa: children aged less than 3 months, α Angle of 50°-59°. Type Ⅱb: children older than 3 months, α Angle 50°-59°, β Angle less than 55°. Type Ⅱc: α Angle 43°-49°, β Angle less than 77°. Type Ⅱd: In type Ⅱc, the β Angle continued to increase more than 77°, the center of the femoral head did not coincide with the center of the acetabular arc; instead, it was offset from it. Additionally, both the dome of the cartilage and the acetabular labrum had shifted in a lateral direction. Type Ⅲ : hip subluxation, the measure of angle α is less than 43 degrees, while the measure of angle β is greater than 77 degrees, divided into type Ⅲa: femoral head upward and lateral dislocation, cartilage apex is hyhyal cartilage and other anechoic structure. Type Ⅲb: the femoral head experienced an upward and outward displacement. There were observable echoes of the cartilage apex to different extents, and the hyaline cartilage had undergone either fibrosis or degeneration. Type Ⅳ : there is a hip joint dislocation where the femoral head has entirely lost its connection with the acetabulum. The surface of the femoral head is merely covered by a thin layer of the joint capsule. Additionally, both the acetabular labrum and the cartilage roof of the acetabulum have shifted to the medial and inferior side of the original acetabulum location. FHC is the ratio of the distance between the iliac line and the deepest point of the acetabular fossa and the distance between the deepest point of the acetabular fossa and the most lateral part of the femoral head. Measurements were performed independently by three physicians, with the surveyor completely unaware of the patient's treatment information, and finally the average of the three measurements was used for statistics.The children were followed up and recorded their gender, birth weight, parental education, breech position at birth, cesarean section, family inheritance and hospital grade at birth. 2.3 Statistical Methods Statistical analysis was carried out using SPSS 25.0. The Shapiro - Wilk test was employed to assess whether the measurement data followed a normal distribution. Measurement data that conformed to a normal distribution were presented in the form of mean ± standard deviation (± s), while measurement data with a skewed distribution were represented by the median and inter-quartile range. The intra-class correlation coefficient (ICC) was applied to analyze the consistency of the measurements of the α angle, β angle, and FHC among different observers. A higher ICC value indicates better agreement. We used the intra - class correlation coefficient (ICC) to examine how consistently different observers measured the α angle, β angle, and FHC. The greater the ICC value, the more consistent the measurements are among the observers. Kappa coefficient was used to measure the consistency of Graf classification of the same index between different observers. Kappa values spanned from − 1 to 1. A Kappa value in the range of 0.81 to 1.00 signified almost perfect agreement, a value between 0.61 and 0.80 denoted moderate agreement, a value from 0.41 to 0.60 indicated fair agreement, and a value of 0.40 or lower represented poor agreement. Moreover, a P value less than 0.05 was regarded as statistically significant. 3. RESULTS 3.1Analysis of consistency Table 1 Consistency analysis of measurements of the same index by different observers Index ICC 95% CI P α° 0.894 0.857–0.924 < 0.001 β° 0.883 0.843–0.916 < 0.001 FHC 0.942 0.921–0.959 < 0.001 Note: ICC, intraclass correlation coefficient; FHC, the proportion of the femoral head that is covered by the bony structure of the acetabulum. Table 2 Kappa coefficient consistency analysis of Graf typing observations of children by different observers Observer combination Kappa SE 95%CI P Observer 1vs Observer 2 0.894 0.036 0.823–0.964 < 0.001 Observer 1vs Observer 3 0.906 0.035 0.8374–0.975 < 0.001 Observer 2vs Observer 3 0.907 0.034 0.840–0.974 < 0.001 Mean value 0.902 0.035 0.833–0.971 < 0.001 Note: Kappa, intraclass correlation coefficient; The agreement between the three observers for the measurements of the same index was high. Among them, α Angle (ICC = 0.894), β Angle (ICC = 0.883), FHC (ICC = 0.942) (Table 1 ), Graf classification (Kappa = 0.902) (Table 2 ). 3.2General data and ultrasound index analysis This study incorporated a total of 102 cases, consisting of 7 males and 95 females, with a male-to-female ratio of 1:13.6. Among the patients, the oldest was 6 months old and the youngest was 27 days old. Regarding the hip dislocation conditions, 51 cases had a left hip dislocation, 22 cases had a right hip dislocation, and 29 cases had a bilateral hip dislocation. In terms of the groups, 22 patients were categorized into the failure group, while 80 patients were placed in the success group. Table 3 shows that the treatment ages of children were concentrated at 1, 2, and 3 months of age. Among them, 93.1% were female. Graf type Ⅱ accounted for the largest proportion. In type Ⅱ, ⅱb was more than ⅱa, and ⅱa was more than ⅱc. The left hip was more affected than the right and bilateral hips. In the education level of parents, junior high school education accounted for the largest proportion. Singleton accounted for 64.7%. The birth season of children was the least in summer. The places of birth were more balanced between urban and rural areas. Among them, 79.4% did not undergo cesarean section. 79.4% of the infants were born at term. The birth weight of 80.4% of the cases was more than 2500g. There was no significant difference in whether the children were born with leg-binding or not. 74.5% of the patients had no family history. Fifty-one percent of the infants were born in a secondary hospital. As presented in Table 4 , when it came to age, gender, the side that was affected, the season of birth, the place of birth, whether it was a cesarean section, a term birth, the birth weight, and inheritance, there were no statistically significant disparities between the two groups, as evidenced by a P value greater than 0.05. However, notable statistical differences were observed between the two groups in terms of Graf classification, the educational attainment of the father, the educational attainment of the mother, the number of fetuses, the body position during birth, the use of leggings, inheritance status, and the level of the hospital where the birth took place, with all these differences having a P value less than 0.05. Table 3 General data of the children Item Variable Number % Age 1 month 24 23.6 2 month 21 20.6 3 month 25 24.5 4 month 19 18.6 5 month 12 11.8 6 month 1 1.0 Sexuality Man 7 6.9 women 95 93.1 Graf typing Ⅱa 24 23.5 Ⅱb 41 40.2 Ⅱc 15 14.7 Ⅲ 14 13.7 Ⅳ 8 7.8 Injured side Left 51 50.0 Right 22 21.6 Bilateral 29 28.4 Education of father Primary school 5 4.9 Junior high school 64 62.7 High school 20 19.6 University 13 12.7 Education of mother Primary school 14 13.7 Junior high school 49 48.0 High school 25 24.5 University 14 13.7 Number of fetus Single fetus 66 64.7 Twin 29 28.4 Triple pregnancy 7 6.9 Birth season Spring ( March-May ) 23 22.5 Summer ( June-August ) 13 12.7 Autumn ( September-November ) 31 30.4 Winter ( December-February ) 35 34.3 Incunabulum Cities 59 57.8 Countryside 43 42.2 Cesarean Section Yes 21 20.6 No 81 79.4 Full-term birth Lead 16 15.7 Normal 81 79.4 Delay 5 4.9 Birth weight 2500g 85 83.3 Fetal position at birth Breech position 20 19.6 Head posture 82 80.4 Legging Yes 46 45.1 No 56 54.9 Inheritance Yes 26 25.5 No 76 74.5 Birth hospital level Primary hospitals 24 23.5 Secondary hospitals 52 51 Tertiary hospital 26 25.5 Table 4 Description of data in the failure and success groups Item Number X 2 P Case group Control group Age 1 month 3 21 7.268 0.402 2 month 7 14 3 month 4 21 4 month 4 15 5 month 3 9 6 month 1 0 Sexuality Man 2 5 0.218 0.641 Women 20 75 Graf typing Ⅱa 4 20 47.876 0.000 Ⅱb 0 41 Ⅱc 2 13 Ⅲ 9 5 Ⅳ 7 1 Injured side Left 11 40 0.262 0.877 Right 4 18 Bilateral 7 22 Education of father Primary school 2 3 9.601 0.022 Junior high school 8 56 High school 6 14 University 6 7 Education of mother Primary school 11 3 32.736 0.000 Junior high school 7 42 High school 4 21 University 0 14 Number of fetus Single fetus 12 54 11.056 0.004 Twin 5 24 Triple pregnancy 5 2 Birth season Spring ( March-May ) 9 14 7.113 0.068 Summer (June-August) 2 11 Autumn (September-November) 3 28 Winter (December-February) 8 27 Incunabulum Cities 12 47 0.125 0.724 Countryside 10 33 Cesarean Section Yes 2 19 2.268 0.132 No 20 61 Full-term birth Lead 1 15 4.504 0.105 Normal 21 60 Delay 0 5 Birth weight 2500g 21 64 Fetal position at birth Breech position 8 12 4.996 0.025 Head posture 14 68 Legging Yes 14 32 3.893 0.048 No 8 48 Inheritance Yes 6 20 0.047 0.828 No 16 60 Birth hospital level Primary hospitals 14 10 25.228 0.000 Secondary hospitals 6 46 Tertiary hospital 2 24 3.3Rate of change in treatment These 102 children were followed up and reexamined, and the alterations in the results of the two ultrasound examinations, which were conducted before and after each follow-up assessment, were documented during the course of the Pavlik harness treatment, so as to calculate the change rate of pavlik harness treatment (the change difference of ultrasound test results/month), as shown in Figs. 1 and 2 . In the failure group, the period of follow-up extended from the age at which the initial examination was carried out to the age at the time of the final examination prior to the surgical procedure.In the group that achieved success, the follow-up duration started from the age at the first examination and ended at the age when an ultrasound examination showed that both hips were of Graf typeⅠ. The shortest follow-up period was one month, while the longest was nine months. At every age, when comparing the two groups, the initial ultrasound classification did not show any statistically significant variation, as indicated by a P value greater than 0.05. At all ages, the follow-up time of the two groups did not exhibit any significant difference. Similarly, there was no significant difference in the operation time within the failure group, with the P values for these comparisons all being greater than 0.05. The results are shown in Tables 5 and 6 : in the failure group, the children who started treatment in March or April had a good treatment effect, of which the children aged 3 months had the best effect, and the children who started treatment in January, February, and May had a poor treatment effect, of which the children aged 5 months had the worst effect. Pavlik harness was effective in all patients in the successful group, and children aged 4 months had the best treatment effect. 3.4Univariate analysis Table 5 Variable assignment table Variable name Item Grouping and assignment X1 Age 1、2、3months of age=0;4、5、6months of age༝1 X2 Sexuality Man=0;Woman༝1 X3 Graf typing Ⅱa、Ⅱb、Ⅱc=0;Ⅲ、Ⅳ༝1 X4 Injured side Right=0;Left、bilateral༝1 X5 Education of father Degree higher=0;Lower education༝1 X6 Education of mother Degree higher=0;Lower education༝1 X7 Number of fetus Single fetus=0;Non-singleton༝1 X8 Birth season Summer and autumn=0;Spring and winter༝1 X9 Incunabulum Cities=0;Countryside༝1 X10 Cesarean Section No=0;Yes༝1 X11 Full-term birth Yes=0;No༝1 X12 Birth weight > 2500g=0;<2500g༝1 X13 Fetal position at birth Head posture=0;Breech position༝1 X14 Legging No=0;Yes༝1 X15 Inheritance No=0;Yes༝1 X16 Birth hospital level Not born in a first-class hospital=0;Born in a first-class hospital༝1 Y Control group=0;Case group༝1 As presented in Table 6 , Binary Logistic regression analysis was employed to explore and examine the association between each factor and the disease. The findings indicated that numerous factors exerted an influence on the therapeutic outcome of the Pavlik harness treatment for children within the age range of 0 to 6 months. The likelihood of treatment failure rose among children who were classified as Graf type Ⅲ and Ⅳ by 14.447 times (95%CI: 4.353–47.946). The risk of Pavlik harness treatment failure increased by 12.25 times (95%CI: 4.108–36.527) in children born in first-class hospitals. Table 6 illustrates the Logistic regression analysis conducted to assess how each factor impacts the disease. Item B S.E X 2 /t P OR 95%CI Lower Upper Age 0.288 0.506 0.323 0.570 1.333 0.495 3.594 Sexuality −0.405 0.874 0.215 0.643 0.667 0.120 3.695 Graf typing 2.671 0.612 19.039 0.000 14.447 4.353 47.946 Injured side 0.267 0.614 0.189 0.663 1.306 0.392 4.354 Education of father −1.215 0.498 5.958 0.015 0.297 0.112 0.787 Education of mother 1.253 0.597 4.404 0.036 3.500 1.086 11.277 Number of fetus 0.549 0.490 1.252 0.263 1.731 0.662 4.524 Birth season 1.174 0.556 4.461 0.035 3.234 1.088 9.612 Incunabulum −0.171 0.485 0.125 0.724 0.843 0.326 2.178 Cesarean Section −1.136 0.787 2.085 0.149 0.321 0.069 1.501 Full-term birth −1.946 1.056 3.398 0.065 0.143 0.018 1.131 Birth weight −1.658 1.061 2.443 0.118 0.190 0.024 1.524 Fetal position at birth 1.175 0.543 4.688 0.030 3.238 1.118 9.380 Legging 0.965 0.499 3.748 0.053 2.625 0.988 