Poul J, Procházka J, Klimsová J, Janovec M, Bajerová J, Jíra I, Straka M, Sommernitz M
Klinika dĕtské ortopedie, Fakultní dĕtské nemocnice s poliklinikou, Brno.
Acta Chir Orthop Traumatol Cech. 1990 Aug;57(5):392-404.
The authors present part of their prospective epidemiological study of congenital dysplasia of hip joints within which newborns were examined by ultrasonogram prior to the beginning of the therapy. Apart from the standard examination in the frontal plane after Graf they examined on principle also the ultrasonographic stability by the dynamic test after Schuler as well as by the application of the probe anteriorly with the simultaneous provocation according to Palmén. The authors have processed pathological ultrasonographic findings in 53 newborns (64 hip joints). The technique of the examination by ultrasound from the anterior approach is explained in detail. The comparison of both dynamic tests has shown that the examination from the anterior approach is considerably more sensitive than Schuler's dynamic test and also fully correlates with the clinical finding. It is a fact that the shift of the head in the flexion dorsally represents the most important component of the movement in unstable hip joint during provocation, it is far more noticeable than the lateralization of the head or the shift in the cranial direction. After achieving ultrasonographic stability the classical Graf method is sufficient for the registration of residual changes on the acetabular rim. The follow-up of patients until their complete healing has shown a surprisingly rapid remodellation of hip joints. The whole complex of clinically unstable hip joints has been divided into subgroups according to Graf classification. In type IIc or IId on the basis of ultrasonographic examination from the anterior approach the stable joints from the ultrasonographic viewpoint have been distinguished from unstable ones. The follow-up carried out in short intervals has shown that of longest duration is the remodellation of total dislocation and, on the contrary, of shortest duration is the healing of joints in the IIc or IId type. An absolute majority of affected hip joints have become normal until 3rd month of the age. The complex does not include two patients with teratological dislocation, the incidence of which has been determined in our study by the ratio of 2 cases in 35,550 of timely examined newborns. The role of the factor of spontaneous stabilization cannot be in this part of the study completely discounted. However, herewith we present part of an accomplished epidemiological study where the number of timely diagnosed patients including late diagnoses corresponds to the number of dislocations and subluxations determined within the conventional late diagnosis.
作者介绍了他们关于先天性髋关节发育不良的前瞻性流行病学研究的一部分内容，在该研究中，新生儿在开始治疗前接受了超声检查。除了按照格拉夫（Graf）方法在额面进行标准检查外，他们原则上还通过舒勒（Schuler）动态试验以及根据帕尔门（Palmén）方法在前侧应用探头并同时进行激发来检查超声稳定性。作者对53例新生儿（64个髋关节）的病理超声检查结果进行了分析。详细解释了从前侧入路进行超声检查的技术。两种动态试验的比较表明，前侧入路检查比舒勒动态试验灵敏度高得多，并且与临床发现完全相关。事实上，在激发过程中，股骨头背侧屈曲时的移位是不稳定髋关节运动中最重要的组成部分，比股骨头的侧方移位或向头侧的移位更明显。在达到超声稳定性后，经典的格拉夫方法足以记录髋臼边缘的残余变化。对患者进行随访直至完全愈合，结果显示髋关节的重塑过程惊人地迅速。根据格拉夫分类，临床上不稳定髋关节的整个复合体被分为亚组。在IIc型或IId型中，根据前侧入路的超声检查，从超声角度区分出稳定关节和不稳定关节。短时间间隔的随访表明，全脱位的重塑持续时间最长，相反，IIc型或IId型关节的愈合持续时间最短。绝大多数受影响的髋关节在3个月龄时已恢复正常。该复合体不包括两名患有畸形性脱位的患者，在我们的研究中，其发病率通过在35550例及时检查的新生儿中有2例的比例来确定。在本研究的这一部分中，不能完全忽视自发稳定因素的作用。然而，我们在此展示了一项已完成的流行病学研究的一部分，其中及时诊断的患者数量（包括晚期诊断）与传统晚期诊断中确定的脱位和半脱位数量相对应。
