Imerci Ahmet, Thacker Mihir, Bowen Richard
Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Department of Orthopaedics and Traumatology, Faculty of Medicine, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Türkiye.
Acta Orthop Traumatol Turc. 2025 Mar 17;59(1):45-48. doi: 10.5152/j.aott.2025.23036.
: For years, physical examination (PE) findings (e.g., Barlow, Ortolani tests, and abduction limitation) have been used as the primary screening method in the early diagnosis of developmental dysplasia of the hip (DDH). There are a limited number of studies in the literature that evaluate the agreement of PE findings and dynamic sonographic evaluation. Our aim was to evaluate the correlation between dynamic sonographic hip types and physical examination findings in infants with DDH.
: A total of 281 infants (562 hips) with DDH younger than 6 months who were given Pavlik harness treatment were included in the study. Socio-demographic characteristics (e.g., age, gender, and race) of the infants were recorded. The concordance between the PE findings and sonographic findings of the patients at the first admission was evaluated. The agreement analysis between the dynamic sonography evaluations and the PE results was demonstrated by Cohen’s kappa (k) coefficient and Kendall’s coefficient (W) of concordance.
: Of the 55 hips evaluated as normal in PE, 21 were normal, 25 were found to have dysplasia, and 9 were subluxated/or subluxatable on dynamic sonography. It was observed that 30 (13%) of 219 hips which were dislocated on dynamic sonography were found to be lax on the PE. The overall percentage of agreement between the physical examination and dynamic sonography was 72.4. The Cohen for agreement between the PE and dynamic sonography was 0.541 (CI: 0.479-0.602). The agreement between Ortolani test evaluation with PE and Ortolani test evaluation of patients diagnosed with dislocated hip by dynamic sonography was 70.3% (Cl: 0.34 (0.22-0.46)), while the agreement of Barlow test was 78.5% (CI: 0-0.26). The Kendall’s coefficient of concordance between reducible hip (Ortolani positive) under dynamic sonography and PE was 0.546. Dynamic sonographic evaluation of 238 hips with restricted hip abduction showed that 78 (32.7%) were subluxated at rest and/or subluxated with stress, and the remaining 150 (67.3%) hips were dislocated at rest or dislocated with stress.
: The agreement between PE and dynamic sonography was fair to moderate. The clinicians should focus on both examinations to reveal essential data for diagnosing and monitoring infants with DDH.
: Level IV, Diagnostic Study.
多年来，体格检查（PE）结果（如巴洛试验、奥托拉尼试验及外展受限）一直被用作发育性髋关节发育不良（DDH）早期诊断的主要筛查方法。文献中评估PE结果与动态超声评估一致性的研究数量有限。我们的目的是评估DDH患儿动态超声髋关节类型与体格检查结果之间的相关性。
本研究纳入了281例6个月以下接受 Pavlik 吊带治疗的 DDH 婴儿（562 个髋关节）。记录婴儿的社会人口学特征（如年龄、性别和种族）。评估首次入院时患者的PE结果与超声检查结果之间的一致性。通过 Cohen's kappa（κ）系数和肯德尔和谐系数（W）对动态超声评估与PE结果之间的一致性进行分析。
在PE评估为正常的55个髋关节中，动态超声检查显示21个正常，25个有发育不良，9个半脱位/或可半脱位。观察到在动态超声检查中脱位的219个髋关节中有30个（13%）在PE检查时发现松弛。体格检查与动态超声检查的总体一致率为72.4%。PE与动态超声检查之间的一致性Cohen's κ为0.541（95%CI：0.479 - 0.602）。PE的奥托拉尼试验评估与动态超声诊断为髋关节脱位患者的奥托拉尼试验评估之间的一致性为70.3%（95%CI：0.34（0.22 - 0.46）），而巴洛试验的一致性为78.5%（95%CI：0 - 0.26）。动态超声检查下可复位髋关节（奥托拉尼试验阳性）与PE之间的肯德尔和谐系数为0.546。对238个髋关节外展受限的动态超声检查显示，78个（32.7%）在静止时半脱位和/或在应力下半脱位，其余150个（67.3%）髋关节在静止时脱位或在应力下脱位。
PE与动态超声检查之间的一致性为中等。临床医生应同时关注这两种检查，以获取诊断和监测DDH患儿的关键数据。
IV级，诊断性研究。