6.974 Inheritance 0.118 0.544 0.047 0.829 1.125 0.387 3.267 Birth hospital level 2.506 0.557 20.204 0.000 12.250 4.108 36.527 3.5 Multivariate analysis Based on the outcomes of the univariate analysis of the follow-up data of children, a multivariate analysis was carried out to examine the risk factors associated with the Pavlik harness treatment for these children. The detailed results of this multivariate analysis are presented in Table 7 . Table 7 shows that in the multivariate analysis, the initial ultrasound classification of children was still a risk factor for Pavlik harness treatment in young DDH children, OR was 22.823, 95%CI was (4.720-110.363); Season of birth was also a risk factor for Pavlik harness treatment (OR = 11.134, 95%CI: 1.071-115.736). The OR value of birth position was 18.205, and its 95%CI was (1.485-223.207). The OR value of the hospital level of birth was 9.868, 95%CI was (2.093–46.524). According to the results of multivariate analysis, the sensitivity of each variable was calculated, and the ROC curve was drawn. The findings are presented in Table 8 and illustrated in Fig. 3 . Table 7 presents the multivariate analysis of the risk factors involved in the treatment of young children with DDH using the Pavlik sling. Item B S.E X 2 P OR 95%CI Lower Upper Graf typing 3.128 0.804 15.131 0.000 22.823 4.720 110.363 Birth season 2.410 1.195 4.070 0.044 11.134 1.071 115.736 Position at birth 2.902 1.279 5.149 0.023 18.205 1.485 223.207 Birth hospital level 2.289 0.791 8.373 0.004 9.868 2.093 46.524 Table 8 shows the sensitivity, specificity, false positive rate, and false negative rate of every variable within the model Sensitivity Specificity False positive False positive rate Graf typing 0.818 0.238 0.182 0.762 Birth season 0.773 0.525 0.227 0.475 Position at birth 0.364 0.150 0.636 0.85 Birth hospital level 0.636 0.125 0.364 0.875 3.6Prediction model In conclusion, taking into account the conclusions from Study I concerning the appropriate timing for ultrasound screening and the discontinuation of Pavlik harness treatment in infants and young children suffering from DDH, and integrating them with the analysis of the risk factors for Pavlik harness treatment in young DDH patients in the present study, the prediction model depicted in Table 9 was derived. The time of ultrasound detection in this model was 2 months old. If the hip joint was still unstable during the treatment of Pavlik harness for 4 months, plaster casting was performed immediately. Table 9 Prediction of risk factors for Pavlik sling in children risk factor Total OR value Combination of risk factors Treatment recommendations very high risk ≤ 50 (A + B + C)/(A + B + D)/(A + B + C + D) Immediate plaster therapy High risk 30–50 (A + B)/(A + C)/(A + D) Strengthen monitoring and improve children 's compliance Middle risk 15–30 A/(B + C)/(B + D)/(C + D) Follow up closely and adjust lifestyle Low risk group < 15 C/D Follow-up, periodic Note: A: Ultrasound examination showed Graf type Ⅲ, Ⅳ; B: the baby was born in breech position; C: The birth seasons were spring (March-May) and winter (December-February); D: the level of the birth hospital was a first-class hospital. 4. DISCUSSION In early DDH from 0 to 6 months, the most accurate diagnostic modality is ultrasonography 16 . According to the characteristics of bone development in infants and young children 17 , before the age of 6 months, the hip joint is in the rapid growth and shaping segment, and the femoral head along with the hip joint mainly consist of cartilage 18 . During this period, the range of motion of the hip joint is large, and the shape and position of the femoral head are easily disturbed by external factors such as posture or external force 19 . The treatment at this stage is non-invasive and avoids greater trauma to the child. The treatment can be dynamically adjusted according to the growth and development of children 20 . Moreover, the treatment method at this stage has fewer complications and shorter treatment period, which can protect the developmental potential of children to the greatest extent and effectively avoid the influence of DDH on the growth and development of children 21 . 4.1Type of Graf The greater the instability indicated by the initial hip ultrasound findings, the poorer the expected outcome will be, and the lower the likelihood of successful treatment with the Pavlik harness 22 . The treatment failure rate and the risk of complications are higher in GrafⅢ/Ⅳ hips 12 , especially in those diagnosed by ultrasound. Lyu 15 recommends the use of a Tubingen splint for Graf III/IV children younger than 6 months of age. The rate of successful fixation achieved using the Tubingen splint was notably greater than that accomplished with the Pavlik harness (71.4% vs. 54.4%, p = 0.047). 4.2 Therapeutic time At present, The Pavlik sling as well as the Von Rosen splint are extensively applied in the treatment of DDH among young children. According to the Chinese guidelines for the treatment of DDH, the Pavlik harness has been put forward as the recommended first-choice harness for such treatment, with a success rate of about 70%-95%. Zhou 11 showed that when it comes to treating children who are younger than 2 months old, the Pavlik harness can achieve a success rate of 95.2%. In this study, the children aged < 2 months had the highest treatment success rate of 87.5%, which was consistent with previous studies. However, in this study, the change rate of Pavlik harness treatment in children aged 2–4 months was much higher than that in children aged < 2 months. Although the success rate of 76.9% was different from that of < 2 months old children, the Pavlik harness treatment effect of 2–4 months old children was significantly better than that of < 2 months old children. In the europe 23 , treatment guidelines for DDH state that hip ultrasound should be performed at 6 weeks after birth. Children with DDH should be treated with Pavlik therapy as soon as possible 24, 25 . However, some scholars have questioned that early ultrasound detection may lead to excessive diagnosis and treatment 26 . At present, there is a lack of international guidelines to develop a unified standard treatment plan for DDH 27 . The results of this study demonstrated that, while the success rate of Pavlik harness treatment for children aged between 2 and 4 months was marginally lower than that for children under 2 months of age, the change rate of harness treatment was significantly improved. For children aged 0–2 months, there are some children who do not need Pavlik harness treatment and their hip can recover spontaneously. Therefore, this study raised the question of whether ultrasound screening for DDH can be delayed until 2 months of age. Administering the Pavlik harness treatment at this specific time juncture not only boosts the rate of effective response to the harness treatment but also helps to evade the potential risks associated with overdiagnosis and overtreatment. In addition, the population of this study is located in the northwest of China, with low per capita income level and uneven distribution of medical resources. Postponing the screening time of DDH can not only reduce the difficulty of ultrasound detection, but also save medical resources and reduce the family burden of children. In addition, Omeroğlu 28 suggested that age > 4 months is the age threshold for failure of Pavlik harness treatment in children. After 4 months of age, the success rate of Pavlik harness treatment decreased significantly, corresponding to the results of this investigation. Whether the 4-month age time point can be used as an end point for Pavlik harness treatment. For children older than 4 months, if ultrasound examination shows that the hip joint is still unstable, the sling treatment should be stopped immediately and replaced by plaster treatment. This not only optimizes the treatment process, saves the treatment time of children, but also avoids the high incidence of AVN. 4.3Gender The gender ratio of the two groups of patients in this study was quite different, and the number of female patients was far more than that of male patients. Studies have shown that the risk of DDH in women is about four times that in men 29 . This may be related to the higher estrogen level of the female fetus during the mother's pregnancy 30 , and excessive estrogen can lead to ligament relaxation, thereby increasing the probability of hip instability. Other scholars have suggested that female infants have smaller femoral heads, shallower acetabulum than male infants, and poor matching of head and acetabulum, which will also increase the risk of female infants. 4.4Side of the disease In the two groups, there was no significant distinction regarding the affected side of DDH. However, for both groups, the incidence of DDH on the left side was higher than that on the right side and when both sides were involved, which may be related to the position of the fetus during pregnancy 31 . Studies have shown that the fetus is mostly cephalic in the uterus, while the left hip joint is closer to the maternal uterine wall and spine. Prolonged compression may lead to developmental delay and joint instability. In addition, during pregnancy, maternal estrogen levels increase significantly 30 , and estrogen can cause fetal ligament relaxation, and the left hip joint is more susceptible to instability due to its greater sensitivity to hormones. Ultimately, the primary blood suppliers to the femoral head are the medial femoral circumflex artery and the lateral femoral circumflex artery. The branches of the left medial femoral circumflex artery are more slender or abnormal than those of the right, and the left internal iliac artery has fewer branches compared to the right one. This disparity can result in the developmental retardation of the left femoral head and elevate the likelihood of instability in the left hip joint. 4.5Education level of parents The higher the educational level of the parents, the greater the success rate of Pavlik harness treatment for young children with DDH, indicating a positive correlation between the two. The higher the education level of the children's parents, the easier they are to understand the treatment plan and pay more attention to the consequences of delayed treatment, so as to improve compliance and reduce treatment interruption 32 . Moreover, educational attainment is generally positively correlated with family income and access to medical resources, which may be more conducive to regular follow-up and long-haul follow-up of the treatment children receive. A multi-center study in the United States 33 confirmed that parental education level was linearly related to the rate of compliance with Pavlik harness wearing time and positively related to the final acetabular index improvement. 4.6Number of fetus Although a notable divergence in the number of deliveries existed between the two groups, neither the univariate analysis nor the multivariate analysis could demonstrate a significant association related to this difference. It has been reported in the literature that multiple pregnancies may increase the risk of fetal hip dysplasia, but in comparison with singleton pregnancies, the success rate of treating DDH does not show a statistically significant difference 34 , this is substantially consistent with the results of this research. Some scholars have also proposed that families with multiple children may be distracted by having too many children, leading to non-standard Pavlik harness wearing for children, but no evidence supports this. 4.7Season of Birth The number of children born in summer was the lowest in the sample, which may be related to the higher temperature in summer and the loose clothing of infants and young children, which is conducive to hip extension.Lee WC 35 confirmed the cold season serves as a contributing factor that increases the likelihood of being diagnosed with DDH and undergoing related surgery. They discovered that the rate of surgical treatment for DDH among infants born in the winter months was notably higher, at 0.70 cases per 1000 infants, compared to those born in the summer months, which was 0.32 cases per 1000 infants. Additionally, this rate of surgical treatment was found to be correlated with the mean temperature during the infants' first three months of life, with a coefficient of determination (r 2 ) of 0.91 and a p-value less than 0.0001, indicating a very strong relationship. It was also associated with the birth month, having an (r 2 ) value of 0.68 and a p-value less than 0.001, suggesting a significant connection between the month of birth and the likelihood of requiring surgical treatment for DDH. This study revealed that the success rate of treating children with a Pavlik harness for Developmental DDH was markedly lower for those born in spring and winter than for those born in summer and autumn. This disparity might be attributed to the local temperature conditions. The subjects were from northwest China. Lower temperatures in spring and winter and heavier clothing for children may affect the standardization of sling wearing. However, there is no study on the relationship between season and children's compliance with Pavlik harness wearing, and more research is needed to further confirm. 