Dorn U
Orthopädische Abteilung, Landeskrankenanstalten Salzburg.
Wien Klin Wochenschr Suppl. 1990;181:3-22.
A routine orthopaedic examination of each newborn was performed at the Salzburger Landesfrauenklinik (Department for gynaecology and obstetrics) since 1964. The results of these examinations were stored in an electronic database since 1978 and were now evaluated in a retrospective analysis. The examinations were performed by 8 orthopaedic surgeons between I/1978 and IX/1984. 5.9 percent of all newborns had a limited abduction and 13.2 percent a lax hip. Hips with limited abduction and lax hips were not classified as pathological but were recommended for strict observation and X-ray control at an age of four months. A similar rate of instable hips such as subluxatable (= 2.11%) and luxatable (= 0.63%) hips were also observed by other authors, whereas quite lower rates of instable hips in newborns were reported from several other European parts. Mau indicated the limited value of clinical examinations particularly when evaluating data in a multicenter study was concerned. In our study each examiner had a statistically significant variation of his results which we found by establishing an examiners ratio (Formula: see text). Since October 1984 the clinical routine newborn screening was completed by an obligatory hip sonography in the first days of life. The sonographic examination and classification was done according to Graf's method. Real-time ultrasound machines with linear 5 MHZ-transducer were used. 8.221 newborns were examined between X/1984 and XII/1988. 72.51 percent were type Ia, b. 25.63% were categorized as type IIa; 1.66 percent were classified type IIc, D; 0.16 percent were type IIIa hips. Only one hip was classified as type IV, this was a teratological dislocated hip. 1.31 percent of all hips showed a pathologic sonogram (= type IIc, D, IIIa) without having shown abnormalities, when clinically examined a few days before. In our opinion these results emphasize the value of a sonographic newborn screening. The majority of hips with distinct abnormalities only (= lax hips, limited abduction) was type Ia, b, or IIa, whereas the majority of clinical instable hips had pathologic sonograms (= IIc, D, IIIa). Newborns delivered by breech presentation had a significant higher percentage of clinically abnormal hips (= 7.48 subluxatable and luxatable hips). The percentage of pathologic sonograms (8.81%) and type IIa-hips (= 42.78%) was significantly higher compared to the normal delivered group. 336 premature newborns were found to have a statistically significant higher percentage of type Ia, b-hips (= 82.73%) and a statistically equal percentage of sonographically pathologic hips (= 0.89%) in comparison to the mature newborns.(ABSTRACT TRUNCATED AT 400 WORDS)
自1964年起，萨尔茨堡州立妇女医院（妇产科）对每名新生儿进行常规骨科检查。自1978年起，这些检查结果被存储在电子数据库中，现进行回顾性分析。检查由8名骨科医生在1978年1月至1984年9月期间完成。所有新生儿中，5.9%的新生儿外展受限，13.2%的新生儿髋关节松弛。外展受限和髋关节松弛的情况未被归类为病理性，但建议在4个月大时进行严格观察和X光检查。其他作者也观察到类似比例的不稳定髋关节，如可半脱位（=2.11%）和可脱位（=0.63%）的髋关节，而欧洲其他几个地区报告的新生儿不稳定髋关节比例则低得多。毛指出临床检查的价值有限，尤其是在涉及多中心研究数据评估时。在我们的研究中，我们通过建立检查者比例（公式：见正文）发现，每位检查者的结果存在统计学上的显著差异。自1984年10月起，临床常规新生儿筛查在出生后的头几天通过强制性髋关节超声检查完成。超声检查和分类按照格拉夫方法进行。使用配备线性5兆赫换能器的实时超声仪。在1984年10月至1988年12月期间，对8221名新生儿进行了检查。72.51%为Ia、b型。25.63%被归类为IIa型；1.66%被分类为IIc、D型；0.16%为IIIa型髋关节。只有一例髋关节被归类为IV型，这是一例畸形性脱位髋关节。在所有髋关节中，1.31%的髋关节超声检查结果异常（=IIc、D、IIIa型），而在几天前进行临床检查时未显示异常。我们认为这些结果强调了新生儿超声筛查的价值。仅具有明显异常（髋关节松弛、外展受限）的大多数髋关节为Ia、b型或IIa型，而大多数临床不稳定髋关节的超声检查结果异常（=IIc、D、IIIa型）。臀位分娩的新生儿临床异常髋关节（=7.48%的半脱位和脱位髋关节）的比例显著更高。与顺产组相比，超声检查结果异常的比例（8.81%）和IIa型髋关节（=42.78%）的比例显著更高。与足月新生儿相比，336名早产新生儿中Ia、b型髋关节的比例（=82.73%）在统计学上显著更高，超声检查结果异常的髋关节比例（=0.89%）在统计学上相当。（摘要截于400字）
