Department of Pediatrics and Neonatology, Máxima Medical Center, PO Box no. 7777, 5500, MB, Veldhoven, The Netherlands.
Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Eur J Pediatr. 2019 Apr;178(4):559-564. doi: 10.1007/s00431-019-03322-x. Epub 2019 Feb 1.
Guidelines for children with Down syndrome (DS) suggest to perform an annual hip screening to enable early detection of developmental dysplasia of the hip (DDH). How to perform this screening is not described. Delayed detection can result in disabling osteoarthritis of the hip. Therefore, we determined the association between clinical history, physical, and radiological examination in diagnosing DDH in children with DS. Referral centers for children with DS were interviewed to explore variety of hip examination throughout the Netherlands. Clinical features of 96 outclinic children were retrospectively collected. Clinical history was taken, physical examination was performed, and X-ray of the hip was analyzed. All the referral centers performed physical examination and clinical history; however, 20% performed X-ray. Following physical examination according to Galeazzi test 26.9% and to limited abduction 10.8% of the outclinic-studied children were at risk for DDH. Radiological examination showed moderate or severe abnormal deviating migration rate of 14.6% resp. 11.5% in the right and left hip. However, no association between clinical history, physical examination, and radiological examination was found.Conclusion: Clinical history and physical examination are insufficient to timely detect DDH in children with Down syndrome. Thereby regular radiological examination of the hip is advised. What is Known: • Developmental dysplasia of the hip (DDH) in people with Down syndrome (DS) develops during childhood. • Guidelines for medical support of children with DS suggest an annual hip screening to enable early detection of hip damaging. How to perform this annual screening is not described. What is New: • This study shows no association between clinical history, physical and radiological examination of the hip. • We recommend regular radiological examination of the hip in children with DS in order to identify DDH early up to 16 years of age.
唐氏综合征（DS）患儿的指导建议每年进行髋关节筛查，以实现早期发现发育性髋关节发育不良（DDH）。但目前并未详细说明如何进行这种筛查。如果发现过晚，可能会导致髋关节骨关节炎而致残。因此，我们旨在研究通过临床病史、体格检查和影像学检查来诊断 DS 患儿 DDH 的相关性。我们对荷兰各地的 DS 患儿转诊中心进行了访谈，以了解髋关节检查的多样性。回顾性收集了 96 名门诊患儿的临床特征。采集临床病史、进行体格检查，并对髋关节 X 线片进行分析。所有转诊中心都进行体格检查和临床病史检查，但只有 20%进行 X 射线检查。根据 Galeazzi 试验进行体格检查后，26.9%的门诊就诊患儿和 10.8%的外展受限患儿存在 DDH 风险。放射学检查显示右髋关节中度或重度异常迁徙率为 14.6%，左髋关节为 11.5%。但是，并未发现临床病史、体格检查和放射学检查之间存在关联。结论：临床病史和体格检查不足以及时发现 DS 患儿的 DDH。因此，建议定期进行髋关节放射学检查。已知情况：•DS 患者的 DDH 在儿童时期发展。•DS 患儿医疗支持指南建议每年进行髋关节筛查，以实现早期发现髋关节损伤。但目前并未详细说明如何进行这种年度筛查。新发现：•本研究显示，髋关节的临床病史、体格检查和放射学检查之间无关联。•我们建议对 DS 患儿进行定期髋关节放射学检查，以便在 16 岁之前尽早识别 DDH。