4.8Fetal position at birth Children in the breech position had 3.238 times the risk of Pavlik harness treatment failure compared to children in the head position. A breech fetus is possible if the mother has oligohydramnios or abnormal estrogen during the course of the present pregnancy 36 . The hip joint of breech fetuses will be in flexion and abduction position in the mother 37 , while the fetal hip joint is incompletely developed, and the acetabular fossa is shallow, which is prone to dislocation of the femoral head 38 . 4.9Birth hospital level In the context of this study, a statistical difference was observed in the level of the birth hospital between the group of children for whom the treatment failed and the group of children for whom the treatment was successful, which was also an important factor affecting the success of Pavlik harness treatment. Studies have shown that the missed diagnosis of DDH in children is partly related to the non-standard ultrasonic detection methods 39 . High-level hospitals have the ability to provide advanced equipment and experienced sonographers, which largely avoid missed diagnosis and delayed treatment. In addition, high-level hospitals mean more patients, doctors have more experience in treating young DDH children, and pay more attention to standardized treatment and health education for family members, which is another factor to improve the success rate of Pavlik harness treatment. The innovative aspect of this study lies in its integration of the rate of change in Pavlik harness treatment with the outcomes of ultrasound testing. This approach enables a more straightforward and intuitive identification of the disparities in ultrasound metrics between the group that experienced treatment failure and the group that achieved treatment success. The findings of this study indicate that, for infants with DDH in northwest China, performing an ultrasound screening two months after birth is a viable option. This timing not only enhances the precision of the diagnosis but also mitigates the risks associated with overdiagnosis and overtreatment. Moreover, it does not substantially decrease the success rate of treatment using the Pavlik harness. The optimal period for conducting Pavlik harness treatment is when the infant is aged between 2 months and 4 months. Therefore, this study used 4 months of age as the termination time point for Pavlik harness treatment, which provides a new reference for choosing between conservative treatment and casting treatment in young children with DDH. This study is accompanied by several limitations. Firstly, the sample size is so limited that it fails to render the statistical outcomes significant, so we can continue to increase the cases and improve the establishment of the database. In addition, this study did not investigate whether Pavlik sling treatment should be terminated immediately after successful treatment. The current mainstream view is that Pavlik harness should be gradually reduced after successful treatment, from full day to night, to half day to none. Such advantages are continued stability of the hip and prevention of redislocation. However, it has also been proposed in the literature that Pavlik harness treatment should be discontinued immediately when the hip becomes ultrasonically normal (when ultrasound of the hip appears to be normal) 40 . That study discovered that, in terms of the radiological structure of the femoral head, the likelihood of complications following treatment, and the probability of re-dislocation, there was no statistically significant distinction between the group of children who stopped treatment abruptly and the group of children who ceased treatment in a gradual manner. Finally, no new ultrasound indicators were proposed in this study, which were studied on the basis of previous ultrasound indicators. At present, there is still a debate about the limit and choice of Pavlik harness therapy and plaster therapy for the treatment of DDH in young people. At present, the existing ultrasound detection indicators cannot fully answer the clinical questions, which urgently needs a new method or indicator to explain, it is also going to be the key area of emphasis and the trajectory for our future research work. 5. CONCLUSION This study proposes an ultrasound prediction model for DDH in young children. Considering the characteristics of China's geography and medical resources, the late ultrasonic detection time of infant DDH reduces the risk of overdiagnosis and treatment, and will not greatly affect the efficacy rate of Pavlik harness treatment in achieving positive outcomes. For the termination time of Pavlik harness, this model combined with the turning point of the change rate of Pavlik harness treatment at the age of 4 months can make individualized treatment plans for different children, which is also consistent with Professor Pavlik's recommendation to encourage individualized treatment for each hip 41 . The model can be used to optimize the treatment process, shorten the detection time of failure of Pavlik harness treatment, and effectively reduce the incidence of subsequent complications of DDH, and better protect the developmental potential of the hip. Declarations Ethics approval and consent to participate: This research work was supported by: Ethic Committee of Honghui Hospital, Xi'an Jiaotong University. Ethical acceptance number：2025-KY-064-01. All participants in this study were clearly informed of the purpose and method of the study and signed informed consent. This study follows the principles of the ' Helsinki Declaration ' and follows the protocol agreed by the Ethics Committee to carry out clinical research to protect the rights and safety of subjects. Consent for publication: Not Applicable. Availability of data and materials : There are no limitations regarding the accessibility of any of the materials and data related to this work. Every author consents to the publication of this work and also approves of making the data and materials available for others to access. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Acknowledgements Funding: This work was supported by a grant from the Innovation Capability Support Program of Shaanxi Province (Grant No. 2024SF-LCZX-16) This work was supported by a grant from the Shaanxi province health scientific research innovation ability promotion plan（No.2024PT-12) This research was funded by the National High Level Hospital Clinical Research Funding (2022-PUMCH-D-004） Competing interests: The authors declare to have no competing interests. Authors' contributions: Jiaju Wang , Qingda Lu and Huan Wang wrote the main manuscript text, Chenxin Liu, Shuai Yang , Yating Yang participatedinthe interpretation of the results, Qiang Jie designed the research subject. 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I W, E S, T O, et al. - The Pavlik harness in the treatment of developmentally dislocated hips: results. J Orthop Sci 2013;18(5):749–53. EA MANA. - Evidence based treatment for developmental dysplasia of the hip in children under. Surgeon. 2021;19(2):77–86. P Z, J Z, T D, et al. - Closed reduction and plaster immobilization: an alternative solution for patients. ANZ J Surg. 2023;93(3):663–8. H Ö. - Treatment of developmental dysplasia of the hip with the Pavlik harness in. J Child Orthop. 2018;12(4):308–16. LA ENN, PM K. - Higher Pavlik Harness Treatment Failure Is Seen in Graf Type IV Ortolani-positive. Clin Orthop Relat Res. 2016;474(8):1847–54. H K, M K, N I. - Predictive factors for unsuccessful treatment of developmental dysplasia of the. J Pediatr Orthop. 2009;29(6):552–7. Z XLTC. Y, - Tübingen hip flexion splint more successful than Pavlik harness for decentred. Bone Joint J 2021. Id CGD. - Length of treatment and ultrasound timing in infants with developmental dysplasia. Eur J Orthop Surg Traumatol. 2024;34(2):1079–86. ME SKSS. - Ultrasonographic screening for developmental dysplasia of the hip: the Graf. Eur J Orthop Surg Traumatol. 2024;34(2):723–34. K W-S HKHP. - Use of the Tübingen splint for the initial management of severely dysplastic and. Arch Orthop Trauma Surg. 2018;138(2):149–53. A N, D Y, J L. - Comparison of outcomes of different Graf grades of developmental dysplasia of the. J Orthop. 2023;49:68–74. Id WK. O, P D, - Screening of Developmental Dysplasia of the Hip in Europe: A Systematic Review. Children. 2024;11(1). B DAM, Z GG. - Impact of age and timing of hip orthosis on treatment outcomes in infants with. J Clin Orthop Trauma. 2025;64(102944):102944. PECMR J, D L, S L, et al. - Screening, diagnosis, treatment and outcomes of developmental dysplasia of the. BMJ Open 2024;14(10):2024–085403. I K, M W, HJ VDW. - Ultrasound of the neonatal hip as a screening tool for DDH: how to screen and. J Ultrason. 2021;21(85):e147–53. O MT, HC H. R, S K,. - Risk Factors for Developmental Dysplasia of the Hip Before 3 Months of Age: A. JAMA Netw Open 2025;8(1). Id ATP. - The impact of the introduction of selective screening in the UK on the. Bone Jt Open. 2023;4(8):635–42. Id ATP, JLJ O. - The cost effectiveness of potential risk factors for developmental dysplasia of. Bone Jt Open. 2023;4(4):234–40. RS A-E, FH A, RM A, W P, AH J. KI K. - Diagnosis and treatment of developmental dysplasia of the hip: A current practice. J Orthop Surg. 2017;25(2). H Ö, N K, A A. - Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in. Clin Orthop Relat Res 2016;474(5):1146–52. HP L, R H, P M, J S. - Developmental dysplasia of the hip practice guideline: technical report. Pediatrics. 2000;105(4). RT L, EN S. - The epidemiology and demographics of hip dysplasia. ISRN Orthop. 2011;10(238607). SW V, B K, SC S, et al. - Altered biomechanical stimulation of the developing hip joint in presence of hip. J Biomech. 2018;78:1–9. MB ESH, GN A. - Developmental dysplasia of the hip: nursing implications and anticipatory. Orthop Nurs. 2006;25(2):100–9. CS KEG. - Education of parents in Pavlik harness application for developmental dysplasia of. J Child Orthop. 2016;10(4):289–93. A S, J C, M K, B G. - Evaluation of risk factors in developmental dysplasia of the hip in children from. Ortop Traumatol Rehabil. 2008;10(2):115–30. Id WCL, HK O. - Cold Weather as a Risk Factor for Late Diagnosis and Surgery for Developmental. J Bone Joint Surg Am. 2022;104(2):115–22. S K, S S, M P, et al. - The risk of DDH between breech and cephalic-delivered neonates using Graf. Eur J Orthop Surg Traumatol. 2024;34(2):1103–9. MJ SPL, Id K. - Developmental Dysplasia of the Hip Is Not Associated with Breech Presentation in. Am J Perinatol. 2024;41(S 01):e465–9. A MMK, EA MAH. AM, - Prevalence of Breech Presentation and Other Gestational/Delivery Characteristics. Cureus. 2023;15(7). S W, E C, D S. - Screening for developmental dysplasia of the hip in a rural health district: An. Aust J Rural Health. 2018;26(3):199–205. DJ W, ND M, MS AW. - Staged weaning versus immediate cessation of Pavlik harness treatment for. J Pediatr Orthop B. 2014;23(2):103–6. V B. - [Pavlik's method in developmental dysplasia of the hip]. Acta Orthop Traumatol Turc. 2007;1:19–24. