Department of Radiology, West Middlesex University Hospital, Isleworth, UK.
Eur Rev Med Pharmacol Sci. 2011 Apr;15(4):394-8.
Developmental dysplasia of the hip (DDH) can result in chronic pain, gait abnormalities and degenerative arthritis. Infants with a family history, Breech delivery or unstable/"clicking" of the hip on examination are at higher risk. The goal is to detect cases early enough for normal hip development and function by the end of adolescence, but clinical examination alone is ineffective.
All infants born at the West Middlesex University Hospital, Isle-worth, U.K., between 3/3/2005 and 21/10/2006 underwent prospective clinical screening to reveal risk factors of unstable hip on examination, family history of DDH and Breech delivery. Infants with risk factors underwent static and dynamic ultrasound of the hips (Harke's method with Terjesen measurements), performed by a consultant radiologist or sonographer. The infant was then examined by an Orthopaedic Surgeon who was blinded to the ultrasound findings until after creating a management plan.
5772 infants were born during the study period. 200 (3.5%) at-risk infants were identified, resulting in 400 hip ultrasounds. Following review of ultrasound findings, the majority of cases (163/200, 81.5%) lead to no change in management. Change in timing or type of clinical follow up occurred in 31 cases with normal ultrasounds and 20 cases with abnormal (immature hip) ultrasounds. Dysplasia was demonstrated in 6 infants (3%) on ultrasound, who were treated with Parvlik Harness. Of these, only 5 were detected on examination. Therefore, the ultrasound findings lead to 1 intervention with Parvlik Harness which would have otherwise gone undiagnosed from clinical examination.
Whereas type and timing of follow up was adjusted in 18.5% of the at-risk infants, targeted screening of at-risk with ultrasound lead to only one intervention. This encourages discussion on the resource implication and viability of ultrasound screening, as only one from two hundred lead to an intervention.
发育性髋关节发育不良（DDH）可导致慢性疼痛、步态异常和退行性关节炎。有家族史、臀位分娩或髋关节检查时不稳定/“弹响”的婴儿风险较高。目标是通过青春期结束时使髋关节正常发育和功能，但是仅凭临床检查效果不佳。
英国西米德尔塞克斯大学医院 Isleworth 院区于 2005 年 3 月 3 日至 2006 年 10 月 21 日期间出生的所有婴儿均接受前瞻性临床筛查，以发现检查时髋关节不稳定的危险因素、DDH 家族史和臀位分娩。有危险因素的婴儿由顾问放射科医生或超声科医生进行髋关节的静态和动态超声检查（采用 Harke 法和 Terjesen 测量）。然后由骨科医生对婴儿进行检查，直到制定管理计划后，骨科医生才会看到超声检查结果。
研究期间共出生 5772 名婴儿。发现 200 名（3.5%）有风险的婴儿，导致 400 次髋关节超声检查。在审查了超声检查结果后，大多数病例（163/200，81.5%）无需改变管理方式。在有正常超声结果的 31 例和有异常（不成熟髋关节）超声结果的 20 例中，改变了临床随访的时间或类型。在 6 名婴儿（3%）的超声检查中发现了发育不良，他们接受了 Parvlik 吊带治疗。其中，只有 5 例是通过检查发现的。因此，超声检查结果导致 1 例使用 Parvlik 吊带进行干预，否则通过临床检查将无法发现。
虽然有 18.5%的高危婴儿调整了随访的类型和时间，但针对高危婴儿的超声筛查仅导致了 1 次干预。这引发了对超声筛查的资源影响和可行性的讨论，因为每 200 例中只有 1 例导致干预。
