Talbot C, Adam J, Paton R
Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester M6 8HD, UK.
Bone Joint J. 2017 Sep;99-B(9):1250-1255. doi: 10.1302/0301-620X.99B9.BJJ-2016-1325.R1.
Despite the presence of screening programmes, infants continue to present with late developmental dysplasia of the hip (DDH), the impact of which is significant. The aim of this study was to assess infants with late presenting dislocation of the hip despite universal clinical neonatal and selective ultrasound screening.
Between 01 January 1997 to 31 December 2011, a prospective, longitudinal study was undertaken of a cohort of 64 670 live births. Late presenting dislocation was defined as presentation after three months of age. Diagnosis was confirmed by ultrasound and plain radiography. Patient demographics, referral type, reason for referral, risk factors (breech presentation/strong family history) and clinical and radiological findings were recorded.
There were 31 infants with an irreducible dislocation of the hip, an incidence of 0.48 (95% confidence interval (CI) 0.34 to 0.68) per 1000 live births. Of these, 18 (0.28 (95% CI 0.17 to 0.44) per 1000 live births; 58%) presented late. All infants had a documented normal newborn clinical examination and no abnormality reported in the six to eight week check. Of the 18 late presenting cases 72% (n = 13) had no risk factors: 16 were referred by GPs and two were late due to administrative issues (missed appointments). The mean time to diagnosis was 62.4 weeks (19 to 84).
Despite universal clinical neonatal and selective ultrasound screening, late cases of irreducible hip dislocation still occur. We recommend an update of the national screening programme for DDH, a review of training and education of healthcare professionals involved in the physical examination of neonates and infants, and the addition of a further assessment after the six to eight week check. Cite this article: 2017;99-B:1250-5.
尽管存在筛查项目，但婴儿仍会出现晚期发育性髋关节发育不良（DDH），其影响重大。本研究的目的是评估尽管进行了普遍的临床新生儿筛查和选择性超声筛查，但仍出现晚期髋关节脱位的婴儿情况。
在1997年1月1日至2011年12月31日期间，对一组64670例活产婴儿进行了一项前瞻性纵向研究。晚期出现的脱位定义为3个月龄后出现。通过超声和X线平片确诊。记录患者人口统计学资料、转诊类型、转诊原因、危险因素（臀位/家族史阳性）以及临床和放射学检查结果。
有31例婴儿出现髋关节不可复位脱位，每1000例活产婴儿中的发病率为0.48（95%置信区间（CI）0.34至0.68）。其中，18例（每1000例活产婴儿中的发病率为0.28（95%CI 0.17至0.44）；占58%）为晚期出现。所有婴儿的新生儿临床检查记录均正常，且在6至8周检查时未报告异常。在18例晚期出现的病例中，72%（n = 13）无危险因素：16例由全科医生转诊，2例因行政问题（错过预约）而延迟就诊。诊断的平均时间为62.4周（19至84周）。
尽管进行了普遍的临床新生儿筛查和选择性超声筛查，但晚期不可复位髋关节脱位病例仍会出现。我们建议更新国家DDH筛查项目，对参与新生儿和婴儿体格检查的医护人员的培训和教育进行审查，并在6至8周检查后增加进一步评估。引用本文：2017；99 - B：1250 - 5。
