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300 Bebeğin Gelişimsel Kalça Displazisi Açısından Ultrasonografi İle Taranması

Year 2009, Volume: 3 Issue: 4, 5 - 9, 01.04.2009

Abstract

Giriş ve Amaç: Doğumsal kalça çıkığı (DKÇ) ülkemizde sık görülen ve erken tanı konulup tedavi edilirse başarılı sonuçlar alınabilen bir anomalidir. Çalışmamızda, bebeklik döneminde kalça ultrasonografisi (USG) yapılarak gelişimsel kalça displazili olguların tanınması, erken tedavilerinin sağlanması amaçlandı.Olgular ve Metod: Çalışmamıza Eylül 2005 ve Eylül 2006 tarihleri arasında hastanemiz sağlam çocuk polikliniğinde takipli 300 yenidoğan ve süt çocuğu dahil edildi. Gelişimsel kalça displazisi açısından risk faktörleri sorgulandı. Kalça muayenesi yapılan olguların hepsine kalça USG istendi. Kalçalar graf ve dinamik USG metoduna göre değerlendirildi. Tip 1 kalçalar izlem dışı bırakılırken, Tip 2a kalçalar izlendi. Tip 2b’ler ortopedi kliniğine sevk edildi.Bulgular: 134’ ü (%44.7) kız, 166’sı (%55.3) erkek olmak üzere 300 bebek GKD açısından tarandı. Yaşları 1- 4 ay arasında idi. Olgulardan 18’inde (%6) makat gelişi, 8’inde (%2.7) oligohidroamniyoz, 14’ünde (%4.7) çoğul gebelik, 86’sında (28.7) ilk kız bebek olma öyküsü mevcuttu. Ortopedik muayenede 2’ sinde (%0.7) tortikolis, 4’ünde (%1.3) ayak deformitesi, kalça muayenesinde 10 (%3.3) çocukta pili asimetrisi, 4 (%1.3) çocukta ise abdüksiyon kısıtlılığı tespit edildi. 286 bebeğin kalça muayenesi normaldi. Tüm olgulara kalça USG yapıldı. 28 olguda (%9.3) graf Tip 2a kalça tespit edildi. Bu olguların 1 ay sonra tekrar edilen kalça USG’lerinde 3 olguda (%1.2) graf tip 2b kalça saptanması üzerine sublukse kalça olarak değerlendirildi ve ortopedi kliniğine refere edildi.Sonuç: Çalışmamızda mevcut olan gelişimsel kalça displazisinin atlanmaması ve tedavi başarısının artırılması için yenidoğan ve süt çocukluğu döneminde yapılacak kalça USG’sinin önemli olduğu saptanmıştır. Ülkemiz koşulları göz önüne alınırsa en azından risk grubunun USG ile taraması yapılmalıdır.

