Ziegler Christian Maximilian, Ertl Katharina Maria, Delius Maria, Foerster Kai Martin, Crispin Alexander, Wagner Ferdinand, Heimkes Bernhard
Musculoskeletal University Center Munich, Department of Orthopedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
J Child Orthop. 2022 Feb;16(1):19-26. doi: 10.1177/18632521221080472. Epub 2022 Apr 5.
To assess the percentage of missed developmental dysplasia of the hip, which escape the German criteria for newborn hip high-risk screening, we analyzed our data gained from the general neonatal sonographic hip screening performed at our department. The aim of the study was to determine the number of potentially belatedly treated developmental dysplasia of the hip.
The data from 1145 standardized newborn hip ultrasound examinations according to the Graf technique were analyzed retrospectively comparing findings for general neonatal sonographic hip screening and high-risk screening subgroups.
We diagnosed developmental dysplasia of the hip in 18 of the 1145 newborns via ultrasound. A total of 10 out of 18 developmental dysplasia of the hip would have been missed by high-risk screening, which corresponds to a proportion of 55.6% false-negative results. The sensitivity of high-risk screening was only 44.4% and specificity, 78.3%. The positive predictive value was 3.2%. Family history as a screening criterion yielded false-negative results in 77.8% and false-positive results in 16.8%. In all, 83.3% of the children who were born with developmental dysplasia of the hip but not from breech position as a risk factor were false negative. The clinical examination was false negative in 88.9% and false positive in 0.6%.
High-risk screening detected less than every second developmental dysplasia of the hip, rendering the first month as the most effective treatment window unavailable for inapparent dysplastic hips, potentially resulting in the need for more invasive treatment. Due to the high sensitivity of ultrasound in the detection of developmental dysplasia of the hip, we recommend to replace the current German high-risk screening guidelines with a general newborn screening for all neonates using Graf ultrasound in the first week of life.
Level II.
为评估未被德国新生儿髋关节高危筛查标准涵盖的髋关节发育不良漏诊率，我们分析了在本部门进行的常规新生儿髋关节超声筛查所获数据。本研究旨在确定可能接受延迟治疗的髋关节发育不良病例数。
回顾性分析1145例根据格拉夫技术进行的标准化新生儿髋关节超声检查数据，比较常规新生儿髋关节超声筛查和高危筛查亚组的检查结果。
在1145例新生儿中，经超声诊断出18例髋关节发育不良。18例髋关节发育不良中，共有10例会被高危筛查漏诊，假阴性结果比例为55.6%。高危筛查的灵敏度仅为44.4%，特异度为78.3%。阳性预测值为3.2%。家族史作为筛查标准时，假阴性结果比例为77.8%，假阳性结果比例为16.8%。总体而言，出生时患有髋关节发育不良但非臀位这一危险因素的患儿中，83.3%为假阴性。临床检查假阴性比例为88.9%，假阳性比例为0.6%。
高危筛查漏诊了近半数的髋关节发育不良病例，使得第一个月这一最有效的治疗窗口期无法用于隐匿性发育不良髋关节，可能导致需要更具侵入性的治疗。鉴于超声对髋关节发育不良检测的高灵敏度，我们建议用在出生后第一周对所有新生儿进行格拉夫超声常规筛查取代当前德国的高危筛查指南。
二级。
