Department of Paediatric Orthopaedic Surgery, Southampton Children's Hospital.
University of Southampton, Southampton, UK.
J Pediatr Orthop. 2020 Sep;40(8):408-412. doi: 10.1097/BPO.0000000000001602.
The aim of this study was to assess the accuracy of clinical screening examination in newborns with dislocated hips compared with ultrasound scan (USS).
Newborns, up to 3 months of age, with confirmed hip dislocations on USS were prospectively enrolled in a multinational observational study. Data from 2010 to 2016 were reviewed to determine pretreatment clinical examination findings of the treating orthopaedic surgeon as well as baseline ultrasound indices of developmental dysplasia of the hip (DDH). All infants had been referred to specialist centres with expertise in DDH, due to abnormal birth examination or risk factor.
The median age of the study population was 2.3 weeks and 84% of patients were female. Of the total 515 USS-confirmed dislocated hips included in the study, 71 (13.8%) were incorrectly felt to be reduced on clinical examination by the treating orthopaedist (P<0.001). Full hip abduction was documented in 106 hips. Of the hips correctly identified as dislocated, 322 hips were further analyzed based on clinical reducibility. Thirty-three of 322 (10.2%) were incorrectly thought to be reducible when in fact they were irreducible or vice versa.
Expert examiners missed a significant number of frankly dislocated hips on clinical examination and their ability to classify hips based on clinical reducibility was only moderately accurate. This study provides evidence that, even in experienced hands, physical examination findings in DDH are often too subtle to elicit clinically in the first few months of life. This may explain the persistent and measurable rate of late presenting dislocations in countries with screening programmes reliant on clinical examination.
Level 1-testing of previously developed diagnostic criteria in series of consecutive patients (with universally applied reference "gold" standard).
本研究旨在评估临床筛查检查在髋关节脱位新生儿中的准确性，与超声扫描（USS）相比。
本项多中心前瞻性观察研究纳入了在 USS 上确诊髋关节脱位的新生儿。回顾了 2010 年至 2016 年的数据，以确定治疗骨科医生的术前临床检查结果以及发育性髋关节发育不良（DDH）的基线超声指标。所有婴儿均因异常出生检查或危险因素被转诊至 DDH 专业中心。
研究人群的中位年龄为 2.3 周，84%的患者为女性。在纳入本研究的 515 例 USS 确诊髋关节脱位中，71 例（13.8%）被治疗骨科医生错误地认为在临床检查中已复位（P<0.001）。106 髋记录了完全髋关节外展。在正确识别为脱位的髋关节中，根据临床可复位性进一步分析了 322 髋。在 322 髋中，有 33 髋（10.2%）被错误地认为是可复位的，而实际上它们是不可复位的或反之亦然。
专家检查者在临床检查中遗漏了大量明显的髋关节脱位，他们基于临床可复位性对髋关节进行分类的能力仅具有中等准确性。本研究表明，即使在经验丰富的医生手中，DDH 的体格检查结果也常常过于微妙，以至于在生命的最初几个月内无法通过临床检查发现。这可能解释了在依赖临床检查的筛查计划的国家中，仍存在持续性且可测量的迟发性脱位。
1 级-在连续患者系列中测试先前开发的诊断标准（普遍应用参考“金标准”）。