References

  • Karapınar L, Sürenkök F, Oztürk H, Us MR, Yurdakul L. The importance of predicted risk factors in developmental hip dysplasia:an ultrasonographic screening program. Acta Orthop Traumatol Turc 2002;36:106-110.
  • Harcke HT, Clarke NM, Lee MS, Borns PF, MacEwen GD. Exa- mination of the infant hip With real-timeultrasonography. J Ultra- sound Med 1984;3:131-137.
  • Morin C, Harcke HT, MacEwen GD. The infant hip: real-time US assessment of acetabular development Radiology 1985 ;157:673
  • Tachdjian MO. Pediatric orthopedics. 2nd ed.Philadelphia: W.B. Saunders 1990:214-215.
  • Graf R. Classification of hip joint dysplasia by means of sonog- raphy. Arch Orthop Trauma Surg 1984;102:248-255.
  • Uçar DH, Işıklar ZU, Kandemir U, Tümer Y. Treatment of the developmental dysplasia of the hip with Pavlik harness: Prospec- tive study in Graf Type Iıc or more severe hips. J Pediatr Orthop B 2004;13:70-74.
  • Sahin F, Akturk A, Beyazova U, Cakir B, Boyunaga O, Tezcan S, Bölükbaşi S, Kanatli U. Screening for the developmental dysplasia of the hip: results of a 7 year follow up study. Pediatr Int 2004; :162-166.
  • Clarke NMP. Congenital dislocation of the hip. Current Orthopa- edics 2004;18:256-261.
  • Bayındır Ş, Tanış Z. Boş batın filmlerinde tesadüfen karşılaşılan doğuştan kalça çıkığı ve diğer kalça patolojileri. Hacettepe Tıp Cer Bül 1970; 3: 220-231.
  • Kutlu A, Memik R, Mutlu M, Kutlu R, Arslan A. Congenital dislo- cation of the hip and its relation to swaddling in Turkey. J Pediatr Orthop 1992; 12: 598-602.
  • Rosenberg N, Bialik V, Norman D, Blazer S. The importance of combined sonographic and clinical examination of instability of the neonatal hip. Int Orthopaedics 1998;22: 185-188.
  • Roovers EA, Boere-Boonekamp MM, Castelein RM, Zielhuis GA, Kerkhoff TH. Effectiveness of ultrasound screening for developmental dysplasia of the hip. Archives of Disease in Child- hood 2005;90:25-30.
  • Söyüncü Y, Özdemir H, Akyıldız FF, Ürgüden M, Altınel E. An- talya ve yöresinde ultrasonografik gelişimsel kalça displazisi tara- ması. Acta Orthop Traumatol Turc 1999;33:105-109.
  • Gunay C, Atalar H, Dogruel H, Yavuz OY, Uras I, Saylı U. Corre- lation of femoral head coverage and Graf alpha angle in infants being screened for developmental dysplasia of the hip. Int Ort- hop. epub ahead of print May 2008;21.
  • Senaran H, Ozdemir HM, Ogun TC, Kapiciuğlu MI. Value of li- mited hip abduction in developmental dysplasia of the hip. Pediatr Int 2004;46:456-458.
  • No authors listed]. Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on Quality Impro- vement, Subcommittee on Developmental Dysplasia of the Hip. American Academy of Pediatrics. Pediatrics 2000;105:896-905.
  • Bialik V, Bialik GM, Blazer S, Sujov P, Wiener F, Berant M. De- velopmental dysplasia of the hip: a new approach to incidence. Pediatrics 1999;103: 93-99.
  • Tschauner C, Klapsch W, Graf R. The effect of ultrasonography screening of hips in newborn infants on femur head necrosis and the rate of surgical interventions. Orthopade 1993; 22:268-276.
  • Akman A, Korkmaz A, Aksoy MC, Yazici M, Yurdakök M, Teki- nalp G. Evaluation of risk factors in developmental dysplasia of the hip: results of infantile hip ultrasonography. Turk J Pediatr ;49:290-294
  • Dogruel H, Atalar H, Yavuz OY, Sayli U. Clinical examination ver- sus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 2008 ;32:415-419.

ULTRASONOGRAPHIC EXAMINATION OF DEVELOPMENTAL DYSPLASIA OF THE HIP IN 300 INFANTS

Year 2009, Volume: 3 Issue: 4, 5 - 9, 01.04.2009

Abstract

Introduction and Objective: Congenital dislocation of the hip (CDH) is a commonly encountered anomaly in our country and successful results can be achieved by early diagnosis and treatment. The aim of our study was to identify the cases of developmental dysplasia of the hip (DDH) among newborn babies and infant those in the early nursing period by the hip ultrasonography (USG) as well as to provide early treatment opportunities.Cases and Method: 300 infants who were being followed up in the healthy children clinic of our hospital, between September 2005 and September 2006, were enrolled in our study. Crossexamination was made with respect to risk factors of DDH. Ultrasonography was applied on all cases that underwent physical examination of the hip. The hips were evaluated according to the graf and dynamic ultrasound method. Type 2a hips were followed up while type 1 hips were excluded from the follow-up program. Type 2b cases were referred to the orthopedic clinic. Results: The DDH examination covered a total of 300 infant including 134 girls (4.7%) and 166 boys (55.3%). They were aged between 1–4 months. There was a medical history of breech position in 18 (6%) of the cases, oligohydramnios in 8 (2.7%), multiple pregnancy in 14 (4.7%) and a history of the first child being a girl in 86 (28.7%) of the cases. During the orthopedic examination torticollis was identified in 2 (0.7%) of the cases, foot deformity in 4 (1.3%); meanwhile hip examination demonstrated pili asymmetry in 10 (3.3%) and abduction limitation in 4 (1.3%) cases. The hip examinations of 286 infants were normal. USG examinations were performed on all cases. Graf Type 2a hips were determined in 28 (9.3%) cases. In the hip USG examinations performed a month later, graf type 2b hips were identified in 3 (1.2%) cases and evaluated as hip subluxation. These cases were referred to the orthopedic clinic. Conclusion: In this study, we established the importance of USG examinations performed on infants in order to diagnose the cases of developmental dysplasia of the hip in and increase treatment success. Our country is taken into consideration at least the conditions of the risk group must be made with USG scan

