Karmazyn Boaz K, Gunderman Richard B, Coley Brian D, Blatt Ellen R, Bulas Dorothy, Fordham Lynn, Podberesky Daniel J, Prince Jeffrey Scott, Paidas Charles, Rodriguez William
Riley Hospital for Children, Indiana University, Indianapolis, Indiana 46202-5200, USA.
J Am Coll Radiol. 2009 Aug;6(8):551-7. doi: 10.1016/j.jacr.2009.04.008.
Developmental dysplasia of the hip (DDH) affects 1.5 of every 1,000 caucasian Americans and less frequently affects African Americans. Developmental dysplasia of the hip comprises a spectrum of abnormalities, ranging from laxity of the joint and mild subluxation to fixed dislocation. Early diagnosis of DDH usually leads to low-risk treatment with a harness. Late diagnosis of DDH in children may lead to increased surgical intervention and complications. Late diagnosis of DDH in adults can result in debilitating end-stage degenerative hip joint disease. Screening decreases the incidence of late diagnosis of DDH. Clinical evaluation for DDH should be performed periodically at each well-baby visit until the age of 12 months. There is no consensus on imaging screening for DDH. Consideration for screening with ultrasound is balanced between the benefits of early detection of DDH and the increased treatment and cost factors. In addition, randomized trials evaluating primary ultrasound screening did not find significant decrease in late diagnosis of DDH. In the United States, hip ultrasound is selectively performed in infants with risk factors, such as family history of DDH, breech presentation, and inconclusive findings on physical examination. Ultrasound for DDH should be performed after 2 weeks of age because laxity is common after birth and often resolves itself. A pelvic radiograph can optimally be performed after the age of 4 months, when most infants will have ossification centers of the femoral heads.
髋关节发育不良（DDH）在每1000名美国白种人中约有1.5人受影响，而在非裔美国人中受影响的频率较低。髋关节发育不良包括一系列异常情况，从关节松弛和轻度半脱位到固定性脱位。DDH的早期诊断通常采用吊带进行低风险治疗。儿童期DDH的晚期诊断可能导致手术干预增加和并发症。成人期DDH的晚期诊断可导致严重的终末期退行性髋关节疾病。筛查可降低DDH晚期诊断的发生率。应在每次健康婴儿检查时定期进行DDH的临床评估，直至12个月龄。对于DDH的影像学筛查尚无共识。超声筛查的考虑需在早期发现DDH的益处与增加的治疗和成本因素之间进行权衡。此外，评估初级超声筛查的随机试验未发现DDH晚期诊断有显著降低。在美国，对于有风险因素的婴儿，如DDH家族史、臀位分娩和体格检查结果不确定的婴儿，会选择性地进行髋关节超声检查。DDH的超声检查应在出生后2周后进行，因为出生后关节松弛很常见，且通常会自行缓解。骨盆X线片最好在4个月龄后进行，此时大多数婴儿会有股骨头的骨化中心。
