Ömeroğlu H, Akceylan A, Köse N
TOBB University of Economics and Technology, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey.
Ministry of Health Aks¸ehir State Hospital, Clinics of Orthopaedics and Traumatology, Konya, Turkey.
J Child Orthop. 2019 Apr 1;13(2):161-166. doi: 10.1302/1863-2548.13.180174.
We aimed to revisit the correlation between the previously defined risk factors and the occurrence of developmental dysplasia of the hip (DDH) and to assess the influence of these factors on the ultrasonographic type of hip dysplasia according to the Graf's classification in patients with DDH.
Data of healthy infants (mean age 33 days) who had bilateral mature (normal) hips (Graf type I) were compared with the data of infants (mean age 105 days) who were treated by abduction brace due to unilateral or bilateral DDH (Graf type IIa- and worse hips).
Infants with at least one risk factor had a significantly higher rate of DDH than those with no risk factors (p < 0.001). Likewise, infants with more than one risk factor had a significantly higher rate of DDH than those with only one risk factor (p = 0.008). Family history, breech presentation and swaddling were found to be the three significant risk factors related to the development of DDH. Family history, swaddling and oligohydramnios were found to be the three significant risk factors correlated with a higher rate of unstable/decentred hip(s) (Graf types D/III/IV) in patients with DDH.
The risk of DDH significantly increases in infants who have more than one risk factor for DDH. Positive family history and postnatal traditional swaddling are the two main factors both in the aetiology of DDH and in development of a more severe hip dysplasia in patients with DDH. Besides, breech presentation increases the risk of development of DDH and oligohydramnios leads to development of a more severe hip dysplasia in patients with DDH. By introducing these four variables as 'absolute risk factors for DDH' to the selective newborn hip screening programmes, the sensitivity and specificity of these programmes may be optimized and the risk of delayed diagnosis may be lessened.
Level III prognostic study.
我们旨在重新审视先前定义的风险因素与发育性髋关节发育不良（DDH）发生之间的相关性，并根据Graf分类评估这些因素对DDH患者髋关节发育不良超声类型的影响。
将双侧髋关节成熟（正常）（Graf I型）的健康婴儿（平均年龄33天）的数据与因单侧或双侧DDH（Graf IIa型及更严重髋关节）接受外展支具治疗的婴儿（平均年龄105天）的数据进行比较。
至少有一个风险因素的婴儿发生DDH的比率显著高于无风险因素的婴儿（p < 0.001）。同样，有多个风险因素的婴儿发生DDH的比率显著高于只有一个风险因素的婴儿（p = 0.008）。家族史、臀位和襁褓包裹被发现是与DDH发生相关的三个重要风险因素。家族史、襁褓包裹和羊水过少被发现是与DDH患者不稳定/脱位髋关节（Graf D/III/IV型）发生率较高相关的三个重要风险因素。
有多个DDH风险因素的婴儿发生DDH的风险显著增加。阳性家族史和产后传统襁褓包裹是DDH病因以及DDH患者更严重髋关节发育不良发展中的两个主要因素。此外，臀位增加了DDH发生的风险，羊水过少导致DDH患者出现更严重的髋关节发育不良。通过将这四个变量作为“DDH的绝对风险因素”引入选择性新生儿髋关节筛查计划，可以优化这些计划的敏感性和特异性，并降低延迟诊断的风险。
III级预后研究。
