Luoto Emma-Sofia, Jalkanen Jenni, Kuitunen Ilari, Sund Reijo, Nietosvaara Yrjänä
Department of Pediatric Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
J Bone Joint Surg Am. 2025 Apr 2;107(7):e26. doi: 10.2106/JBJS.24.00313. Epub 2025 Feb 20.
The late diagnosis rate of developmental dysplasia of the hip (DDH) with universal ultrasound screening is 0.2 per 1,000 children according to a recent meta-analysis, which is the same as in Japan where selective ultrasound screening is used. We hypothesized that Finland's current program of universal clinical screening complemented with targeted ultrasound is noninferior to universal and selective ultrasound screening programs.
For this retrospective cohort study, we collected the number of children <15 years of age who were diagnosed with DDH (International Classification of Diseases, Tenth Revision [ICD-10] codes Q65.0-Q65.6 and Ninth Revision [ICD-9] code 7543) as their primary diagnosis after ≥3 visits to a physician. These data were obtained from the Finnish Care Register for Health Care, which collects the ICD-10 and ICD-9 codes from every medical appointment. We calculated the annual incidence of DDH diagnoses per 1,000 newborns between 2002 and 2021. Late diagnosis of DDH was defined as a finding of DDH in children aged 6 months through <15 years at the initial diagnosis who had undergone treatment under anesthesia (closed reduction and casting or surgery). We also registered the geographic, age, and sex distributions of the DDH diagnoses.
During the 20-year study period, 1,103,269 babies were born (median per year, 57,214 babies; range per year, 45,346 to 60,694 babies). A total of 6,421 children had a diagnosis of DDH (mean per year, 321 children; range per year, 193 to 405 children), with a mean calculated incidence of 5.8 per 1,000 newborns (95% confidence interval [CI], 5.7 to 6.0). Altogether, 120 children aged 6 months through <15 years were treated for DDH, with little annual variation (median, 6.5 children; range, 2 to 9 children). The mean national incidence of late-diagnosed cases was 0.11 per 1,000 newborns (95% CI, 0.09 to 0.13).
Finland's current DDH screening program, which includes universal clinical screening with targeted ultrasound, is noninferior when compared with other screening programs.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
根据最近的一项荟萃分析，采用普遍超声筛查时，发育性髋关节发育不良（DDH）的晚期诊断率为每1000名儿童中有0.2例，这与日本采用选择性超声筛查时的情况相同。我们假设，芬兰目前的普遍临床筛查辅以针对性超声检查的方案，并不逊于普遍和选择性超声筛查方案。
在这项回顾性队列研究中，我们收集了15岁以下儿童的数量，这些儿童在至少3次就诊后被诊断为DDH（国际疾病分类第十版[ICD-10]编码Q65.0-Q65.6和第九版[ICD-9]编码7543）作为其主要诊断。这些数据来自芬兰医疗保健登记册，该登记册收集每次医疗预约的ICD-10和ICD-9编码。我们计算了2002年至2021年间每1000名新生儿中DDH诊断的年发病率。DDH的晚期诊断定义为在初始诊断时年龄为6个月至<15岁且接受过麻醉下治疗（闭合复位和石膏固定或手术）的儿童中发现DDH。我们还记录了DDH诊断的地理、年龄和性别分布。
在20年的研究期间，共出生1103269名婴儿（每年中位数为57214名婴儿；每年范围为45346至60694名婴儿）。共有6421名儿童被诊断为DDH（每年平均321名儿童；每年范围为193至405名儿童），计算得出的平均发病率为每1000名新生儿中有5.8例（95%置信区间[CI]，5.7至6.0）。共有120名年龄在6个月至<15岁的儿童接受了DDH治疗，每年变化不大（中位数为6.5名儿童；范围为2至9名儿童）。晚期诊断病例的全国平均发病率为每1000名新生儿中有0.11例（95%CI，0.09至0.13）。
芬兰目前的DDH筛查方案，包括普遍临床筛查辅以针对性超声检查，与其他筛查方案相比并不逊色。
预后III级。有关证据水平的完整描述，请参阅作者须知。
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