背景:在婴儿期诊断为髋关节发育不良(DDH)时,保守的管理往往是成功的,有良好的长期结果。在印度,DDH通常直到步行年龄才被诊断出来,并且其筛查指南有限。
方法:由印度儿科骨科学会成员组成的多学科专家组,印度儿科学会,印度国家新生儿学论坛,印度放射和成像协会,印度医学和生物学超声联合会,印度产科和妇科协会联合会,和印度骨科协会合作制定DDH监测指南.
目的:通过制定和实施标准化的监测护理途径,提高印度DDH的早期检出率,从而减轻后期出现DDH的负担。
结论:必须在出生时和免疫访视期间,在6、10和14周;6、9、12、15和18个月大的这些大致时间点对所有婴儿进行常规临床髋关节检查。评估包括对<14周的婴儿进行Ortolani和Barlow测试;对>14周的婴儿进行有限的髋关节外展和腿部长度差异;以及对行走儿童的跛行评估。如果临床检查异常或不确定,建议转诊至骨科进行进一步评估和管理.在巴洛试验阳性但Ortolani试验阴性的小于6周的婴儿中,建议在6周龄时进行髋关节超声检查。还必须对婴儿进行DDH危险因素筛查:臀位表现,DDH家族史,不安全的臀围,和髋关节不稳定在任何以前的临床检查。在有危险因素但临床检查正常的婴儿中,进一步评估应包括对14周龄以下的婴儿进行不早于6周龄的超声检查,14周至6月龄婴儿的超声或X线检查,6个月以上婴儿的X光片。如果放射学检查异常,建议转诊给整形外科医生。
BACKGROUND: When developmental dysplasia of the hip (DDH) is diagnosed during infancy, conservative management is often successful, with good long-term outcomes. In India, DDH is often not diagnosed until walking age and there are limited
guidelines for its screening.
METHODS: A multidisciplinary Expert Group consisting of members of the Paediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and
Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association worked collaboratively to develop surveillance
guidelines for DDH.
OBJECTIVE: To enhance the early detection rate of DDH in India through development and implementation of a standardized surveillance care pathway, thus reducing the burden of late-presenting DDH.
CONCLUSIONS: Routine clinical hip examinations must be performed on all infants at birth and during immunization visits at these approximate time points: 6, 10, and 14 weeks; 6, 9, 12, 15, and 18 months of age. Assessments include Ortolani and Barlow tests for infants <14 weeks; limited hip abduction and leg length discrepancy for infants >14 weeks; and evaluation of limp in walking children. If clinical examination is abnormal or inconclusive, referral to orthopedics for further evaluation and management is recommended. In infants younger than 6 weeks with positive Barlow test but negative Ortolani test, hip ultrasound is recommended at 6 weeks of age. Infants must also be screened for DDH risk factors: breech presentation, family history of DDH, unsafe hip swaddling, and hip instability at any previous clinical examination. In infants with risk factors but normal clinical examination, further evaluation should include ultrasound taken no earlier than 6 weeks of age for infants younger than 14 weeks, ultrasound or X-ray for infants 14 weeks to 6 months of age, and X-ray for infants older than 6 months. Referral to an orthopedic surgeon is recommended if radiological tests are abnormal.