Gelişimsel Kalça Displazisi Hastalarında Tanı ve Tedavide Gecikme Nedenlerinin Araştırılması
Öz
Özet
Amaç: Gelişimsel kalça displazisi (GKD) önemli bir halk sağlığı problemidir. Tanı ve tedavide gecikme artmış tedavi maliyeti ve sakatlığa yol açabilmektedir. Bu bağlamda çalışmamızın amacı kliniğimize başvuran GKD’li hastalarda tanı ve tedavide gecikme nedenlerinin sunulmasıdır.
Materyal-yöntem: Ocak 2017 - Ocak 2020 yılları arasında 3-12 aylık arasındaki kliniğimize başvuran ve GKD tanısı konan 44 hasta çalışmaya alındı. Hastaların yaş, cinsiyet, kaçıncı doğum olduğu, aile öyküsü, kundaklama öyküsü, tanıda gecikme sebep ve süreleri, uygulanan eski tedavi şekilleri ile sosyodemografik özellikleri retrospektif olarak toplanarak analiz edildi.
Bulgular: Çalışmaya alınan 44 hastanın 4 (%9,1) ü erkek, 40 (%90,9) ı kız çocuktu. Ortalama yaş 5,44 ay (mean 3,5-12) idi. 19 hasta (%43,2) ailelerin birinci çocukları idi. 11 hasta da (%25) pozitif aile öyküsü, 22 (%50) hasta anamnezinde kundaklama uygulaması vardı.
Çalışmadaki GKD’li hastalardan; 6 hastanın (%13,6) normal raporlanmış kalça USG nedeniyle, 8 hasta (%18,2) sosyal nedenlerle ihmal, 2 hasta (%4,5) yeterli bilgilendirilmeme, 28 hasta (%63,6) çoklu ara bezi tedavisi nedenleri ile geç başvuru yaptıkları tespit edildi. Hastalarda ortalama 2,34 ay (aralık: 0,5-9) doğru tanı ve tedaviye ulaşmada gecikme tespit edildi. Gecikme süreleri ile gecikme nedenleri arasında istatiksel olarak anlamlı bir farklılık bulunmazken, (p=0,538), gecikme süresi ile yapılan tedavi şekli arasında anlamlı bir farklılık tespit edildi (p=0,006).
Sonuç: GKD gecikmiş tanı ve tedavinin en önemli ayağını yanlış kalça usg değerlendirmesi ve kalça usg sonucununda uygun tedavi protokolunun izlenmemesi oluşturmakta idi. 3 aydan büyük GKD’li çocuklarda Çoklu ara bezi kullanımının devam ettirilmesi tedavi yaklaşımını olumsuz etkilemektedir.
Anahtar Kelimeler
Gelişimsel kalça displazisi tedavi gecikmesi tanı gecikmesi kalça ultrasonografisi çoklu ara bezi kullanımı kundaklama
Kaynakça
- 1. Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am 2009;91(7):1705– 19. 2. Köse N, Ömeroğlu H, Dağlar B. Gelişimsel Kalça Displazisi Ulusal Erken Tanı ve Tedavi Programı, TC. Sağlık Bakanlığı-TOTBİD Çocuk Ortopedisi Şubesi Ortak Çalışması,2013; http://www.istanbulsaglik.gov.tr/w/sb/cekus/docs/18-gelisimsel_Kalca_Displazisi.pdf 3. Mehmet Müfit Orak1, Tolga Onay2. Ultrasonographic evaluation in developmental dysplasia of the hip. TOTBİD Dergisi 2014; 13:381–389 4. Rosenberg N, Bialik V, Norman D, Blazer S. The importance of combined clinical and sonographic examination of instability of the neonatal hip. Int Orthop 1998;22:185–188 5. Bilgili F, Sağlam Y. The treatment of developmental hip dysplasia (DDH) between 0–6 months of age. TOTBİD Dergisi 2014; 13:396–402 6. Keller MS, Nijs EL. The role of radiographs and US in developmental dysplasia of the hip: how good are they? Pediatr Radiol 2009;39 Suppl 2: S211–5. 7. Ertürk C. Büyükdoğan H. Etiology and Diagnosis in Developmental Dysplasia of the Hip (I). İKSSTD 2019;11(2):61-69 8. Guille JT, Pizzutillo PD, MacEwen GD. Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg 2000;8(4):232–42. 9. Akman A, Korkmaz A, Aksoy MC, Yazıcı M, Yurdakök M, Tekinalp G. Evaluation of risk factors in developmental dysplasia of the hip: results of infantile hip ultrasonography. Turk J Pediatr 2007; 49: 290-294. 10. Kutlu A, Memik R, Mutlu M, Kutlu R, Arslan A. Congenital dislocation of the hip and its relation to swaddling used in Turkey. J Pediatr Orthop. 1992;12:598-602. 