Humphry Simon, Hall Timothy, Hall-Craggs Margaret A, Roposch Andreas
Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.
Department of Diagnostic Imaging, University College London Hospital, London, United Kingdom.
JB JS Open Access. 2021 Jan 19;6(1). doi: 10.2106/JBJS.OA.20.00108. eCollection 2021 Jan-Mar.
While perinatal risk factors are widely used to help identify those at risk for developmental dysplasia of the hip (DDH) within the first 6 to 8 weeks of life, limited data exist about their association with radiographic evidence of dysplasia in childhood. The purpose of this study was to determine which perinatal risk factors are associated with acetabular dysplasia in children who are ≥2 years of age.
Pelvic radiographs were made in 1,053 children (mean age, 4.4 years [range, 2 to 7 years]) who had been assessed prospectively as having at least 1 of 9 widely accepted perinatal risk factors for DDH. Two radiologists who were blinded to patient risk factors, history, and age determined the acetabular index (AI). The primary outcome was defined as an AI >2 standard deviations from the Tönnis reference values ("severe" dysplasia). The secondary outcome was an AI of >20° at >2 years of age. The association between risk factors and outcomes was assessed using logistic regression. The effect of treatment in infancy was adjusted for in 37 hips.
Twenty-seven participants (3%) showed "severe" hip dysplasia; 3 of these had received treatment for DDH in infancy. Girls were more likely to experience this outcome (odds ratio [OR] = 2.59; 95% confidence interval [CI] = 1.04 to 6.46; p = 0.04); no other examined risk factors were significant. The secondary outcome appeared in 146 participants (14%), 12 of whom had received treatment in infancy. We observed the following predictors for this outcome: female sex (OR = 1.77; 95% CI = 1.21 to 2.59; p = 0.003), breech presentation (OR = 1.74; 95% CI = 1.08 to 2.79; p = 0.02), and being a firstborn child, which had a protective effect (OR = 0.67; 95% CI = 0.46 to 0.96; p = 0.03).
We identified a substantial number of cases that will require at least radiographic surveillance for mild and severe hip dysplasia; 92% had no prior diagnosis of DDH. Those who had been born breech were affected by this outcome even if ultrasonography of the hip had been normal at 6 to 8 weeks, suggesting a benefit from additional radiographic testing.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
虽然围产期危险因素被广泛用于在出生后6至8周内帮助识别有发育性髋关节发育不良（DDH）风险的人群，但关于这些因素与儿童期发育不良的影像学证据之间的关联的数据有限。本研究的目的是确定哪些围产期危险因素与2岁及以上儿童的髋臼发育不良有关。
对1053名儿童（平均年龄4.4岁[范围2至7岁]）进行骨盆X光检查，这些儿童被前瞻性评估为具有9种广泛认可的DDH围产期危险因素中的至少一种。两名对患者危险因素、病史和年龄不知情的放射科医生确定髋臼指数（AI）。主要结局定义为AI高于Tönnis参考值2个标准差（“严重”发育不良）。次要结局是2岁以上时AI>20°。使用逻辑回归评估危险因素与结局之间的关联。对37例髋关节的婴儿期治疗效果进行了校正。
27名参与者（3%）表现出“严重”髋关节发育不良；其中3例在婴儿期接受过DDH治疗。女孩更易出现此结局（比值比[OR]=2.59；95%置信区间[CI]=1.04至6.46；p=0.04）；其他检查的危险因素均无统计学意义。146名参与者（14%）出现次要结局，其中12例在婴儿期接受过治疗。我们观察到以下该结局的预测因素：女性（OR=1.77；95%CI=1.21至2.59；p=0.003）、臀位分娩（OR=1.74；95%CI=1.08至2.79；p=0.02）以及作为头胎子女具有保护作用（OR=0.67；95%CI=0.46至0.96；p=0.03）。
我们发现大量病例至少需要进行影像学监测以筛查轻度和重度髋关节发育不良；92%之前未被诊断为DDH。那些臀位出生的儿童即使在6至8周时髋关节超声检查正常也会受此结局影响，这表明额外的X光检查有益。
预后III级。有关证据水平的完整描述，请参见《作者须知》。
