Orthopaedic Department, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK.
Arch Dis Child. 2013 Sep;98(9):692-6. doi: 10.1136/archdischild-2013-303647. Epub 2013 Jul 13.
Developmental dysplasia of the hip (DDH) is the most common neonatal musculoskeletal condition. In 2008, the NHS Newborn and Infant Physical Examination committee added selective 'at risk' screening to the existing universal neonatal and general practitioner clinical hip screening guidelines.
Assessment of breech and family history risk factors in DDH.
A 15 year prospective, observational, longitudinal cohort study.
Breech presentation and evidence of a strong family history for DDH were the 'risk factors' studied. All infants referred were clinically and sonographically screened by one consultant paediatric orthopaedic surgeon.
From a cohort of 64 670 live births, 2984 neonates/infants, 46.1 (95% CI 44.6 to 47.8) per 1000 live births, were referred and sonographically screened with these risk factors alone. 1360 were male, of which four were identified as having 'pathological' DDH (an incidence of 0.003 (95% CI 0.001 to 0.008)). 1624 were female, of which 45 were identified as having 'pathological' DDH (an incidence of 0.028 (95% CI 0.021 to 0.037)). This difference in incidence of 0.025 (95% CI 0.016 to 0.033) was statistically significant (p<0.001). From those who were clinically stable and screened with either or both of the two risk factors, four individuals were diagnosed with irreducible hip dislocation (0.06 (95% CI 0.024 to 0.159) per 1000 live births). All were females.
This study questions the current UK screening policy for DDH in clinically stable males referred with risk factors, and may influence future DDH screening programme policy.
发育性髋关节发育不良（DDH）是最常见的新生儿肌肉骨骼疾病。2008 年，NHS 新生儿和婴儿体检委员会在现有的通用新生儿和全科医生临床髋关节筛查指南中增加了选择性“高危”筛查。
评估 DDH 的臀位和家族史危险因素。
一项为期 15 年的前瞻性、观察性、纵向队列研究。
臀位和 DDH 家族史强阳性是研究的“危险因素”。所有被转诊的婴儿均由一名顾问小儿矫形外科医生进行临床和超声筛查。
在 64670 例活产儿中，2984 例新生儿/婴儿（每 1000 例活产儿中有 46.1 例，95%可信区间为 44.6 至 47.8）因这些危险因素单独被转诊并接受超声筛查。其中 1360 例为男性，其中 4 例被诊断为“病理性”DDH（发病率为 0.003（95%可信区间为 0.001 至 0.008））。1624 例为女性，其中 45 例被诊断为“病理性”DDH（发病率为 0.028（95%可信区间为 0.021 至 0.037））。这种发病率差异为 0.025（95%可信区间为 0.016 至 0.033），具有统计学意义（p<0.001）。在那些临床稳定并通过两种危险因素中的一种或两种进行筛查的患者中，有 4 例被诊断为不可复位性髋关节脱位（每 1000 例活产儿中发病率为 0.06（95%可信区间为 0.024 至 0.159））。所有患者均为女性。
本研究对目前英国对有危险因素的临床稳定男性进行 DDH 筛查的政策提出了质疑，并可能影响未来的 DDH 筛查计划政策。