11. Suzuki S, Yamamuro T. The mechanical cause of congenital dislocation of the hip joint. Acta Orthop Scand 1993;64:303–4. 12. Yamamuro T, Ishida K. Recent advances in the prevention, early diagnosis, and treatment of congenital dislocation of the hip in Japan. Clin Orthop Relat Res 1984;184:34–40. 13. Price, CT. Ramo BA. Prevention of Hip Dysplasia in Children and Adults. Orthop Clin N Am. 2012 43 (3), 269-279. 14. Ishida K: Preventian of the ensel of congenital dislocation of the hip. In: Anda M, ed, Prevention of Congenital Dislocation of the Hip in Infants. Asahikawa, Japan Xamada Co. Ltd, 1-10 , 1993 15. Tümer Y. Ömeroğlu H. Türkiye'de gelişimsel kalça displazisinin önlenmesi. Acta Ortop Traumatol Turc. 1997; 31; 176-181. 16. Graf R. The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg. 1980.97:117–133 17. Graf R. The use of ultrasonography in developmental dysplasia of the hip. Acta Orthop Traumatol Turc 2007;41 Suppl 1:6–13. 18. Dogruel H. Atalar H. Yavuz OY. Sayli U. Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip International Orthopaedics (SICOT) 2008;32:415–419 19. Karakus O, Karaman O, Sari AS, Orak MM, Muratli HH. Is it difficult to obtain inter-observer agreement in the measurement of the beta angle in ultrasound evaluation of the paediatric hip? J Orthop Surg Res. 2019 Jul 17;14(1):221. 20. Klisic P, Pasic D: Progress in the preventive approach to developmental dysplasia of the hip. J Pediatr Ortho" Part B 1993;2: 108-111. 21. Bursalı A: Gelişimsel kalça displazisi ve koruyucu hekimlik. Ed; Temelli Y, Göksan SB. Gelişimsel kalça displazisi. İstanbul: TOTBID yayınları, 2007: 8-15.
An Investigation of the Causes of Delay in the Diagnosis and Treatment of Patients with Developmental Hip Dysplasia
Öz
Abstract
Objective: Developmental dysplasia of the hip (DDH) is an important public health problem. A delayed diagnosis and treatment may lead to increased treatment costs and disability. The purpose of our study is to present the causes of delay in the diagnosis and treatment of DDH patients who applied to our clinic.
Material-Method: Forty-four patients who were 3-12 months old, were admitted to our clinic between January 2017 and January 2020 and diagnosed with DDH were included in the study. The age, gender, birth order, familial history, history of swaddling, reason for and the time to delayed diagnosis, previous treatment methods and sociodemographic characteristics of the patients were analyzed retrospectively.
Results: Of the 44 patients included in the study, four (9.1%) were boys and 40 (90.9%) were girls. The average age was 5.44 months (mean: 3.5-12). Nineteen patients (43.2%) were the first children in their families. Eleven patients (25%) had a positive family history, and 22 (50%) had a history of swaddling.
Of the patients with DDH in the study; the reason for late presentation was a hip USG report with normal results in six patients (13.6%), neglect due to social reasons in eight patients (18.2%), provision of insufficient information in two patients (4.5%), and treatment with multiple diapers in 28 patients (63.6%). While there was no statistically significant difference between the delay time and cause of delay (p=0.538), a significant difference was found between the delay time and the treatment method (p=0.006).
Conclusion: The most important factor for delayed diagnosis and treatment of DDH was the wrongful USG evaluation of the hip and the failure to follow the appropriate treatment protocol based on the hip USG results. The continued use of multiple diapers in DDH patients older than 3 months has an adverse effect on the treatment approach.
