Walsh J J, Morrissy R T
Scottish Rite Children's Medical Center, Atlanta, Georgia 30342, USA.
J Pediatr Orthop. 1998 Mar-Apr;18(2):219-21.
Reports in the literature suggest that there is an association between two childhood disorders: torticollis, an easily recognized clinical deformity, and developmental dislocation or dysplasia of the hip, an occult disorder. The identification of the obvious disease, torticollis, may prompt a search for the occult disease, developmental dislocation of the hip. If the association of these two disorders is common, it may be justified to expend resources to diagnose the occult disorder in all cases in which the more obviously noticed disorder is recognized. The reported association varies between 2 and 29%. We retrospectively reviewed 70 patients with the diagnosis of congenital muscular torticollis to determine the incidence of hip dislocation or subluxation in these patients. Fifty-four patients had radiographs of their hips. Forty-one patients were available for follow-up at an average of age 3+4 years. Six patients were noted to have hip subluxation or dislocation, all at presentation. Of these, four had been referred for diagnosed hip disease, whereas two were referred for torticollis, and the hip disease was then diagnosed by the pediatric orthopaedist. No patient had abnormal radiographs or physical findings at follow-up. We conclude that the rate of hip disease in those with torticollis is approximately 8% and is lower than the 20% often quoted.
文献报道表明，两种儿童疾病之间存在关联：斜颈，一种易于识别的临床畸形，以及发育性髋关节脱位或发育异常，一种隐匿性疾病。明显疾病斜颈的确诊可能会促使对隐匿性疾病发育性髋关节脱位进行检查。如果这两种疾病的关联很常见，那么在所有确诊了更明显疾病的病例中投入资源诊断隐匿性疾病可能是合理的。报道的关联发生率在2%至29%之间。我们回顾性研究了70例诊断为先天性肌性斜颈的患者，以确定这些患者中髋关节脱位或半脱位的发生率。54例患者进行了髋关节X线检查。41例患者可进行随访，平均年龄为3岁4个月。6例患者在初诊时被发现有髋关节半脱位或脱位。其中，4例因诊断为髋关节疾病而转诊，2例因斜颈转诊，随后小儿骨科医生诊断出髋关节疾病。随访时没有患者的X线片或体格检查结果异常。我们得出结论，斜颈患者中髋关节疾病的发生率约为8%，低于通常引用的20%。
