Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.
Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Pediatr Orthop. 2023 Jul 1;43(6):e416-e420. doi: 10.1097/BPO.0000000000002414. Epub 2023 Apr 13.
The prevalence of developmental dysplasia of the hip (DDH) has been considered to be low in East Asia, but this may be incorrect because of inconsistent diagnostic definitions and testing criteria. In 2015, the AAOS released guidelines for systematic screening for DDH in newborns. We implemented these guidelines and compared DDH incidence and outcomes before and after their implementation.
We used a historic comparison cohort of newborns with DDH between July 2015 and May 2017 before guideline implementation (the preguideline group); their data were retrieved using electronic medical records. In this group, the newborns received general hip screening without systemic follow-up. The postguideline group included newborns who were screened for hip dysplasia and followed up per the AAOS guidelines between July 2017 and May 2019. Their data were prospectively collected. The primary outcome in the postguideline group was DDH incidence. Other outcomes included rates of referral, surgery, and complications, and DDH prognosis.
The preguideline and postguideline groups included 3534 and 2663 newborns, respectively, of whom 49 (1.1%) and 225 (8.4%), respectively, were referred to the pediatric orthopaedic clinic enrolled. In the postguideline group, 35 patients were diagnosed as having DDH (incidence: 1.3%, 95% CI: 0.8%-1.9%). Both the incidence and referral rates were significantly higher in the postguideline group than in the preguideline group. Furthermore, the mean age at referral was 6.7±10.06 months and 0.9±0.25 months in the preguideline and postguideline groups, respectively, indicating a potential for early treatment in the postguideline group. Finally, the female sex was identified as a risk factor for residual hip dysplasia at 6 months of age.
DDH incidence in East Asia seems comparable to that in Western countries. Implementing the AAOS guidelines increased the diagnosis rate and opportunity for early treatment initiation, thus potentially avoiding surgical intervention. Nevertheless, residual DDH may be detected in some patients at 6 months of age, particularly in female infants.
Level IV.
发育性髋关节发育不良（DDH）的发病率在东亚被认为较低，但由于诊断定义和检测标准不一致，这可能并不准确。2015 年，AAOS 发布了新生儿 DDH 系统筛查指南。我们实施了这些指南，并比较了实施前后 DDH 的发病率和结果。
我们使用了 2015 年 7 月至 2017 年 5 月指南实施前（指南前组）患有 DDH 的新生儿的历史性对照队列，使用电子病历检索了该组数据。在此组中，新生儿接受常规髋关节筛查，但无系统随访。指南后组包括 2017 年 7 月至 2019 年 5 月期间根据 AAOS 指南筛查髋关节发育不良并进行随访的新生儿。他们的数据是前瞻性收集的。指南后组的主要结局是 DDH 的发病率。其他结局包括转诊率、手术率和并发症发生率以及 DDH 的预后。
指南前组和指南后组分别纳入了 3534 名和 2663 名新生儿，分别有 49 名（1.1%）和 225 名（8.4%）被转诊到儿科骨科诊所。在指南后组中，有 35 名患者被诊断为 DDH（发病率：1.3%，95%CI：0.8%-1.9%）。指南后组的发病率和转诊率均明显高于指南前组。此外，指南前组和指南后组的平均转诊年龄分别为 6.7±10.06 个月和 0.9±0.25 个月，表明指南后组有早期治疗的可能。最后，女性被确定为 6 个月时髋关节发育不良残留的危险因素。
东亚的 DDH 发病率似乎与西方国家相当。实施 AAOS 指南提高了诊断率和早期治疗的机会，从而可能避免手术干预。然而，一些患者在 6 个月时可能仍会发现残留的 DDH，尤其是女婴。
IV 级。
Zotero 插件