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6463899","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":456772434,"identity":"457ec6bb-133d-4c2e-9636-d13d99bd3647","order_by":0,"name":"Jiaju Wang","email":"","orcid":"","institution":"Honghui Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Jiaju","middleName":"","lastName":"Wang","suffix":""},{"id":456772435,"identity":"94c64191-05d1-46e3-9a73-df192b839840","order_by":1,"name":"Qingda Lu","email":"","orcid":"","institution":"Honghui Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Qingda","middleName":"","lastName":"Lu","suffix":""},{"id":456772436,"identity":"eb4b5acd-193f-48a9-8723-a20b124cdab5","order_by":2,"name":"Huan Wang","email":"","orcid":"","institution":"Honghui Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Wang","suffix":""},{"id":456772437,"identity":"c0ea214c-5ac6-497d-afca-b68d3f5960fc","order_by":3,"name":"Chenxin Liu","email":"","orcid":"","institution":"Honghui Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Chenxin","middleName":"","lastName":"Liu","suffix":""},{"id":456772438,"identity":"ea73d61c-2a7c-446f-ac95-a6481e14e761","order_by":4,"name":"Shuai Yang","email":"","orcid":"","institution":"Honghui Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Shuai","middleName":"","lastName":"Yang","suffix":""},{"id":456772439,"identity":"03b5d1fa-596a-4bb9-96df-fc09529bb63c","order_by":5,"name":"Yating Yang","email":"","orcid":"","institution":"Honghui Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Yating","middleName":"","lastName":"Yang","suffix":""},{"id":456772440,"identity":"a6baa9b2-9429-4c53-963d-6c657932f211","order_by":6,"name":"Qiang Jie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBACxmYgkQBiSTA2MDBUSMjxk6jljIWxZAPR9kmADGirSNxASAtzO/PBGw9q7tj1z25ue/BzngTjBgbmh49u4HUYW7JFwrFnyTPuHGw37N0mwWzOwGZsnINXC4+ZRALb4WQDicQ2Cd5tEmyWDTxs0vi18H+TSPgH0SL5d44Ej8EBglp42ICKD9uBtEjzNkhIEKGFzdgise9wgsQNoBaZYxIGks0E/GLYf/jhzR/fDtvzz0h/Jvmmpq6+n7354WO8WhogMZLYABdixqMcBOQZIFrsCagbBaNgFIyCkQwAW+1KKuLUsa8AAAAASUVORK5CYII=","orcid":"","institution":"Honghui Hospital, Xi’an Jiaotong University","correspondingAuthor":true,"prefix":"","firstName":"Qiang","middleName":"","lastName":"Jie","suffix":""}],"badges":[],"createdAt":"2025-04-16 13:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6463899/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6463899/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83157918,"identity":"07d2c7ff-e277-4f17-9d2d-7131962dc73a","added_by":"auto","created_at":"2025-05-20 14:53:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":72553,"visible":true,"origin":"","legend":"\u003cp\u003eRate of change in Pavlik harness treatment in children in the failure group at initial treatment month\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6463899/v1/97d3c6ab96027876cde7387a.jpg"},{"id":83159440,"identity":"e1e8abc3-3408-4af6-94e3-0154e3c97e65","added_by":"auto","created_at":"2025-05-20 15:01:55","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":72553,"visible":true,"origin":"","legend":"\u003cp\u003eChange rate of Pavlik harness treatment in children in the success group at initial treatment month\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6463899/v1/63dda32f3a48babbaae20985.jpg"},{"id":83157987,"identity":"1e6a6144-a1a4-4cf1-8bea-e82501e8eb21","added_by":"auto","created_at":"2025-05-20 14:53:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":36095,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve of risk factors for Pavlik harness treatment in young DDH children\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6463899/v1/f5c93dc3f944989da0303d8f.png"},{"id":84582842,"identity":"64c94d6b-615e-4f79-adbc-1f3f1c7d5ce2","added_by":"auto","created_at":"2025-06-13 19:31:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1480978,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6463899/v1/712c7501-2ba6-4e2c-8b71-73f0d5ea054e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Establishment and discussion of ultrasonic prediction model for outcome of children with DDH under 6 months treated with Pavlik sling","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eChildhood developmental dysplasia of the hip (DDH) is a common bone dysplasia disease in children worldwide. Owing to diverse regions and races, the incidence of DDH shows remarkable variation, ranging from 1\u0026permil; to 2\u0026permil;\u003csup\u003e1\u003c/sup\u003e.At present, there is a consensus that the treatment strategy for young DDH patients is early detection, early diagnosis, and early treatment.If there is no standardized treatment in the early stage or the treatment time is delayed, it can cause serious complications, bringing about a decline in the developmental potential of the hip joint, the aggravation of developmental deformities, abnormal gait, chronic pain, hip arthritis and other serious problems, affecting the quality of life of children\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.The latest guidelines for the treatment of developmental hip dysplasia in China indicate that the Pavlik sling is generally employed to treat children from 0 to 6 months of age. As for children in the age group of 6\u0026ndash;18 months suffering from DDH, closed or open reduction plaster fixation is generally used. Regarding children with an age of more than 18 months, surgical incision osteotomy orthopedic treatment is generally used\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.As medical technology keeps advancing and medical workers make unceasing efforts, the visiting rate of older DDH children decreases year by year, and the visiting rate of younger DDH children increases year by year\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, suggesting that the whole society has gradually deepened the understanding of DDH and gradually increased the degree of attention. However, how to achieve early, standardized and accurate screening and treatment of this disease has become the focus of current attention.\u003c/p\u003e\n\u003cp\u003eAt present, the ultrasonic examination of DDH at home and abroad mainly includes Graf\u0026apos;s method, Harcke\u0026apos;s method, Morin\u0026apos;s method, Terjesen\u0026apos;s method, etc., and it is constantly improving with the progress of medicine and technology. Graf\u0026apos;s method is the most representative of many ultrasound examination methods\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. In 1980, Reinhard Graf\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, professor of orthopedic surgery in Austria, put forward this concept on the basis of rigorous anatomy. The feasibility and accuracy of Graf\u0026apos;s method have been recognized by many scholars\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Implementing Graf\u0026apos;s morphological approach necessitates a comprehensive knowledge of the hip joint\u0026apos;s anatomical traits, the exact acquisition of standard cross-sections, and vigilance towards the subtle morphological variances between diverse types. By measuring the \u0026alpha; and \u0026beta; angles in the standard ultrasound section, this method gauges the anatomical abnormality of the hip.\u003c/p\u003e\n\u003cp\u003ePavlik harness is currently recommended for children aged 0\u0026ndash;6 months with DDH. Pavlik harness was invented by Czech orthopaedic surgeon Arnold Pavlik in 1944\u003csup\u003e8\u003c/sup\u003e. The design concept of Pavlik harness is based on the dynamic reduction principle of the hip joint, by holding the hip joint in a natural position of flexion and abduction, it spurs the normal development of the femoral head and acetabulum. A multi-center study by Wada et al\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e in Japan showed that for completely dislocated hips, the Pavlik harness treatment achieved a success rate within the range of 80\u0026ndash;82%, and the long-term tracking afterward Severin grade excellent and good rate was approximately 72 to 78%. But Pavlik slings have their limitations. First of all, it is a soft, comfortable and safe band, which allows the hip joint to maintain a specific limited range of motion during the treatment. However, it is inconvenient to dress and care during the treatment process. There are also certain complications during the treatment process, including skin abrasion, femoral nerve palsy, residual acetabular dysplasia, and AVN\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In general, because of its high success rates and a small number of complications, the Pavlik harness is the preferred treatment for children younger than 6 months with hip issues. Only when the Pavlik harness application proves unsuccessful in these young children are rigid braces used as a secondary treatment option. For children older than 6 months, in cases where an early harness application has failed, closed reduction along with cast fixation is likely to be a more suitable approach compared to other methods\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Previous studies have found that there are risk factors that may lead to treatment failure, including older age at initial treatment, Graf III/IV\u003csup\u003e12\u003c/sup\u003e, male\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, combined with other deformities, bilateral dislocation, hip adduction contracture\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, etc. It is suggested that if the Pavilik sling cannot be reattached after 3 weeks of treatment, the treatment should be terminated in time\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. However, there are still many problems to be clarified in the study of the correlation between these phenomena. In view of the above problems, the objective of this study was to discover a secure and reliable method or a reference index that could accurately forecast the results of Pavlik harness treatment administered to young children (under 6 months of age) who have DDH, filter out those children who have a significant probability of Pavlik harness treatment not being successful, and guide the early intervention of closed reduction and plaster external fixation to reduce the occurrence of subsequent AVN. Whether it is possible to treat children with plaster in advance through some predictive indicators in the clinic, so as to reduce the incidence of AVN.\u003c/p\u003e\n\u003cp\u003eThe aim of this study is to screen out the risk factors for failure of Pavliv harness treatment and establish a prediction model to provide theoretical support for early plaster intervention and reduce the occurrence of AVN, and to provide evidence for clinical decision-making.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 General information\u003c/h2\u003e\n \u003cp\u003eThe ultrasound data of children with DDH aged 0\u0026ndash;6 months who were treated with Pavlik harness in Xi \u0026apos;an Honghui Hospital of Children\u0026apos;s Disease from December 2019 to December 2024 were collected and analyzed.Inclusion criteria: ① The initial ultrasound examination was conducted in our hospital, and the outcome led to a diagnosis of developmental dysplasia of the hip, the ultrasound findings were classified as Graf type Ⅱ or above; ② age\u0026thinsp;\u0026le;\u0026thinsp;6 months; ③ The children and their families cooperated with the treatment plan and were regularly reviewed and followed up. Exclusion criteria: ① DDH caused by neurogenic, trauma or other factors; ② Patients whose family members did not agree and signed the informed consent; ③ cases with missing ultrasound results during follow-up; ④ the ultrasound examination image is not clearly distinguished.\u003c/p\u003e\n \u003cp\u003eIn accordance with the established inclusion and exclusion criteria, a total of 102 patients were recruited, there were 7 male patients and 95 female patients among them, and the ratio of males to females was 1:13.6. The patients\u0026apos; ages ranged from 27 days at the youngest to 6 months at the oldest. There were 51 cases of left hip, 22 cases of right hip and 29 cases of bilateral DDH. The patients were divided into a failure group (n\u0026thinsp;=\u0026thinsp;22) and a success group (n\u0026thinsp;=\u0026thinsp;80) according to whether Pavlik harness treatment was successful. In the failure group, 22 patients received closed reduction and plaster immobilization under anesthesia or surgery after failure regarding the Pavlik harness treatment. The age of the youngest patient was 3.1 months, while that of the oldest patient was 12 months. On average, the patients were 7.2 months old. In the success group, 80 patients were followed up for 2 weeks after Pavlik harness treatment. Ultrasound examination of bilateral hips showed bilateral Graf type Ⅰ.