Møse Frederik Berstad, Mohseni Shahin, Borg Tomas
Department of Orthopedic Surgery, Orebro University Hospital, Orebro 701 85, Sweden.
School of Medical Sciences, Orebro University, Orebro 702 81, Sweden.
J Hip Preserv Surg. 2024 Mar 9;11(3):176-181. doi: 10.1093/jhps/hnae010. eCollection 2024 Jul.
Hip dysplasia in young adults is underdiagnosed and can cause pain and discomfort. Progression to osteoarthritis (OA) is common, necessitating total hip arthroplasty at an early age. When discovered early, symptomatic patients can be offered physiotherapy and/or hip-preserving surgery to alleviate pain and decrease the risk of early OA. A pilot project to screen radiograms for hip dysplasia was started across the Swedish region of Örebro Län in January 2019, comparing the incidence of dysplasia before and after initiation of the screening program. All elective conventional radiograms of the hip (age 12-44 years), requested by primary care physicians, were analyzed by consultant radiologists according to a pre-established algorithm to identify hip abnormalities. If the hip radiograms showed dysplastic changes, or other pathological signs, the radiologist advised referral to a specialized Youth Hip Clinic for further work-up and treatment. A total of 1056 radiograms were requested by clinicians during the study periods (601 and 455 during 2018 and 2020, respectively). A total of 457 trauma-related cases were excluded, resulting in 599 available for analysis (348 and 251 during 2018 and 2020, respectively). During 2018, 17 patients (4.9%) received the radiologic diagnosis of dysplasia, compared with 44 patients (17.5%) during 2020 ( < 0. 001). A three-fold increase of patients diagnosed with hip dysplasia was detected as a result of the implementation of the screening program. The advantage of screening is early referral to an orthopedic department for evaluation and consideration for physiotherapy and/or surgical intervention.
年轻成年人的髋关节发育不良往往诊断不足，会导致疼痛和不适。发展为骨关节炎（OA）很常见，这使得在年轻时就需要进行全髋关节置换术。早期发现时，有症状的患者可接受物理治疗和/或保髋手术，以缓解疼痛并降低早期患OA的风险。2019年1月，瑞典厄勒布鲁省启动了一项筛查髋关节发育不良的X线片的试点项目，并比较了筛查项目启动前后发育不良的发病率。由初级保健医生要求的所有髋关节选择性常规X线片（年龄12 - 44岁），由放射科顾问医生根据预先制定的算法进行分析，以识别髋关节异常。如果髋关节X线片显示发育异常变化或其他病理体征，放射科医生会建议转诊至专门的青少年髋关节诊所进行进一步检查和治疗。在研究期间，临床医生共要求拍摄1056张X线片（2018年和2020年分别为601张和455张）。总共排除了457例与创伤相关的病例，最终有599例可供分析（2018年和2020年分别为348例和251例）。2018年，17例患者（4.9%）被放射学诊断为发育不良，而2020年为44例患者（17.5%）（P < 0.001）。实施筛查项目后，被诊断为髋关节发育不良的患者数量增加了两倍。筛查的优势在于能够早期转诊至骨科进行评估，并考虑是否进行物理治疗和/或手术干预。
