Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway.
Department of Orthopedic surgery, Vestre Viken Hospital Trust, Kongsberg, Norway.
Acta Paediatr. 2018 Feb;107(2):255-261. doi: 10.1111/apa.14057. Epub 2017 Oct 5.
There is no evidence on the effect of universal ultrasound screening on developmental dysplasia of the hip. We examined the impact of adding an ultrasound examination to a one examiner clinical screening strategy on treatment, follow-up rates and the number of cases detected late in a low-prevalence population.
All eligible babies born at Kongsberg Hospital, Norway, from 1998 to 2006 (n = 4245) underwent both clinical and ultrasound hip examinations within three days of life. Indications for immediate treatment were positive Barlow or Ortolani manoeuvres and, or, sonographic dysplasia. Sonographic immature hips were followed until normalisation. Treatment rates and rates from the 1989 to 1997 prestudy period (n = 3594), including late diagnoses, were collected from hospital records.
Treatment was initiated in 90 (2.1%) infants (74 girls), 63 (70%) from birth, compared to 33 (0.9%) during the prestudy period. The follow-up rate did not change (11%). There were two (0.5/1000) and four (1.0/1000) cases detected late, respectively. No one underwent surgery during the first year of life and no avascular necrosis was seen.
Adding universal ultrasound to clinical screening performed by the same, experienced paediatrician doubled the treatment rate, without influencing the already low numbers of late cases.
目前尚无关于普遍超声筛查对发育性髋关节发育不良的效果的证据。我们研究了在低流行人群中，将超声检查添加到单一检查者临床筛查策略中对治疗、随访率和晚期病例检出数的影响。
1998 年至 2006 年期间，挪威 Kongsberg 医院出生的所有符合条件的婴儿（n=4245）均在出生后 3 天内接受临床和超声髋关节检查。立即治疗的指征为阳性巴氏或奥尔托拉尼手法以及/或超声发育不良。超声不成熟髋关节在正常化之前进行随访。治疗率和 1989 年至 1997 年预研究期间（n=3594）的晚期诊断率均从医院记录中收集。
90 例（2.1%）婴儿（74 例为女孩）接受了治疗，其中 63 例（70%）在出生时开始治疗，而预研究期间仅 33 例（0.9%）接受了治疗。随访率没有变化（11%）。分别有 2 例（0.5/1000）和 4 例（1.0/1000）病例被延迟诊断。在生命的第一年没有一人接受手术，也没有出现股骨头缺血性坏死。
将普遍超声检查添加到由同一位经验丰富的儿科医生进行的临床筛查中，将治疗率提高了一倍，而晚期病例的数量仍然较低。
