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Orta Anadolu'da ultrason tarama yönteminin değerlendirilmesi ve gelişimsel kalça displazisi prevalansı

Yıl 2024, Cilt: 17 Sayı: 3, 486 - 496, 05.07.2024
https://doi.org/10.31362/patd.1412442

Öz

Amaç: Bu çalışma, Şehir Hastanesi'ne başvuran bebeklerde Graf sınıflaması kullanılarak Gelişimsel Kalça Displazisi (GKD) insidansını ve takip sonuçlarını değerlendirmeyi amaçlamaktadır. Ayrıca, Orta Anadolu'da GKD prevalansını araştırmayı ve GKD'nin tespit edilmesi ve yönetilmesi için mevcut tarama ve tedavi protokollerinin etkinliğini değerlendirmeyi hedeflemektedir.
Gereç ve yöntem: Ağustos 2020 ile Eylül 2022 tarihleri arasında Şehir Hastanesi'nde Ulusal GKD tarama programının bir parçası olarak toplam 10.650 bebek Graf USG yöntemiyle GKD taramasından geçirilmiştir. Doğum haftası 38 hafta ve üzeri olan ve doğumdan 30-90 gün sonra taranan bebekler dahil edilirken, prematüre bebekler hariç tutulmuştur. Kalçalar alfa açılarına dayanarak Graf yöntemine göre Tip 1 (normal), 2 (olgunlaşmamış), 2A (+), 2A (-), 2B, 2C, D, 3 ve 4 şeklinde sınıflandırılmıştır.
Bulgular: Çalışma, 2020-2022 yılları arasında 8.695 term bebek (%52,5 erkek ve %47,5 dişi) USG sonuçlarını incelemiştir. Katılımcıların ilk USG muayenesi sırasındaki ortalama gebelik haftası yaklaşık 7,94±2,07 hafta idi. Graf Tip 1 erkeklerde daha yaygındı (%97-96,5), Graf Tip 2 ise kadınlarda daha yaygındı (%7,2-7,8).
Graf Tip 2A kalçalar için radyologlar genellikle bir ay sonra tekrar muayene önerirken (%84,49-82,02), Tip 2B, 2C ve Tip-3 kalçalar için ortopedik danışma önerilmiştir. Bebeklerin büyük çoğunluğu (%93,6) yalnızca bir kez USG taramasına tabi tutulmuştur. Hastaların %15,9'una pelvis grafisi istenmiş ve %5,7'sine ek USG'ler istenmiştir. Takiplerinde normale dönmeyen hastaların %4,2'sine Pavlik tedavisi uygulanmış, %1,5'ine Frejka yastığı tedavisi uygulanmıştır. İlginç bir şekilde, düzenli USG takibi ve tedavisi devam eden hastalar arasında hiçbirinin osteotomi gerektiren cerrahi müdahaleye ihtiyaç duymadığı gözlemlenmiştir.
Sonuç: USG, GKD tanısı için erken, basit, ucuz ve invaziv olmayan bir tanı yöntemidir. Sonuçlarında GKD tanısı konulan çocukların basit tedavi modaliteleri ile tedavi edilmelerine ve komplikasyonların önlenmesine olanak sağlar. Çalışmamız, bebeklerde düzenli USG taramalarının osteotomi gerektiren cerrahi işlemlere ihtiyacı ortadan kaldırdığını desteklemektedir. Ancak, anormal sonuçlar almasına rağmen takip randevularına uymayan bireylerin oranı hala yüksektir, bu da ebeveyn farkındalığını artırmaya yönelik çeşitli stratejilerin uygulanması gerekliliğini vurgular.

