Woodacre Timothy, Dhadwal A, Ball T, Edwards C, Cox P J A
Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK,
J Child Orthop. 2014 Aug;8(4):325-32. doi: 10.1007/s11832-014-0599-7. Epub 2014 Jun 29.
Debate currently exists regarding the economic viability for screening for developmental dysplasia of the hip in infants.
A prospective study of infant hip dysplasia over the period of 1998-2008 (36,960 live births) was performed to determine treatment complexity and associated costs of disease detection and hospital treatment, related to the age at presentation and treatment modality. The involved screening programme utilised universal clinical screening of all infants and selective ultrasound screening of at-risk infants.
One hundred and seventy-nine infants (4.8/1,000) presented with hip dysplasia. Thirty-four infants presented late (> 3 months of age) and required closed or open reduction. One hundred and forty-five infants presented at < 3 months of age, 14 of whom failed early Pavlik harness treatment. A detailed cost analysis revealed: 131 early presenters with successful management in a Pavlik harness at a cost of £601/child; 34 late presenters who required surgery (36 hips, 19 closed/17 open reductions, one revision procedure) at a cost of £4,352/child; and 14 early presenters with failed management in a Pavlik harness requiring more protracted surgery (18 hips, four closed/14 open reductions, seven revision procedures) at a cost of £7,052/child.
Late detection causes increased treatment complexity and a sevenfold increase in the short-term costs of treatment, compared to early detection and successful management in a Pavlik harness.
Improved strategies are needed for the 10 % of early presenting infants who fail Pavlik harness treatment and require the most complex and costly interventions.
目前关于婴儿髋关节发育不良筛查的经济可行性存在争议。
对1998年至2008年期间（36,960例活产婴儿）的婴儿髋关节发育不良进行了一项前瞻性研究，以确定与就诊年龄和治疗方式相关的疾病检测和住院治疗的复杂性及相关成本。所涉及的筛查计划采用了对所有婴儿进行普遍性临床筛查以及对高危婴儿进行选择性超声筛查。
179名婴儿（4.8/1000）患有髋关节发育不良。34名婴儿就诊较晚（>3个月龄），需要进行闭合或开放复位。145名婴儿在<3个月龄时就诊，其中14名未能通过早期帕夫利克吊带治疗成功治愈。详细的成本分析显示：131名早期就诊者通过帕夫利克吊带成功治疗，每名儿童的成本为601英镑；34名晚期就诊者需要手术（36个髋关节，19例闭合/17例开放复位，1例翻修手术），每名儿童的成本为4352英镑；14名早期就诊者在帕夫利克吊带治疗失败后需要更持久的手术（18个髋关节，4例闭合/14例开放复位，7例翻修手术），每名儿童的成本为7052英镑。
与早期发现并通过帕夫利克吊带成功治疗相比，晚期发现会导致治疗复杂性增加，短期治疗成本增加七倍。
对于10%早期就诊但帕夫利克吊带治疗失败且需要最复杂和昂贵干预措施的婴儿，需要改进策略。
