Faculty of Medicine, TOBB University of Economics and Technology, Ankara.
Faculty of Medicine, University of Eskişehir Osmangazi, Eskişehir, Turkey.
J Pediatr Orthop. 2020 Sep;40(8):e761-e765. doi: 10.1097/BPO.0000000000001531.
No high level of scientific evidence exists about the use of asymmetry of skin creases (ASC) on the groin and thigh regions in diagnosing developmental dysplasia of the hip. The aim of this comparative study was to revisit whether or not ASC was a significant clinical finding in developmental dysplasia of the hip.
This was retrospective analysis of a prospectively collected data. Control group was composed of 1000 consecutive healthy infants (mean age, 46.7 d) whose both hips were considered Graf type I (normal). Study group (SG) was composed of 246 consecutive patients (mean age, 96.5 d) whose treatments by abduction bracing were initiated due to unilateral or bilateral Graf type IIa(-) and worse hips.
SG included 178 patients with bilateral or unilateral dysplastic hips [Graf type IIa(-), IIb, IIc] and 68 patients with at least 1 decentered hip (Graf type D, III, IV). ASC was seen in 63 of 101 patients (63%) having positive clinical finding(s). The rates of both ASC alone (P<0.001; odds ratio, 3.46) and ASC total (ASC with and without additional findings) (P<0.0001; odds ratio, 7.48) were significantly higher in SG than in control group. ASC was the only clinical finding in 31 patients and 24 of these 31 patients (77%) had unilateral or bilateral dysplastic hips. Sensitivity and specificity of ASC alone were 12.60% and 96.00%, respectively. ASC was accompanied by other clinical findings (mostly Galeazzi sign and limitation of abduction) in 32 patients and 23 of these 32 patients (72%) had at least 1 decentered hip. Sensitivity and specificity of ASC total were 25.61% and 95.60%, respectively.
ASC is a significant finding, as there is considerable increased risk of having dysplastic or decentered hips in infants having such a finding alone or associated with other findings. ASC alone is more commonly seen in patients with dysplastic hip(s) whereas ASC is mostly accompanied with other clinical finding(s) in patients with decentered hip(s). This study shows that, ASC can be introduced as a risk factor in selected newborn hip screening programs.
Level II-diagnostic study.
在诊断发育性髋关节发育不良方面，腹股沟和大腿区域皮肤褶皱不对称（ASC）的使用并没有高水平的科学证据。本项对比研究的目的是重新评估 ASC 是否为发育性髋关节发育不良的重要临床发现。
这是一项前瞻性数据的回顾性分析。对照组由 1000 名连续健康婴儿（平均年龄 46.7d）组成，其双侧髋关节均为 Graf Ⅰ型（正常）。研究组（SG）由 246 名连续患者（平均年龄 96.5d）组成，这些患者因单侧或双侧 Graf Ⅱa（-）和更差的髋关节而开始使用外展支具治疗。
SG 包括 178 例双侧或单侧发育性髋关节不良（Graf Ⅱa（-）、Ⅱb、Ⅱc）患者和 68 例至少有 1 个偏心髋关节（Graf 型 D、Ⅲ、Ⅳ）患者。在 101 例有阳性临床发现的患者中，有 63 例（63%）出现 ASC。仅 ASC 阳性（P<0.001；优势比，3.46）和 ASC 总阳性（伴有和不伴有其他发现的 ASC）（P<0.0001；优势比，7.48）的发生率在 SG 中明显高于对照组。在 31 例患者中仅出现 ASC，其中 24 例（77%）为单侧或双侧发育性髋关节不良。单独 ASC 的敏感性和特异性分别为 12.60%和 96.00%。在 32 例患者中，ASC 伴有其他临床发现（主要为 Galeazzi 征和外展受限），其中 23 例（72%）至少有 1 个偏心髋关节。ASC 总阳性的敏感性和特异性分别为 25.61%和 95.60%。
ASC 是一个重要的发现，因为在出现这种情况的婴儿中，存在发育性或偏心性髋关节的风险显著增加，无论是单独出现还是伴有其他发现。单独 ASC 更常见于发育性髋关节不良的患者，而 ASC 主要与偏心性髋关节的其他临床发现有关。本研究表明，在选择的新生儿髋关节筛查计划中，ASC 可作为一个危险因素。
Ⅱ级诊断研究。
