Laborie Lene Bjerke, Markestad Trond Jacob, Davidsen Henrik, Brurås Kari Røine, Aukland Stein Magnus, Bjørlykke John Asle, Reigstad Hallvard, Indrekvam Kari, Lehmann Trude Gundersen, Engesæter Ingvild Øvstebø, Engesæter Lars Birger, Rosendahl Karen
Department of Clinical Medicine, University of Bergen, Bergen, Norway,
Pediatr Radiol. 2014 Apr;44(4):410-24. doi: 10.1007/s00247-013-2838-3. Epub 2013 Dec 13.
Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the choice of screening strategy is debated.
We evaluated the effect of a selective ultrasound (US) screening programme.
All infants born in a defined region during 1991-2006 with increased risk of developmental dysplasia of the hip, i.e. clinical hip instability, breech presentation, congenital foot deformities or a family history of DDH, underwent US screening at age 1-3 days. Severe sonographic dysplasia and dislocatable/dislocated hips were treated with abduction splints. Mild dysplasia and pathological instability, i.e. not dislocatable/dislocated hips were followed clinically and sonographically until spontaneous resolution, or until treatment became necessary. The minimum observation period was 5.5 years.
Of 81,564 newborns, 11,539 (14.1%) were identified as at-risk, of whom 11,190 (58% girls) were included for further analyses. Of the 81,564 infants, 2,433 (3.0%) received early treatment; 1,882 (2.3%) from birth and 551 (0.7%) after 6 weeks or more of clinical and sonographic surveillance. An additional 2,700 (3.3%) normalised spontaneously after watchful waiting from birth. Twenty-six infants (0.32 per 1,000, 92% girls, two from the risk group) presented with late subluxated/dislocated hips (after 1 month of age). An additional 126 (1.5 per 1,000, 83% girls, one from the risk group) were treated after isolated late residual dysplasia. Thirty-one children (0.38 per 1,000) had surgical treatment before age 5 years. Avascular necrosis was diagnosed in seven of all children treated (0.27%), four after early and three after late treatment.
The first 16 years of a standardised selective US screening programme for developmental dysplasia of the hip resulted in acceptable rates of early treatment and US follow-ups and low rates of late subluxated/dislocated hips compared to similar studies.
早期治疗被认为是发育性髋关节发育不良（DDH）的关键，但筛查策略的选择仍存在争议。
我们评估了选择性超声（US）筛查方案的效果。
1991年至2006年在特定区域出生的所有有发育性髋关节发育不良风险增加的婴儿，即临床髋关节不稳定、臀位、先天性足部畸形或有DDH家族史的婴儿，在1至3天龄时接受超声筛查。严重超声发育不良和可脱位/脱位的髋关节采用外展夹板治疗。轻度发育不良和病理性不稳定，即可脱位/未脱位的髋关节，进行临床和超声随访，直至自行恢复或有必要进行治疗。最短观察期为5.5年。
在81,564名新生儿中，11,539名（14.1%）被确定为高危，其中11,190名（58%为女孩）纳入进一步分析。在81,564名婴儿中，2,433名（3.0%）接受了早期治疗；1,882名（2.3%）出生时接受治疗，551名（0.7%）在临床和超声监测6周或更长时间后接受治疗。另外2,700名（3.3%）在出生后密切观察等待中自行恢复正常。26名婴儿（每1000名中有0.32名，92%为女孩，2名来自高危组）出现晚期半脱位/脱位髋关节（1月龄后）。另外126名（每1000名中有1.5名，83%为女孩，1名来自高危组）在孤立的晚期残留发育不良后接受治疗。31名儿童（每1000名中有0.38名）在5岁前接受了手术治疗。所有接受治疗的儿童中有7名（0.27%）被诊断为缺血性坏死，4名在早期治疗后，3名在晚期治疗后。
与类似研究相比，标准化的选择性超声筛查发育性髋关节发育不良方案的前16年，早期治疗和超声随访率可接受，晚期半脱位/脱位髋关节发生率低。