Anahtar Kelimeler
Delayed diagnosis delayed treatment developmental hip dysplasia hip ultrasonography multiple diaper use swaddling
Kaynakça
- 1. Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am 2009;91(7):1705– 19. 2. Köse N, Ömeroğlu H, Dağlar B. Gelişimsel Kalça Displazisi Ulusal Erken Tanı ve Tedavi Programı, TC. Sağlık Bakanlığı-TOTBİD Çocuk Ortopedisi Şubesi Ortak Çalışması,2013; http://www.istanbulsaglik.gov.tr/w/sb/cekus/docs/18-gelisimsel_Kalca_Displazisi.pdf 3. Mehmet Müfit Orak1, Tolga Onay2. Ultrasonographic evaluation in developmental dysplasia of the hip. TOTBİD Dergisi 2014; 13:381–389 4. Rosenberg N, Bialik V, Norman D, Blazer S. The importance of combined clinical and sonographic examination of instability of the neonatal hip. Int Orthop 1998;22:185–188 5. Bilgili F, Sağlam Y. The treatment of developmental hip dysplasia (DDH) between 0–6 months of age. TOTBİD Dergisi 2014; 13:396–402 6. Keller MS, Nijs EL. The role of radiographs and US in developmental dysplasia of the hip: how good are they? Pediatr Radiol 2009;39 Suppl 2: S211–5. 7. Ertürk C. Büyükdoğan H. Etiology and Diagnosis in Developmental Dysplasia of the Hip (I). İKSSTD 2019;11(2):61-69 8. Guille JT, Pizzutillo PD, MacEwen GD. Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg 2000;8(4):232–42. 9. Akman A, Korkmaz A, Aksoy MC, Yazıcı M, Yurdakök M, Tekinalp G. Evaluation of risk factors in developmental dysplasia of the hip: results of infantile hip ultrasonography. Turk J Pediatr 2007; 49: 290-294. 10. Kutlu A, Memik R, Mutlu M, Kutlu R, Arslan A. Congenital dislocation of the hip and its relation to swaddling used in Turkey. J Pediatr Orthop. 1992;12:598-602. 11. Suzuki S, Yamamuro T. The mechanical cause of congenital dislocation of the hip joint. Acta Orthop Scand 1993;64:303–4. 12. Yamamuro T, Ishida K. Recent advances in the prevention, early diagnosis, and treatment of congenital dislocation of the hip in Japan. Clin Orthop Relat Res 1984;184:34–40. 13. Price, CT. Ramo BA. Prevention of Hip Dysplasia in Children and Adults. Orthop Clin N Am. 2012 43 (3), 269-279. 14. Ishida K: Preventian of the ensel of congenital dislocation of the hip. In: Anda M, ed, Prevention of Congenital Dislocation of the Hip in Infants. Asahikawa, Japan Xamada Co. Ltd, 1-10 , 1993 15. Tümer Y. Ömeroğlu H. Türkiye'de gelişimsel kalça displazisinin önlenmesi. Acta Ortop Traumatol Turc. 1997; 31; 176-181. 16. Graf R. The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg. 1980.97:117–133 17. Graf R. The use of ultrasonography in developmental dysplasia of the hip. Acta Orthop Traumatol Turc 2007;41 Suppl 1:6–13. 18. Dogruel H. Atalar H. Yavuz OY. Sayli U. Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip International Orthopaedics (SICOT) 2008;32:415–419 19. Karakus O, Karaman O, Sari AS, Orak MM, Muratli HH. Is it difficult to obtain inter-observer agreement in the measurement of the beta angle in ultrasound evaluation of the paediatric hip? J Orthop Surg Res. 2019 Jul 17;14(1):221. 20. Klisic P, Pasic D: Progress in the preventive approach to developmental dysplasia of the hip. J Pediatr Ortho" Part B 1993;2: 108-111. 21. Bursalı A: Gelişimsel kalça displazisi ve koruyucu hekimlik. Ed; Temelli Y, Göksan SB. Gelişimsel kalça displazisi. İstanbul: TOTBID yayınları, 2007: 8-15.