Walter R S, Donaldson J S, Davis C L, Shkolnik A, Binns H J, Carroll N C, Brouillette R T
Department of Pediatrics, A. I. duPont Institute, Division of General Pediatrics, Wilmington, Del; 19899.
Am J Dis Child. 1992 Feb;146(2):230-4. doi: 10.1001/archpedi.1992.02160140096028.
Congenital dysplasia of the hip (CDH) continues to be missed by routine physical screening examinations in the early months when treatment is most effective. Real-time ultrasonography (US) is valuable in the detection of CDH in the young infant. We performed a prospective study to evaluate one US screening strategy that targets a select "high-risk newborn" population at risk for CDH aiming to increase the early diagnosis of this condition. From 1772 consecutive births at one hospital, we identified 97 (5.5%) newborns with risk factors for CDH: breech delivery, 73 babies; family history, 26 babies; postural abnormalities, five babies; and oligohydramnios, four babies. Eleven newborns had two risk factors. We studied 69 of these newborns with US. There were four cases of CDH in this group. Three of these babies had completely normal pediatric physical examination results at the time of the US study (at 14, 75, and 100 days, respectively) despite dysplasia diagnosed by US. All were successfully treated with a harness as outpatients. We conclude that a screening program entailing identification and subsequent US of the hip of newborns with specific physical and historical risk factors for CDH increases early diagnosis. Further analysis suggests this approach is cost-effective.
先天性髋关节发育不良（CDH）在治疗最有效的最初几个月，仍会被常规体格筛查检查漏诊。实时超声检查（US）在检测婴幼儿CDH方面具有重要价值。我们进行了一项前瞻性研究，以评估一种针对特定“高危新生儿”群体的超声筛查策略，这些新生儿有患CDH的风险，旨在提高对这种疾病的早期诊断。在一家医院连续出生的1772例新生儿中，我们确定了97例（5.5%）有CDH危险因素的新生儿：臀位分娩73例；家族史26例；姿势异常5例；羊水过少4例。11例新生儿有两种危险因素。我们对其中69例新生儿进行了超声检查。该组中有4例CDH病例。其中3例婴儿在美国研究时（分别为14天、75天和100天）儿科体格检查结果完全正常，尽管超声诊断为发育不良。所有患儿均作为门诊病人成功接受了吊带治疗。我们得出结论，一项针对有CDH特定体格和病史危险因素的新生儿进行识别并随后进行髋关节超声检查的筛查计划可提高早期诊断率。进一步分析表明，这种方法具有成本效益。