References

  • Karapınar L, Sürenkök F, Oztürk H, Us MR, Yurdakul L. The importance of predicted risk factors in developmental hip dysplasia:an ultrasonographic screening program. Acta Orthop Traumatol Turc 2002;36:106-110.
  • Harcke HT, Clarke NM, Lee MS, Borns PF, MacEwen GD. Exa- mination of the infant hip With real-timeultrasonography. J Ultra- sound Med 1984;3:131-137.
  • Morin C, Harcke HT, MacEwen GD. The infant hip: real-time US assessment of acetabular development Radiology 1985 ;157:673
  • Tachdjian MO. Pediatric orthopedics. 2nd ed.Philadelphia: W.B. Saunders 1990:214-215.
  • Graf R. Classification of hip joint dysplasia by means of sonog- raphy. Arch Orthop Trauma Surg 1984;102:248-255.
  • Uçar DH, Işıklar ZU, Kandemir U, Tümer Y. Treatment of the developmental dysplasia of the hip with Pavlik harness: Prospec- tive study in Graf Type Iıc or more severe hips. J Pediatr Orthop B 2004;13:70-74.
  • Sahin F, Akturk A, Beyazova U, Cakir B, Boyunaga O, Tezcan S, Bölükbaşi S, Kanatli U. Screening for the developmental dysplasia of the hip: results of a 7 year follow up study. Pediatr Int 2004; :162-166.
  • Clarke NMP. Congenital dislocation of the hip. Current Orthopa- edics 2004;18:256-261.
  • Bayındır Ş, Tanış Z. Boş batın filmlerinde tesadüfen karşılaşılan doğuştan kalça çıkığı ve diğer kalça patolojileri. Hacettepe Tıp Cer Bül 1970; 3: 220-231.
  • Kutlu A, Memik R, Mutlu M, Kutlu R, Arslan A. Congenital dislo- cation of the hip and its relation to swaddling in Turkey. J Pediatr Orthop 1992; 12: 598-602.
  • Rosenberg N, Bialik V, Norman D, Blazer S. The importance of combined sonographic and clinical examination of instability of the neonatal hip. Int Orthopaedics 1998;22: 185-188.
  • Roovers EA, Boere-Boonekamp MM, Castelein RM, Zielhuis GA, Kerkhoff TH. Effectiveness of ultrasound screening for developmental dysplasia of the hip. Archives of Disease in Child- hood 2005;90:25-30.
  • Söyüncü Y, Özdemir H, Akyıldız FF, Ürgüden M, Altınel E. An- talya ve yöresinde ultrasonografik gelişimsel kalça displazisi tara- ması. Acta Orthop Traumatol Turc 1999;33:105-109.
  • Gunay C, Atalar H, Dogruel H, Yavuz OY, Uras I, Saylı U. Corre- lation of femoral head coverage and Graf alpha angle in infants being screened for developmental dysplasia of the hip. Int Ort- hop. epub ahead of print May 2008;21.
  • Senaran H, Ozdemir HM, Ogun TC, Kapiciuğlu MI. Value of li- mited hip abduction in developmental dysplasia of the hip. Pediatr Int 2004;46:456-458.
  • No authors listed]. Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on Quality Impro- vement, Subcommittee on Developmental Dysplasia of the Hip. American Academy of Pediatrics. Pediatrics 2000;105:896-905.
  • Bialik V, Bialik GM, Blazer S, Sujov P, Wiener F, Berant M. De- velopmental dysplasia of the hip: a new approach to incidence. Pediatrics 1999;103: 93-99.
  • Tschauner C, Klapsch W, Graf R. The effect of ultrasonography screening of hips in newborn infants on femur head necrosis and the rate of surgical interventions. Orthopade 1993; 22:268-276.
  • Akman A, Korkmaz A, Aksoy MC, Yazici M, Yurdakök M, Teki- nalp G. Evaluation of risk factors in developmental dysplasia of the hip: results of infantile hip ultrasonography. Turk J Pediatr ;49:290-294
  • Dogruel H, Atalar H, Yavuz OY, Sayli U. Clinical examination ver- sus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 2008 ;32:415-419.
There are 20 citations in total.

Details

Other ID JA52PZ72ZJ
Journal Section Research Article
Authors

Bahar Çuhaci Çakır This is me

Ayşe Esin Kibar This is me

Hasan Tahsin Çakır This is me

Ebru Arhan This is me

Ayşegül Cansu This is me

H. İbrahim Yakut This is me

Publication Date April 1, 2009
Submission Date April 1, 2009
Published in Issue Year 2009 Volume: 3 Issue: 4

Cite

Vancouver Çakır BÇ, Kibar AE, Çakır HT, Arhan E, Cansu A, Yakut Hİ. ULTRASONOGRAPHIC EXAMINATION OF DEVELOPMENTAL DYSPLASIA OF THE HIP IN 300 INFANTS. Türkiye Çocuk Hast Derg. 2009;3(4):5-9.


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