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Indicator Measurement\u003c/h2\u003e\n \u003cp\u003eThe ultrasound examination of the children was performed in the outpatient department accompanied by their family members. Keep the child in a quiet and comfortable supine position, and the hip joint is naturally relaxed and lightly abducted. A thin pillow can be placed under the hip of the child to make the hip joint naturally flech slightly. The examiner stood at the foot of the child, and the high-frequency 5\u0026ndash;10 MHZ linear array probe was selected. The probe was positioned at a right angle to the longitudinal axis of the child\u0026apos;s body. It was placed on the upper part of the lateral greater trochanter of the child\u0026apos;s hip joint. In this way, the ultrasound beam was made to be perpendicular to the longitudinal axis of the child\u0026apos;s femoral neck. The position and orientation of the probe were modified in order to acquire a distinct coronal cross-section of the hip joint. The standard section should simultaneously display the acetabular fossa, acetabular roof, acetabular lip, femoral head, femoral neck and other structures. After the relevant structures were clearly displayed, The measurements of the \u0026alpha; angle, \u0026beta; angle, FHC, and Graf classification were carried out. The angle \u0026alpha; represents the angular measurement formed between the line that extends from the deepest point of the acetabular fossa to the uppermost part of the acetabulum, and a horizontal line that lies within the plane of the pelvis. The angle \u0026beta; is defined as the angular separation between the line connecting the most lateral position of the acetabular lip and the deepest location of the acetabular fossa, and a horizontal line that is in the plane of the pelvis. According to the \u0026alpha; Angle and \u0026beta; Angle, the Graf classification of children can be determined. Type Ⅰ : normal hip joint, which can be divided into type Ⅰa: \u0026alpha; Angle greater than or equal to 60\u0026deg;, \u0026beta; Angle less than 55\u0026deg;, excellent contour of acetabular parietal bone, sharp and angular outer edge of bone crest. Type Ⅰb: the \u0026alpha; Angle was 50\u0026deg;-59\u0026deg;, the contour of the acetabular parietal bone was slightly blunted. Type Ⅱ : immature or slightly abnormal hip development, divided into type Ⅱa: children aged less than 3 months, \u0026alpha; Angle of 50\u0026deg;-59\u0026deg;. Type Ⅱb: children older than 3 months, \u0026alpha; Angle 50\u0026deg;-59\u0026deg;, \u0026beta; Angle less than 55\u0026deg;. Type Ⅱc: \u0026alpha; Angle 43\u0026deg;-49\u0026deg;, \u0026beta; Angle less than 77\u0026deg;. Type Ⅱd: In type Ⅱc, the \u0026beta; Angle continued to increase more than 77\u0026deg;, the center of the femoral head did not coincide with the center of the acetabular arc; instead, it was offset from it. Additionally, both the dome of the cartilage and the acetabular labrum had shifted in a lateral direction. Type Ⅲ : hip subluxation, the measure of angle \u0026alpha; is less than 43 degrees, while the measure of angle \u0026beta; is greater than 77 degrees, divided into type Ⅲa: femoral head upward and lateral dislocation, cartilage apex is hyhyal cartilage and other anechoic structure. Type Ⅲb: the femoral head experienced an upward and outward displacement. There were observable echoes of the cartilage apex to different extents, and the hyaline cartilage had undergone either fibrosis or degeneration. Type Ⅳ : there is a hip joint dislocation where the femoral head has entirely lost its connection with the acetabulum. The surface of the femoral head is merely covered by a thin layer of the joint capsule. Additionally, both the acetabular labrum and the cartilage roof of the acetabulum have shifted to the medial and inferior side of the original acetabulum location. FHC is the ratio of the distance between the iliac line and the deepest point of the acetabular fossa and the distance between the deepest point of the acetabular fossa and the most lateral part of the femoral head. Measurements were performed independently by three physicians, with the surveyor completely unaware of the patient\u0026apos;s treatment information, and finally the average of the three measurements was used for statistics.The children were followed up and recorded their gender, birth weight, parental education, breech position at birth, cesarean section, family inheritance and hospital grade at birth.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Statistical Methods\u003c/h2\u003e\n \u003cp\u003eStatistical analysis was carried out using SPSS 25.0. The Shapiro - Wilk test was employed to assess whether the measurement data followed a normal distribution. Measurement data that conformed to a normal distribution were presented in the form of mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026plusmn;\u0026thinsp;s), while measurement data with a skewed distribution were represented by the median and inter-quartile range. The intra-class correlation coefficient (ICC) was applied to analyze the consistency of the measurements of the \u0026alpha; angle, \u0026beta; angle, and FHC among different observers. A higher ICC value indicates better agreement. We used the intra - class correlation coefficient (ICC) to examine how consistently different observers measured the \u0026alpha; angle, \u0026beta; angle, and FHC. The greater the ICC value, the more consistent the measurements are among the observers. Kappa coefficient was used to measure the consistency of Graf classification of the same index between different observers. Kappa values spanned from \u0026minus;\u0026thinsp;1 to 1. A Kappa value in the range of 0.81 to 1.00 signified almost perfect agreement, a value between 0.61 and 0.80 denoted moderate agreement, a value from 0.41 to 0.60 indicated fair agreement, and a value of 0.40 or lower represented poor agreement. Moreover, a P value less than 0.05 was regarded as statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1Analysis of consistency\u003c/h2\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eConsistency analysis of measurements of the same index by different observers\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eICC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026alpha;\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.857\u0026ndash;0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026beta;\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.843\u0026ndash;0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.921\u0026ndash;0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote: ICC, intraclass correlation coefficient; FHC, the proportion of the femoral head that is covered by the bony structure of the acetabulum.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eKappa coefficient consistency analysis of Graf typing observations of children by different observers\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eObserver combination\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKappa\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObserver 1vs Observer 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.823\u0026ndash;0.964\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObserver 1vs Observer 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.8374\u0026ndash;0.975\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObserver 2vs Observer 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.840\u0026ndash;0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.833\u0026ndash;0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eNote: Kappa, intraclass correlation coefficient;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe agreement between the three observers for the measurements of the same index was high. Among them, \u0026alpha; Angle (ICC\u0026thinsp;=\u0026thinsp;0.894), \u0026beta; Angle (ICC\u0026thinsp;=\u0026thinsp;0.883), FHC (ICC\u0026thinsp;=\u0026thinsp;0.942) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e), Graf classification (Kappa\u0026thinsp;=\u0026thinsp;0.902) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2General data and ultrasound index analysis\u003c/h2\u003e\n \u003cp\u003eThis study incorporated a total of 102 cases, consisting of 7 males and 95 females, with a male-to-female ratio of 1:13.6. Among the patients, the oldest was 6 months old and the youngest was 27 days old. Regarding the hip dislocation conditions, 51 cases had a left hip dislocation, 22 cases had a right hip dislocation, and 29 cases had a bilateral hip dislocation. In terms of the groups, 22 patients were categorized into the failure group, while 80 patients were placed in the success group.\u003c/p\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the treatment ages of children were concentrated at 1, 2, and 3 months of age. Among them, 93.1% were female. Graf type Ⅱ accounted for the largest proportion. In type Ⅱ, ⅱb was more than ⅱa, and ⅱa was more than ⅱc. The left hip was more affected than the right and bilateral hips. In the education level of parents, junior high school education accounted for the largest proportion. Singleton accounted for 64.7%. The birth season of children was the least in summer. The places of birth were more balanced between urban and rural areas. Among them, 79.4% did not undergo cesarean section. 79.4% of the infants were born at term. The birth weight of 80.4% of the cases was more than 2500g. There was no significant difference in whether the children were born with leg-binding or not. 74.5% of the patients had no family history. Fifty-one percent of the infants were born in a secondary hospital.\u003c/p\u003e\n \u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, when it came to age, gender, the side that was affected, the season of birth, the place of birth, whether it was a cesarean section, a term birth, the birth weight, and inheritance, there were no statistically significant disparities between the two groups, as evidenced by a P value greater than 0.05. However, notable statistical differences were observed between the two groups in terms of Graf classification, the educational attainment of the father, the educational attainment of the mother, the number of fetuses, the body position during birth, the use of leggings, inheritance status, and the level of the hospital where the birth took place, with all these differences having a P value less than 0.05.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGeneral data of the children\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexuality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGraf typing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInjured side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation of father\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation of mother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of fetus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle fetus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTwin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTriple pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth season\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpring ( March-May )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSummer ( June-August )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAutumn ( September-November )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWinter ( December-February )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncunabulum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCountryside\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCesarean Section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull-term birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDelay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;2500g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;2500g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFetal position at birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreech position\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHead posture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLegging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInheritance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth hospital level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescription of data in the failure and success groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCase group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexuality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.641\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGraf typing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.876\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInjured side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation of father\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation of mother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of fetus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle fetus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTwin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTriple pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth season\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpring\u003c/p\u003e\n \u003cp\u003e( March-May )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSummer\u003c/p\u003e\n \u003cp\u003e(June-August)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAutumn (September-November)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWinter (December-February)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncunabulum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCountryside\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCesarean Section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull-term birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDelay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;2500g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.967\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;2500g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFetal position at birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreech position\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHead posture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLegging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInheritance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth hospital level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3Rate of change in treatment\u003c/h2\u003e\n \u003cp\u003eThese 102 children were followed up and reexamined, and the alterations in the results of the two ultrasound examinations, which were conducted before and after each follow-up assessment, were documented during the course of the Pavlik harness treatment, so as to calculate the change rate of pavlik harness treatment (the change difference of ultrasound test results/month), as shown in Figs. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. In the failure group, the period of follow-up extended from the age at which the initial examination was carried out to the age at the time of the final examination prior to the surgical procedure.In the group that achieved success, the follow-up duration started from the age at the first examination and ended at the age when an ultrasound examination showed that both hips were of Graf typeⅠ. The shortest follow-up period was one month, while the longest was nine months.\u003c/p\u003e\n \u003cp\u003eAt every age, when comparing the two groups, the initial ultrasound classification did not show any statistically significant variation, as indicated by a P value greater than 0.05. At all ages, the follow-up time of the two groups did not exhibit any significant difference. Similarly, there was no significant difference in the operation time within the failure group, with the P values for these comparisons all being greater than 0.05. The results are shown in Tables \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e: in the failure group, the children who started treatment in March or April had a good treatment effect, of which the children aged 3 months had the best effect, and the children who started treatment in January, February, and May had a poor treatment effect, of which the children aged 5 months had the worst effect. Pavlik harness was effective in all patients in the successful group, and children aged 4 months had the best treatment effect.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4Univariate analysis\u003c/h2\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eVariable assignment table\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable name\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGrouping and assignment\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1、2、3months of age=0;4、5、6months of age༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexuality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMan=0;Woman༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGraf typing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡa、Ⅱb、Ⅱc=0;Ⅲ、Ⅳ༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInjured side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRight=0;Left、bilateral༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation of father\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDegree higher=0;Lower education༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation of mother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDegree higher=0;Lower education༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of fetus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle fetus=0;Non-singleton༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth season\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSummer and autumn=0;Spring and winter༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncunabulum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCities=0;Countryside༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCesarean Section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo=0;Yes༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull-term birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes=0;No༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;2500g=0;\u0026lt;2500g༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFetal position at birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHead posture=0;Breech position༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLegging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo=0;Yes༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInheritance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo=0;Yes༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eX16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth hospital level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot born in a first-class hospital=0;Born in a first-class hospital༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl group=0;Case group༝1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAs presented in Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e, Binary Logistic regression analysis was employed to explore and examine the association between each factor and the disease.\u003c/p\u003e\n \u003cp\u003eThe findings indicated that numerous factors exerted an influence on the therapeutic outcome of the Pavlik harness treatment for children within the age range of 0 to 6 months. The likelihood of treatment failure rose among children who were classified as Graf type Ⅲ and Ⅳ by 14.447 times (95%CI: 4.353\u0026ndash;47.946). The risk of Pavlik harness treatment failure increased by 12.25 times (95%CI: 4.108\u0026ndash;36.527) in children born in first-class hospitals.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eillustrates the Logistic regression analysis conducted to assess how each factor impacts the disease.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eS.E\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e/t\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.594\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexuality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.874\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.695\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGraf typing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.447\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.946\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInjured side\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.354\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation of father\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;1.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.498\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation of mother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.277\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of fetus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth season\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.461\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncunabulum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.178\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCesarean Section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;1.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull-term birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;1.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.131\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;1.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFetal position at birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.380\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLegging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.974\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInheritance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.267\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth hospital level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.527\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Multivariate analysis\u003c/h2\u003e\n \u003cp\u003eBased on the outcomes of the univariate analysis of the follow-up data of children, a multivariate analysis was carried out to examine the risk factors associated with the Pavlik harness treatment for these children. The detailed results of this multivariate analysis are presented in Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e shows that in the multivariate analysis, the initial ultrasound classification of children was still a risk factor for Pavlik harness treatment in young DDH children, OR was 22.823, 95%CI was (4.720-110.363); Season of birth was also a risk factor for Pavlik harness treatment (OR\u0026thinsp;=\u0026thinsp;11.134, 95%CI: 1.071-115.736). The OR value of birth position was 18.205, and its 95%CI was (1.485-223.207). The OR value of the hospital level of birth was 9.868, 95%CI was (2.093\u0026ndash;46.524).\u003c/p\u003e\n \u003cp\u003eAccording to the results of multivariate analysis, the sensitivity of each variable was calculated, and the ROC curve was drawn. The findings are presented in Table \u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e and illustrated in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003epresents the multivariate analysis of the risk factors involved in the treatment of young children with DDH using the Pavlik sling.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eS.E\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eX\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGraf typing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.804\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e110.363\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth season\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e115.736\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePosition at birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e223.207\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth hospital level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.868\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab8\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eshows the sensitivity, specificity, false positive rate, and false negative rate of every variable within the model\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFalse positive\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFalse positive rate\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGraf typing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.762\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth season\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePosition at birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth hospital level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.875\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e3.6Prediction model\u003c/h2\u003e\n \u003cp\u003eIn conclusion, taking into account the conclusions from Study I concerning the appropriate timing for ultrasound screening and the discontinuation of Pavlik harness treatment in infants and young children suffering from DDH, and integrating them with the analysis of the risk factors for Pavlik harness treatment in young DDH patients in the present study, the prediction model depicted in Table \u003cspan class=\"InternalRef\"\u003e9\u003c/span\u003e was derived. The time of ultrasound detection in this model was 2 months old. If the hip joint was still unstable during the treatment of Pavlik harness for 4 months, plaster casting was performed immediately.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab9\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePrediction of risk factors for Pavlik sling in children\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003erisk factor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal OR value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCombination of risk factors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTreatment recommendations\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003every high risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(A\u0026thinsp;+\u0026thinsp;B\u0026thinsp;+\u0026thinsp;C)/(A\u0026thinsp;+\u0026thinsp;B\u0026thinsp;+\u0026thinsp;D)/(A\u0026thinsp;+\u0026thinsp;B\u0026thinsp;+\u0026thinsp;C\u0026thinsp;+\u0026thinsp;D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImmediate plaster therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(A\u0026thinsp;+\u0026thinsp;B)/(A\u0026thinsp;+\u0026thinsp;C)/(A\u0026thinsp;+\u0026thinsp;D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStrengthen monitoring and improve children \u0026apos;s compliance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA/(B\u0026thinsp;+\u0026thinsp;C)/(B\u0026thinsp;+\u0026thinsp;D)/(C\u0026thinsp;+\u0026thinsp;D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFollow up closely and adjust lifestyle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow risk group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC/D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFollow-up, periodic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote: A: Ultrasound examination showed Graf type Ⅲ, Ⅳ; B: the baby was born in breech position; C: The birth seasons were spring (March-May) and winter (December-February); D: the level of the birth hospital was a first-class hospital.