Department of Pediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra. Correspondence to: Dr Alaric Aroojis, Department of Pediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai 400 012, Maharashtra.
Department of Pediatrics, All India Institute of Medical Sciences, Hyderabad, Telangana.
Indian Pediatr. 2022 Aug 15;59(8):626-635. Epub 2022 Mar 28.
When developmental dysplasia of the hip (DDH) is diagnosed during infancy, conservative management is often successful, with good long-term outcomes. In India, DDH is often not diagnosed until walking age and there are limited guidelines for its screening.
A multidisciplinary Expert Group consisting of members of the Paediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association worked collaboratively to develop surveillance guidelines for DDH.
To enhance the early detection rate of DDH in India through development and implementation of a standardized surveillance care pathway, thus reducing the burden of late-presenting DDH.
Routine clinical hip examinations must be performed on all infants at birth and during immunization visits at these approximate time points: 6, 10, and 14 weeks; 6, 9, 12, 15, and 18 months of age. Assessments include Ortolani and Barlow tests for infants <14 weeks; limited hip abduction and leg length discrepancy for infants >14 weeks; and evaluation of limp in walking children. If clinical examination is abnormal or inconclusive, referral to orthopedics for further evaluation and management is recommended. In infants younger than 6 weeks with positive Barlow test but negative Ortolani test, hip ultrasound is recommended at 6 weeks of age. Infants must also be screened for DDH risk factors: breech presentation, family history of DDH, unsafe hip swaddling, and hip instability at any previous clinical examination. In infants with risk factors but normal clinical examination, further evaluation should include ultrasound taken no earlier than 6 weeks of age for infants younger than 14 weeks, ultrasound or X-ray for infants 14 weeks to 6 months of age, and X-ray for infants older than 6 months. Referral to an orthopedic surgeon is recommended if radiological tests are abnormal.
当髋关节发育不良（DDH）在婴儿期被诊断出来时，通常采用保守治疗方法，而且治疗效果良好，长期预后佳。在印度，DDH 通常要到会走路的年龄才被诊断出来，而且针对其筛查的指南也很有限。
一个由印度儿科学会、印度小儿矫形外科学会、印度国家新生儿学论坛、印度放射学和影像协会、印度超声医学和生物学联合会、印度妇产科学会联合会以及印度矫形外科学会的成员组成的多学科专家小组合作制定了 DDH 的监测指南。
通过制定和实施标准化的监测护理路径，提高印度 DDH 的早期检出率，从而降低迟发性 DDH 的负担。
所有婴儿在出生时和接种疫苗时进行常规的临床髋关节检查，大约在以下时间点进行：6 周、10 周和 14 周；6 个月、9 个月、12 个月、15 个月和 18 个月。评估包括 14 周以下婴儿的 Ortolani 和 Barlow 试验；14 周以上婴儿的髋关节外展受限和下肢不等长；以及行走儿童的跛行评估。如果临床检查异常或不确定，建议转诊至矫形外科进一步评估和管理。对于 6 周龄以下、Barlow 试验阳性但 Ortolani 试验阴性的婴儿，建议在 6 周龄时进行髋关节超声检查。
还必须对婴儿进行 DDH 危险因素筛查：臀位分娩、DDH 家族史、不安全的髋关节襁褓包裹、任何先前临床检查时髋关节不稳定。对于有危险因素但临床检查正常的婴儿，进一步评估应包括：对于 14 周龄以下婴儿，不早于 6 周龄进行超声检查；对于 14 周至 6 月龄婴儿，进行超声或 X 射线检查；对于 6 月龄以上婴儿，进行 X 射线检查。如果影像学检查异常，建议转诊至矫形外科医生。