Kaynakça

  • 1. Guille JT, Pizzutillo PD, MacEwen GD. Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg 2000;8:232-242. https://doi.org/10.5435/00124635-200007000-00004
  • 2. Sioutis S, Kolovos S, Papakonstantinou ME, Reppas L, Koulalis D, Mavrogenis AF. Developmental dysplasia of the hip: a review. J Long Term Eff Med Implants 2022;32:39-56. https://doi.org/10.1615/JLongTermEffMedImplants.2022040393
  • 3. Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: what has changed in the last 20 years?. World J Orthop 2015;6:886-901. https://doi.org/10.5312/wjo.v6.i11.886
  • 4. Liu B, Hu X, Li L, Gao S. Morphological development of the hip in normal infants under six months of age by the graf ultrasound method. Front Pediatr 2022;10:914545. https://doi.org/10.3389/fped.2022.914545
  • 5. Husum HC, Møller Madsen B, Thomsen JL, Maimburg RD, Rahbek O. Screening of dysplasia of the hip in denmark. Ugeskr Laeger 2021;183:V05200371.
  • 6. Chand S, Aroojis A, Pandey RA, Johari AN. The incidence, diagnosis, and treatment practices of developmental dysplasia of Hip (DDH) in India: a scoping systematic review. Indian J Orthop 2021;55:1428-1439. https://doi.org/10.1007/s43465-021-00526-y
  • 7. Harsanyi S, Zamborsky R, Krajciova L, Kokavec M, Danisovic L. Developmental dysplasia of the hip: a review of etiopathogenesis, risk factors, and genetic aspects. Medicina (Kaunas) 2020;56:153. https://doi.org/10.3390/medicina56040153
  • 8. Zhu D, Zhu H. Incidence and epidemiological characters of developmental dysplasia of the hip in lianyungang: based on ultrasound screening: a retrospective study. Int J Gen Med 2022;15:8547-8555. https://doi.org/10.2147/IJGM.S389145
  • 9. Çekiç B, Erdem Toslak İ, Sertkaya Ö, et al. Incidence and follow-up outcomes of developmental hip dysplasia of newborns in the Western Mediterranean Region. Turk J Pediatr 2015;57:353-358.
  • 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. Rosendahl K, Toma P. Ultrasound in the diagnosis of developmental dysplasia of the hip in newborns. The European approach. A review of methods, accuracy and clinical validity. Eur Radiol 2007;17:1960-1967. https://doi.org/10.1007/s00330-006-0557-y
  • 12. Roovers EA, Boere Boonekamp MM, Mostert AK, Castelein RM, Zielhuis GA, Kerkhoff THM. The natural history of developmental dysplasia of the hip: sonographic findings in infants of 1-3 months of age. J Pediatr Orthop B 2005;14:325-330. https://doi.org/10.1097/01202412-200509000-00003
  • 13. Omeroğlu H, Caylak R, Inan U, Köse N. Ultrasonographic graf type IIa hip needs more consideration in newborn girls. J Child Orthop 2013;7:95-98. https://doi.org/10.1007/s11832-012-0476-1
  • 14. Munkhuu B, Essig S, Renchinnyam E, et al. Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study. PLoS One 2013;8:e79427. https://doi.org/10.1371/journal.pone.0079427
  • 15. Duramaz A, Peker G, Arslan L, Bilgili MG, Erçin E, Kural C. Gelişimsel kalça displazisi tanısında kalça ultrasonografisi: Bakırköy tecrübesi. Haseki Tıp Bülteni 2014;52:262-267. https://doi.org/10.4274/haseki.1669
  • 16. Ceylan HH, Paksoy Y. İstanbul Sultangazi regional incidence of newborn developmental dysplasia of hip. Med Bull Haseki 2018;56:68-73. https://doi.org/10.4274/haseki.4029

Evaluation of ultrasound screening method and prevalence for developmental hip dysplasia in the central Anatolia

Yıl 2024, Cilt: 17 Sayı: 3, 486 - 496, 05.07.2024
https://doi.org/10.31362/patd.1412442

Öz

Purpose: This study aims to evaluate the incidence and follow-up outcomes of Developmental Hip Dysplasia (DDH) in infants admitted to City Hospital using the Graf classification. Furthermore, it aims to investigate the prevalence of DDH in Central Anatolia and assess the effectiveness of current screening and treatment protocols for detecting and managing DDH in infants.
Materials and methods: A total of 10.650 infants underwent screening for DDH using the Graf USG method as part of the National DDH screening program at City Hospital between August 2020 and September 2022. Infants born at term (38 weeks and above) and screened between 30-90 days of birth were included, while premature infants were excluded. Hips were classified according to the Graf method into Types 1 (normal), 2 (immature), 2A (+), 2A (-), 2B, 2C, D, 3, and 4, based on alpha angles.
Results: The study examined the USG results of 8,695 term infants (52.5% male and 47.5% female) between 2020 and 2022. The mean gestational age of participants at the time of the initial USG examination was approximately 7.94±2.07 weeks. Graf Type 1 was more prevalent in males (97-96.5%), while Graf Type 2 was more common in females (7.2-7.8%). Radiologists tended to recommend a re-examination after one month for Type 2A Graf hips (84.49-82.02%), whereas orthopedic consultation was advised for Type 2B, 2C, and Type 3 hips. The vast majority of infants (93.6%) underwent only one USG screening. Pelvic X-ray was requested for 15.9% of patients, and additional USGs were requested for 5.7% of patients. Pavlik treatment was applied to 4.2% of patients who did not return to normal, Frejka pillow treatment was applied to 1.5% Interestingly, none of the patients who maintained regular USG monitoring and treatment required surgical intervention involving osteotomy.
Conclusion: USG is an early diagnostic method for DDH, which allows for simple treatment options and the prevention of complications. It is a simple, inexpensive, and non-invasive method. Our study supports that regular USG screenings in infants eliminate the need for surgical procedures requiring osteotomy. However, the proportion of individuals who failed to adhere to their follow-up appointments despite receiving abnormal results remains elevated, underscoring the necessity for implementing diverse strategies aimed at augmenting parental awareness in this context.