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eIn early DDH from 0 to 6 months, the most accurate diagnostic modality is ultrasonography\u003csup\u003e16\u003c/sup\u003e. According to the characteristics of bone development in infants and young children\u003csup\u003e17\u003c/sup\u003e, before the age of 6 months, the hip joint is in the rapid growth and shaping segment, and the femoral head along with the hip joint mainly consist of cartilage\u003csup\u003e18\u003c/sup\u003e. During this period, the range of motion of the hip joint is large, and the shape and position of the femoral head are easily disturbed by external factors such as posture or external force\u003csup\u003e19\u003c/sup\u003e. The treatment at this stage is non-invasive and avoids greater trauma to the child. The treatment can be dynamically adjusted according to the growth and development of children\u003csup\u003e20\u003c/sup\u003e. Moreover, the treatment method at this stage has fewer complications and shorter treatment period, which can protect the developmental potential of children to the greatest extent and effectively avoid the influence of DDH on the growth and development of children\u003csup\u003e21\u003c/sup\u003e.\u003c/p\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003e4.1Type of Graf\u003c/h2\u003e\n \u003cp\u003eThe greater the instability indicated by the initial hip ultrasound findings, the poorer the expected outcome will be, and the lower the likelihood of successful treatment with the Pavlik harness\u003csup\u003e22\u003c/sup\u003e. The treatment failure rate and the risk of complications are higher in GrafⅢ/Ⅳ hips\u003csup\u003e12\u003c/sup\u003e, especially in those diagnosed by ultrasound. Lyu\u003csup\u003e15\u003c/sup\u003e recommends the use of a Tubingen splint for Graf III/IV children younger than 6 months of age. The rate of successful fixation achieved using the Tubingen splint was notably greater than that accomplished with the Pavlik harness (71.4% vs. 54.4%, p\u0026thinsp;=\u0026thinsp;0.047).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003e4.2 Therapeutic time\u003c/h2\u003e\n \u003cp\u003eAt present, The Pavlik sling as well as the Von Rosen splint are extensively applied in the treatment of DDH among young children. According to the Chinese guidelines for the treatment of DDH, the Pavlik harness has been put forward as the recommended first-choice harness for such treatment, with a success rate of about 70%-95%. Zhou\u003csup\u003e11\u003c/sup\u003e showed that when it comes to treating children who are younger than 2 months old, the Pavlik harness can achieve a success rate of 95.2%. In this study, the children aged\u0026thinsp;\u0026lt;\u0026thinsp;2 months had the highest treatment success rate of 87.5%, which was consistent with previous studies. However, in this study, the change rate of Pavlik harness treatment in children aged 2\u0026ndash;4 months was much higher than that in children aged\u0026thinsp;\u0026lt;\u0026thinsp;2 months. Although the success rate of 76.9% was different from that of \u0026lt;\u0026thinsp;2 months old children, the Pavlik harness treatment effect of 2\u0026ndash;4 months old children was significantly better than that of \u0026lt;\u0026thinsp;2 months old children. In the europe\u003csup\u003e23\u003c/sup\u003e, treatment guidelines for DDH state that hip ultrasound should be performed at 6 weeks after birth. Children with DDH should be treated with Pavlik therapy as soon as possible\u003csup\u003e24, 25\u003c/sup\u003e. However, some scholars have questioned that early ultrasound detection may lead to excessive diagnosis and treatment\u003csup\u003e26\u003c/sup\u003e. At present, there is a lack of international guidelines to develop a unified standard treatment plan for DDH\u003csup\u003e27\u003c/sup\u003e. The results of this study demonstrated that, while the success rate of Pavlik harness treatment for children aged between 2 and 4 months was marginally lower than that for children under 2 months of age, the change rate of harness treatment was significantly improved. For children aged 0\u0026ndash;2 months, there are some children who do not need Pavlik harness treatment and their hip can recover spontaneously. Therefore, this study raised the question of whether ultrasound screening for DDH can be delayed until 2 months of age. Administering the Pavlik harness treatment at this specific time juncture not only boosts the rate of effective response to the harness treatment but also helps to evade the potential risks associated with overdiagnosis and overtreatment. In addition, the population of this study is located in the northwest of China, with low per capita income level and uneven distribution of medical resources. Postponing the screening time of DDH can not only reduce the difficulty of ultrasound detection, but also save medical resources and reduce the family burden of children.\u003c/p\u003e\n \u003cp\u003eIn addition, Omeroğlu\u003csup\u003e28\u003c/sup\u003e suggested that age\u0026thinsp;\u0026gt;\u0026thinsp;4 months is the age threshold for failure of Pavlik harness treatment in children. After 4 months of age, the success rate of Pavlik harness treatment decreased significantly, corresponding to the results of this investigation. Whether the 4-month age time point can be used as an end point for Pavlik harness treatment. For children older than 4 months, if ultrasound examination shows that the hip joint is still unstable, the sling treatment should be stopped immediately and replaced by plaster treatment. This not only optimizes the treatment process, saves the treatment time of children, but also avoids the high incidence of AVN.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003e4.3Gender\u003c/h2\u003e\n \u003cp\u003eThe gender ratio of the two groups of patients in this study was quite different, and the number of female patients was far more than that of male patients. Studies have shown that the risk of DDH in women is about four times that in men\u003csup\u003e29\u003c/sup\u003e. This may be related to the higher estrogen level of the female fetus during the mother\u0026apos;s pregnancy\u003csup\u003e30\u003c/sup\u003e, and excessive estrogen can lead to ligament relaxation, thereby increasing the probability of hip instability. Other scholars have suggested that female infants have smaller femoral heads, shallower acetabulum than male infants, and poor matching of head and acetabulum, which will also increase the risk of female infants.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\"\u003e\n \u003ch2\u003e4.4Side of the disease\u003c/h2\u003e\n \u003cp\u003eIn the two groups, there was no significant distinction regarding the affected side of DDH. However, for both groups, the incidence of DDH on the left side was higher than that on the right side and when both sides were involved, which may be related to the position of the fetus during pregnancy\u003csup\u003e31\u003c/sup\u003e. Studies have shown that the fetus is mostly cephalic in the uterus, while the left hip joint is closer to the maternal uterine wall and spine. Prolonged compression may lead to developmental delay and joint instability. In addition, during pregnancy, maternal estrogen levels increase significantly\u003csup\u003e30\u003c/sup\u003e, and estrogen can cause fetal ligament relaxation, and the left hip joint is more susceptible to instability due to its greater sensitivity to hormones. Ultimately, the primary blood suppliers to the femoral head are the medial femoral circumflex artery and the lateral femoral circumflex artery. The branches of the left medial femoral circumflex artery are more slender or abnormal than those of the right, and the left internal iliac artery has fewer branches compared to the right one. This disparity can result in the developmental retardation of the left femoral head and elevate the likelihood of instability in the left hip joint.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\"\u003e\n \u003ch2\u003e4.5Education level of parents\u003c/h2\u003e\n \u003cp\u003eThe higher the educational level of the parents, the greater the success rate of Pavlik harness treatment for young children with DDH, indicating a positive correlation between the two. The higher the education level of the children\u0026apos;s parents, the easier they are to understand the treatment plan and pay more attention to the consequences of delayed treatment, so as to improve compliance and reduce treatment interruption\u003csup\u003e32\u003c/sup\u003e. Moreover, educational attainment is generally positively correlated with family income and access to medical resources, which may be more conducive to regular follow-up and long-haul follow-up of the treatment children receive. A multi-center study in the United States\u003csup\u003e33\u003c/sup\u003e confirmed that parental education level was linearly related to the rate of compliance with Pavlik harness wearing time and positively related to the final acetabular index improvement.\u003c/p\u003e\u003cbr\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\"\u003e\n \u003ch2\u003e4.6Number of fetus\u003c/h2\u003e\u003cbr\u003e\n \u003cp\u003eAlthough a notable divergence in the number of deliveries existed between the two groups, neither the univariate analysis nor the multivariate analysis could demonstrate a significant association related to this difference. It has been reported in the literature that multiple pregnancies may increase the risk of fetal hip dysplasia, but in comparison with singleton pregnancies, the success rate of treating DDH does not show a statistically significant difference\u003csup\u003e34\u003c/sup\u003e, this is substantially consistent with the results of this research. Some scholars have also proposed that families with multiple children may be distracted by having too many children, leading to non-standard Pavlik harness wearing for children, but no evidence supports this.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\"\u003e\n \u003ch2\u003e4.7Season of Birth\u003c/h2\u003e\n \u003cp\u003eThe number of children born in summer was the lowest in the sample, which may be related to the higher temperature in summer and the loose clothing of infants and young children, which is conducive to hip extension.Lee WC\u003csup\u003e35\u003c/sup\u003e confirmed the cold season serves as a contributing factor that increases the likelihood of being diagnosed with DDH and undergoing related surgery. They discovered that the rate of surgical treatment for DDH among infants born in the winter months was notably higher, at 0.70 cases per 1000 infants, compared to those born in the summer months, which was 0.32 cases per 1000 infants. Additionally, this rate of surgical treatment was found to be correlated with the mean temperature during the infants\u0026apos; first three months of life, with a coefficient of determination (r\u003csup\u003e2\u003c/sup\u003e) of 0.91 and a p-value less than 0.0001, indicating a very strong relationship. It was also associated with the birth month, having an (r\u003csup\u003e2\u003c/sup\u003e) value of 0.68 and a p-value less than 0.001, suggesting a significant connection between the month of birth and the likelihood of requiring surgical treatment for DDH. This study revealed that the success rate of treating children with a Pavlik harness for Developmental DDH was markedly lower for those born in spring and winter than for those born in summer and autumn. This disparity might be attributed to the local temperature conditions. The subjects were from northwest China. Lower temperatures in spring and winter and heavier clothing for children may affect the standardization of sling wearing. However, there is no study on the relationship between season and children\u0026apos;s compliance with Pavlik harness wearing, and more research is needed to further confirm.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\"\u003e\n \u003ch2\u003e4.8Fetal position at birth\u003c/h2\u003e\n \u003cp\u003eChildren in the breech position had 3.238 times the risk of Pavlik harness treatment failure compared to children in the head position. A breech fetus is possible if the mother has oligohydramnios or abnormal estrogen during the course of the present pregnancy\u003csup\u003e36\u003c/sup\u003e. The hip joint of breech fetuses will be in flexion and abduction position in the mother\u003csup\u003e37\u003c/sup\u003e, while the fetal hip joint is incompletely developed, and the acetabular fossa is shallow, which is prone to dislocation of the femoral head\u003csup\u003e38\u003c/sup\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\"\u003e\n \u003ch2\u003e4.9Birth hospital level\u003c/h2\u003e\n \u003cp\u003eIn the context of this study, a statistical difference was observed in the level of the birth hospital between the group of children for whom the treatment failed and the group of children for whom the treatment was successful, which was also an important factor affecting the success of Pavlik harness treatment. Studies have shown that the missed diagnosis of DDH in children is partly related to the non-standard ultrasonic detection methods\u003csup\u003e39\u003c/sup\u003e. High-level hospitals have the ability to provide advanced equipment and experienced sonographers, which largely avoid missed diagnosis and delayed treatment. In addition, high-level hospitals mean more patients, doctors have more experience in treating young DDH children, and pay more attention to standardized treatment and health education for family members, which is another factor to improve the success rate of Pavlik harness treatment.