Touzopoulos Panagiotis, Markeas Nikolaos G
2nd Orthopaedic Department of General Pediatric Hospital of Athens "Panagiotis and Aglaia Kyriakou", 11527, Athens, Greece.
Eur J Orthop Surg Traumatol. 2020 Jan;30(1):133-138. doi: 10.1007/s00590-019-02529-w. Epub 2019 Aug 12.
The clinical importance of asymmetrical thigh creases in the diagnosis of developmental dysplasia of the hip (DDH) in infants remains controversial. The aim of this study is to investigate the association of asymmetrical skinfolds of the thigh as the only clinical finding with the DDH in infants.
One hundred and thirty-four infants between January 2010 and December 2015 were referred to our clinics for DDH with the only clinical sign being asymmetrical or isolated thigh creases and met the inclusion criteria of the study. Patients with another clinical sign for DDH in our initial evaluation, those infants suspicious for syndrome and those older than 6 months were excluded. Finally, 117 patients had undergone clinical and ultrasound evaluation and were included to statistical analysis.
There were 82 females and 35 males, with mean age of 2.2 months old. In 96 of the 117 infants (82.1%), there were provocative skin creases in the opposite thigh after a little pressure of the thigh by the examiner during the evaluation. Three of the babies (3.1%) with provocative skin creases and 1 (4.8%) with true isolated thigh crease had immature hips in ultrasonography. Positive predictive value for DDH of an isolated or asymmetrical thigh crease was 4.55% (95% CI 0.83-21.36%), and negative predictive value was 96.97% (95% CI 94.75-98.27%). Sensitivity of skinfold asymmetry found to be 25% (95% CI 0.63-80.59%), and specificity was 82.05% (95% CI 73.88-88.53%) for DDH.
The positive predictive value of asymmetrical or isolated thigh creases for DDH in infants was found to be low, as the majority of hips with normal clinical examination and asymmetry in thigh skinfolds seemed to be normal. Moreover, in-depth evaluation of the patients could highlight new provocative thigh creases in the opposite thigh, which could limit the referrals to expert physicians to exclude DDH.
Level III.
婴儿大腿褶皱不对称在发育性髋关节发育不良（DDH）诊断中的临床重要性仍存在争议。本研究旨在探讨仅以大腿皮肤褶皱不对称作为唯一临床发现与婴儿DDH之间的关联。
2010年1月至2015年12月期间，134例因DDH前来我院就诊的婴儿，其唯一临床体征为大腿褶皱不对称或孤立性大腿褶皱，且符合本研究的纳入标准。在我们的初步评估中，有其他DDH临床体征的患者、疑似综合征的婴儿以及6个月以上的婴儿被排除。最终，117例患者接受了临床和超声评估并纳入统计分析。
其中女性82例，男性35例，平均年龄2.2个月。在117例婴儿中的96例（82.1%）中，检查者在评估过程中对大腿稍加压力后，对侧大腿出现了激发性皮肤褶皱。3例（3.1%）有激发性皮肤褶皱的婴儿和1例（4.8%）有真正孤立性大腿褶皱的婴儿在超声检查中髋关节不成熟。孤立或不对称大腿褶皱对DDH的阳性预测值为4.55%（95%可信区间0.83 - 21.36%），阴性预测值为96.97%（95%可信区间94.75 - 98.27%）。发现皮肤褶皱不对称对DDH的敏感性为25%（95%可信区间0.63 - 80.59%），特异性为82.05%（95%可信区间73.88 - 88.53%）。
发现婴儿中不对称或孤立性大腿褶皱对DDH的阳性预测值较低，因为大多数临床检查正常且大腿皮肤褶皱不对称的髋关节似乎是正常的。此外，对患者的深入评估可能会突出对侧大腿新出现的激发性大腿褶皱，这可能会减少转诊至专家医生处排除DDH的情况。
三级。
