Tschauner Christian, Fürntrath Frank, Saba Yasaman, Berghold Andrea, Radl Roman
General and Orthopaedic Hospital Stolzalpe, 8852 Stolzalpe, Austria.
J Child Orthop. 2011 Dec;5(6):415-24. doi: 10.1007/s11832-011-0366-y. Epub 2011 Sep 18.
PURPOSE/BACKGROUND/INTRODUCTION: The aim of this study was to retrospectively evaluate the impact of neonatal sonographic hip screening using Graf's method for the management and outcome of orthopaedic treatment of decentered hip joints with developmental dysplasia of the hip (DDH), using three decades (1978-2007) of clinical information compiled in a medical database.
Three representative cohorts of consecutive cases of decentered hip joints were selected according to different search criteria and inclusion and exclusion parameters: (1) cohort 1 (1978-1982; n = 80), without sonographic screening; (2) cohort 2.1 (1994-1996; n = 91), with nationwide established general sonographic screening according to the Graf-method; (3) cohort 2.2 (2003-2005; n = 91), with sonographic screening including referred cases for open reduction from non-screened populations. These three cohorts were compared for the following parameters: age at initial treatment, successful closed reduction, necessary overhead traction, necessary adductor-tenotomy, rate of open reduction, rate of avascular necrosis (AVN) and rate of secondary acetabuloplasty.
The age at initial treatment was reduced from 5.5 months in the first cohort to 2 months in the two subsequent two cohorts and the rate of successful closed reduction increased from 88.7 to 98.9 and 95.6%, respectively. There was a statistically significant improvement in six out of seven parameters with sonographic hip screening; only the rate of secondary acetabuloplasty did not improve significantly.
Compared to the era before the institution of a sonographic hip screening programme according to the Graf-method in Austria in 1992, ultrasound screening based-treatment of decentered hip joints has become safer, shorter and simpler: "safer" means lower rate of AVN, "shorter" means less treatment time due to earlier onset and "simpler" means that the devices are now less invasive and highly standardized.
目的/背景/引言：本研究的目的是利用医学数据库中收集的三十年（1978 - 2007年）临床信息，回顾性评估采用格拉夫（Graf）方法进行新生儿髋关节超声筛查对发育性髋关节发育不良（DDH）所致髋关节脱位的骨科治疗管理及结果的影响。
根据不同的搜索标准以及纳入和排除参数，选择了三组具有代表性的连续性髋关节脱位病例队列：（1）队列1（1978 - 1982年；n = 80），未进行超声筛查；（2）队列2.1（1994 - 1996年；n = 91），根据格拉夫方法在全国范围内开展常规超声筛查；（3）队列2.2（2003 - 2005年；n = 91），超声筛查包括从未经筛查人群中转来接受切开复位的病例。比较这三组队列的以下参数：初次治疗年龄、成功闭合复位率、必要的头端牵引、必要的内收肌切断术、切开复位率、无血管坏死（AVN）率和二次髋臼成形术率。
初次治疗年龄从第一组队列的5.5个月降至后两组队列的2个月，成功闭合复位率分别从88.7%提高到98.9%和95.6%。髋关节超声筛查使七个参数中的六个有统计学意义的改善；只有二次髋臼成形术率没有显著提高。
与1992年奥地利实施格拉夫方法的髋关节超声筛查计划之前的时代相比，基于超声筛查的髋关节脱位治疗变得更安全、更短且更简单：“更安全”意味着AVN率更低，“更短”意味着由于更早开始治疗而治疗时间更短，“更简单”意味着现在的器械侵入性更小且高度标准化。