\u003c/p\u003e\n \u003cp\u003eThe innovative aspect of this study lies in its integration of the rate of change in Pavlik harness treatment with the outcomes of ultrasound testing. This approach enables a more straightforward and intuitive identification of the disparities in ultrasound metrics between the group that experienced treatment failure and the group that achieved treatment success. The findings of this study indicate that, for infants with DDH in northwest China, performing an ultrasound screening two months after birth is a viable option. This timing not only enhances the precision of the diagnosis but also mitigates the risks associated with overdiagnosis and overtreatment. Moreover, it does not substantially decrease the success rate of treatment using the Pavlik harness. The optimal period for conducting Pavlik harness treatment is when the infant is aged between 2 months and 4 months. Therefore, this study used 4 months of age as the termination time point for Pavlik harness treatment, which provides a new reference for choosing between conservative treatment and casting treatment in young children with DDH.\u003c/p\u003e\n \u003cp\u003eThis study is accompanied by several limitations. Firstly, the sample size is so limited that it fails to render the statistical outcomes significant, so we can continue to increase the cases and improve the establishment of the database. In addition, this study did not investigate whether Pavlik sling treatment should be terminated immediately after successful treatment. The current mainstream view is that Pavlik harness should be gradually reduced after successful treatment, from full day to night, to half day to none. Such advantages are continued stability of the hip and prevention of redislocation. However, it has also been proposed in the literature that Pavlik harness treatment should be discontinued immediately when the hip becomes ultrasonically normal (when ultrasound of the hip appears to be normal)\u003csup\u003e40\u003c/sup\u003e. That study discovered that, in terms of the radiological structure of the femoral head, the likelihood of complications following treatment, and the probability of re-dislocation, there was no statistically significant distinction between the group of children who stopped treatment abruptly and the group of children who ceased treatment in a gradual manner. Finally, no new ultrasound indicators were proposed in this study, which were studied on the basis of previous ultrasound indicators. At present, there is still a debate about the limit and choice of Pavlik harness therapy and plaster therapy for the treatment of DDH in young people. At present, the existing ultrasound detection indicators cannot fully answer the clinical questions, which urgently needs a new method or indicator to explain, it is also going to be the key area of emphasis and the trajectory for our future research work.\u003c/p\u003e\u003cbr\u003e\n\u003c/div\u003e"},{"header":"5. CONCLUSION","content":" \u003cp\u003eThis study proposes an ultrasound prediction model for DDH in young children. Considering the characteristics of China's geography and medical resources, the late ultrasonic detection time of infant DDH reduces the risk of overdiagnosis and treatment, and will not greatly affect the efficacy rate of Pavlik harness treatment in achieving positive outcomes. For the termination time of Pavlik harness, this model combined with the turning point of the change rate of Pavlik harness treatment at the age of 4 months can make individualized treatment plans for different children, which is also consistent with Professor Pavlik's recommendation to encourage individualized treatment for each hip\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. The model can be used to optimize the treatment process, shorten the detection time of failure of Pavlik harness treatment, and effectively reduce the incidence of subsequent complications of DDH, and better protect the developmental potential of the hip.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eThis research work was supported by: Ethic Committee of Honghui Hospital, Xi'an Jiaotong University. Ethical acceptance number：2025-KY-064-01.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants in this study were clearly informed of the purpose and method of the study and signed informed consent.\u003c/p\u003e\n\u003cp\u003eThis study follows the principles of the ' Helsinki Declaration ' and follows the protocol agreed by the Ethics Committee to carry out clinical research to protect the rights and safety of subjects.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not Applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials :\u003c/p\u003e\n\u003cp\u003eThere are no limitations regarding the accessibility of any of the materials and data related to this work. Every author consents to the publication of this work and also approves of making the data and materials available for others to access. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eAcknowledgements Funding:\u003c/p\u003e\n\u003cp\u003eThis work was supported by a grant from the Innovation Capability Support Program of Shaanxi Province (Grant No. 2024SF-LCZX-16)\u003c/p\u003e\n\u003cp\u003eThis work was supported by a grant from \u0026nbsp;the Shaanxi province health scientific research innovation ability promotion plan（No.2024PT-12)\u003c/p\u003e\n\u003cp\u003eThis research was funded by the National High Level Hospital Clinical Research Funding (2022-PUMCH-D-004）\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare to have no competing interests.\u003c/p\u003e\n\u003cp\u003eAuthors' contributions:\u003c/p\u003e\n\u003cp\u003eJiaju Wang , Qingda Lu and Huan Wang wrote the main manuscript text, Chenxin Liu, Shuai Yang , Yating Yang participatedinthe interpretation of the results, Qiang Jie designed the research subject.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eME SSSK, L P. - Developmental Dysplasia of the Hip: A Review. J Long Term Eff Med Implants. 2022;32(3):39\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eC P-C HS. - Developmental Dysplasia of the Hip: Guide for the Pediatric Primary Care. Pediatr Ann. 2022;51(9):e346\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSA HA. - Comparing results of clinical versus ultrasonographic examination in. J Res Med Sci. 2013;18(12):1051\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eId SWS, SJ O. P, MH B, KH P. - The usefulness of universal ultrasound before hospital discharge for early. Medicine. 2024;103(21).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eId IMA. - ECAD study: Evaluating agreement degree among paediatricians in hip dysplasia. Eur J Pediatr. 2024;183(11):4671\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR G. - The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound. Arch Orthop Trauma Surg. 1978;97(2):117\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTY YPC, CC F. - Automatic and human level Graf's type identification for detecting developmental. Biomed J. 2024;47(2):10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eA P. - The functional method of treatment using a harness with stirrups as the primary. Clin Orthop Relat Res 1992;281:4\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eI W, E S, T O, et al. - The Pavlik harness in the treatment of developmentally dislocated hips: results. J Orthop Sci 2013;18(5):749\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEA MANA. - Evidence based treatment for developmental dysplasia of the hip in children under. Surgeon. 2021;19(2):77\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eP Z, J Z, T D, et al. - Closed reduction and plaster immobilization: an alternative solution for patients. ANZ J Surg. 2023;93(3):663\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH \u0026Ouml;. - Treatment of developmental dysplasia of the hip with the Pavlik harness in. J Child Orthop. 2018;12(4):308\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLA ENN, PM K. - Higher Pavlik Harness Treatment Failure Is Seen in Graf Type IV Ortolani-positive. Clin Orthop Relat Res. 2016;474(8):1847\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH K, M K, N I. - Predictive factors for unsuccessful treatment of developmental dysplasia of the. J Pediatr Orthop. 2009;29(6):552\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZ XLTC. Y, - T\u0026uuml;bingen hip flexion splint more successful than Pavlik harness for decentred. Bone Joint J 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eId CGD. - Length of treatment and ultrasound timing in infants with developmental dysplasia. Eur J Orthop Surg Traumatol. 2024;34(2):1079\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eME SKSS. - Ultrasonographic screening for developmental dysplasia of the hip: the Graf. Eur J Orthop Surg Traumatol. 2024;34(2):723\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK W-S HKHP. - Use of the T\u0026uuml;bingen splint for the initial management of severely dysplastic and. Arch Orthop Trauma Surg. 2018;138(2):149\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eA N, D Y, J L. - Comparison of outcomes of different Graf grades of developmental dysplasia of the. 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R, S K,. - Risk Factors for Developmental Dysplasia of the Hip Before 3 Months of Age: A. JAMA Netw Open 2025;8(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eId ATP. - The impact of the introduction of selective screening in the UK on the. Bone Jt Open. 2023;4(8):635\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eId ATP, JLJ O. - The cost effectiveness of potential risk factors for developmental dysplasia of. Bone Jt Open. 2023;4(4):234\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRS A-E, FH A, RM A, W P, AH J. KI K. - Diagnosis and treatment of developmental dysplasia of the hip: A current practice. J Orthop Surg. 2017;25(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH \u0026Ouml;, N K, A A. - Success of Pavlik Harness Treatment Decreases in Patients\u0026thinsp;\u0026ge;\u0026thinsp;4 Months and in. 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AM, - Prevalence of Breech Presentation and Other Gestational/Delivery Characteristics. Cureus. 2023;15(7).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS W, E C, D S. - Screening for developmental dysplasia of the hip in a rural health district: An. Aust J Rural Health. 2018;26(3):199\u0026ndash;205.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDJ W, ND M, MS AW. - Staged weaning versus immediate cessation of Pavlik harness treatment for. J Pediatr Orthop B. 2014;23(2):103\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eV B. - [Pavlik's method in developmental dysplasia of the hip]. Acta Orthop Traumatol Turc. 2007;1:19\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Developmental dysplasia of the hip, Ultrasound, Graf classification, Pavlik harness, Closed reduction","lastPublishedDoi":"10.21203/rs.3.rs-6463899/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6463899/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAlthough Pavlik slings are widely used for the treatment of DDH in children aged 0\u0026ndash;6 months, the time point between Pavlik sling and cast treatment is currently debated.This study aims to establish a set of prediction models based on ultrasound indicators and risk factors of children.A total of 102 children, with Pavlik harness failure (n\u0026thinsp;=\u0026thinsp;22) and Pavlik harness success (n\u0026thinsp;=\u0026thinsp;80) were included in this study.By comparing the change rate of Pavlik harness treatment between the two groups and establishing a predictive model based on multivariate analysis of follow-up data, 2 months after birth is recommended as the initial age for ultrasound screening of DDH in northwest China. According to the risk factors, the children were divided into 4 grades, and different grades corresponded to different treatment strategies. The end of Pavlik harness treatment was set at 4 months of age.In case the hip joint remained unstable by the time the infant was 4 months old, plaster therapy would then be carried out.\u003c/p\u003e","manuscriptTitle":"Establishment and discussion of ultrasonic prediction model for outcome of children with DDH under 6 months treated with Pavlik sling","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-20 14:53:32","doi":"10.21203/rs.3.rs-6463899/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"770abae7-f48c-4465-9a8d-59125724a0a2","owner":[],"postedDate":"May 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-13T19:23:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-20 14:53:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6463899","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6463899","identity":"rs-6463899","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}