Etik Beyan

Ethical Approval: Ethical approval was obtained for this study from the Necmettin Erbakan University Ethics Committee with the decision dated 17.02.2023 and numbered 2023/4197. Peer-review: Externally peer-reviewed. Conflict of Interest: The authors declared that there is no conflict of interest. Financial Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Teşekkür

The authors would like to thank Adnan Karaibrahimoğlu a faculty member in the Department of Biostatistics at Suleyman Demirel University Faculty of Medicine fort he statistical analysis.

Kaynakça

  • 1. Guille JT, Pizzutillo PD, MacEwen GD. Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg 2000;8:232-242. https://doi.org/10.5435/00124635-200007000-00004
  • 2. Sioutis S, Kolovos S, Papakonstantinou ME, Reppas L, Koulalis D, Mavrogenis AF. Developmental dysplasia of the hip: a review. J Long Term Eff Med Implants 2022;32:39-56. https://doi.org/10.1615/JLongTermEffMedImplants.2022040393
  • 3. Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: what has changed in the last 20 years?. World J Orthop 2015;6:886-901. https://doi.org/10.5312/wjo.v6.i11.886
  • 4. Liu B, Hu X, Li L, Gao S. Morphological development of the hip in normal infants under six months of age by the graf ultrasound method. Front Pediatr 2022;10:914545. https://doi.org/10.3389/fped.2022.914545
  • 5. Husum HC, Møller Madsen B, Thomsen JL, Maimburg RD, Rahbek O. Screening of dysplasia of the hip in denmark. Ugeskr Laeger 2021;183:V05200371.
  • 6. Chand S, Aroojis A, Pandey RA, Johari AN. The incidence, diagnosis, and treatment practices of developmental dysplasia of Hip (DDH) in India: a scoping systematic review. Indian J Orthop 2021;55:1428-1439. https://doi.org/10.1007/s43465-021-00526-y
  • 7. Harsanyi S, Zamborsky R, Krajciova L, Kokavec M, Danisovic L. Developmental dysplasia of the hip: a review of etiopathogenesis, risk factors, and genetic aspects. Medicina (Kaunas) 2020;56:153. https://doi.org/10.3390/medicina56040153
  • 8. Zhu D, Zhu H. Incidence and epidemiological characters of developmental dysplasia of the hip in lianyungang: based on ultrasound screening: a retrospective study. Int J Gen Med 2022;15:8547-8555. https://doi.org/10.2147/IJGM.S389145
  • 9. Çekiç B, Erdem Toslak İ, Sertkaya Ö, et al. Incidence and follow-up outcomes of developmental hip dysplasia of newborns in the Western Mediterranean Region. Turk J Pediatr 2015;57:353-358.
  • 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. Rosendahl K, Toma P. Ultrasound in the diagnosis of developmental dysplasia of the hip in newborns. The European approach. A review of methods, accuracy and clinical validity. Eur Radiol 2007;17:1960-1967. https://doi.org/10.1007/s00330-006-0557-y
  • 12. Roovers EA, Boere Boonekamp MM, Mostert AK, Castelein RM, Zielhuis GA, Kerkhoff THM. The natural history of developmental dysplasia of the hip: sonographic findings in infants of 1-3 months of age. J Pediatr Orthop B 2005;14:325-330. https://doi.org/10.1097/01202412-200509000-00003
  • 13. Omeroğlu H, Caylak R, Inan U, Köse N. Ultrasonographic graf type IIa hip needs more consideration in newborn girls. J Child Orthop 2013;7:95-98. https://doi.org/10.1007/s11832-012-0476-1
  • 14. Munkhuu B, Essig S, Renchinnyam E, et al. Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study. PLoS One 2013;8:e79427. https://doi.org/10.1371/journal.pone.0079427
  • 15. Duramaz A, Peker G, Arslan L, Bilgili MG, Erçin E, Kural C. Gelişimsel kalça displazisi tanısında kalça ultrasonografisi: Bakırköy tecrübesi. Haseki Tıp Bülteni 2014;52:262-267. https://doi.org/10.4274/haseki.1669
  • 16. Ceylan HH, Paksoy Y. İstanbul Sultangazi regional incidence of newborn developmental dysplasia of hip. Med Bull Haseki 2018;56:68-73. https://doi.org/10.4274/haseki.4029
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Araştırma Makalesi
Yazarlar

Oğuzhan Pekince 0000-0002-3988-9818

Ferhat Sayar 0000-0002-0084-2414

Emrah Cevat Ercan 0000-0001-8263-7547

Özkan Köse 0000-0002-7679-9635

Erken Görünüm Tarihi 20 Mayıs 2024
Yayımlanma Tarihi 5 Temmuz 2024
Gönderilme Tarihi 2 Ocak 2024
Kabul Tarihi 20 Mayıs 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 17 Sayı: 3

Kaynak Göster

AMA Pekince O, Sayar F, Ercan EC, Köse Ö. Evaluation of ultrasound screening method and prevalence for developmental hip dysplasia in the central Anatolia. Pam Tıp Derg. Temmuz 2024;17(3):486-496. doi:10.31362/patd.1412442
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