SİNAN ZEHİR, Uğur Erdem IŞIKAN, SERKAN SİPAHİOĞLU, Sevgi SİPAHİOĞLU TEMİZ, İbrahim KORUK

Dört hafta- altı ay arası bebeklerde gelişimsel kalça displazisi taramasında ultrasonografik çalışma sonuçları

Amaç: Dört haftalıktan büyük altı aylıktan küçük bebeklerin kalça incelemesinde ultrasonografi(Graf yöntemi) kullanarak Gelişimsel Kalça Displazi- si(GKD) bölgesel insidansının saptanması ve yenidoğanlarda GKD’nin erken teşhisinde ultrasonografi ile yapılan tarama çalışmasının etkinliğinin belirlenmesidir. Gereç ve Yöntem: Çalışma Şubat 2008 ile Mart 2009 tarihleri arasında çocuk ve Harran Ü. Tıp Fak Araştırma hastanesine travma ve ortopedi dışı nedenler ile başvuran dört haftalıktan büyük altı aylıktan küçük 1127 yenidoğan bebek ultrasonografik olarak değerlendirildi. Bulgular: Ultrasonografi yapılan 2254 kalça Graf sınıflandırmasına göre değerlendirildiğinde 1100(%48.8) kalça tip Ia, 758(%33.6) kalça tip Ib, 215(%9.53) kalça tip IIa, 55(%2.4) kalça tip IIb, 51(%2.26) kalça tipIIc, 4(%0.17) kalça tip D ve 71(%3.14) kalça tip III-IV olarak tespit edildi. GKD’li olgularda tespit edilen önemli risk faktörleri; kundak uygulaması %81.6, kız cinsiyet %72.5, ilk bebek olma %46.4, evde doğum %19, pozitif aile hikayesi %14.7, makat geliş %4.2 şeklindeydi. Doğumsal ortopedik bir hastalık bulunan bebeklerde GKD görülme riski ortopedik hastalığa olmayanlara göre anlamlı olarak daha fazla tespit edildi. Sonuç: Günümüzde güncelliğini korumaya devam eden GKD tedavisinde ilk ve en önemli koşul erken tanıdır. Hastalığın bir halk sağlığı problemi olarak karşımıza çıktığı ülkemizde genel tarama yapılamayan bölgelerde, kalça ultrasonografisinin uygulanması GKD’ye ilk yaklaşımda alternatif bir yöntem olarak tartışılabilir.

Ultrasonographic examination results in the screening of the developmental hip dysplasia babies between four weeks to six months

Objective: The aim of this study is to assess regional incidence of developmental dysplasia(DDH) between four weeks and six months age of infants by ultrasonographic evaluation(Graf Method) and to determine the effectivity of ultrasonography in the early diagnosis of developmental dysplasia of hip. Materials and Methods: This study was conducted on 1127 newborns that applied to Children Hospital and Harran University Hospital in between February 2008 and March 2009 for non orthopedics reasons Babies older than 4 week and younger than 6 months were evaluated with hip- ultrasonography. Results: Ultrasonography performed 2254 hips were classified according to Graf classification; 1100( 48.8 %) hips were type Ia, 758(33.6 % ) hips were type Ib, 215(9.53 %) hips were type IIa, 55(2.4 %) hips were type IIb, 51(2.26 %) his were type IIc, 4( 0.17 %) hips were type D and 71(3.14 %) hips were type III-IV. Important risk factors determined in DDH cases were swaddling 81.6 %, female gender 72.5 %, first born 46.4 %, home delivery 19 %, positive family history 14,7 % and breech presentation 4,2 %. The incidence of DDH was significantly higher in the babies that had a congenital orthopaedic disorder. Conclusion: The most important prognostic factor for the threament of DDH is early diagnosis with hip-ultrasonography.As we face with DDH as a public health problem in our country, if you consider the regions that screening cannot be performed, ultrasonography can be discussed as an alternative diagnosis method in the cases where risk factors were determined.

PDF

___

Wientroub S, Grill F. Current concepts review: Ultrasonogra- phy in developmental dysplasia of the hip. Journal of Bone and Joint Surgery 2000; 82: 1004-18.
Hennrikus WL. Developmental dysplasia of the hip: Diagnosis and treatment in children younger than 6 months. Pediatr Ann 1999; 28: 740-6.
Ertürk C. Short-term results of Pemberton pericapsular osteot- omy for the treatment of developmental dysplasia of the hip. Eklem Hastalik Cerrahisi 2008; 19: 13-7.
Söyüncü Y, Özenci AM, Ürgüden M, Akyıldız F, Gür S. One- stage operatıve treatment of congenıtal dysplasıa of the hıp ın chıldren of walkıng age. Eklem Hastalık Cerrahisi 2004; 15: 200-6.
Özçelik A, Akçar N, Inan U, Ömeroglu H. Assessment of the use of hip ultrasonography by Graf's method between 1 and 6 years of age. J Pediatr Orthop B 2005; 14: 97-100.
Harcke HT. Imaging Methods Used for Children with Hip Dysplasia. Clin Orthop Relat Res 2005; 434: 71-7.
Smergel E, Losik S, Rosenberg HK. Sonography of Hip Dysplasia. Ultrasound Q 2004; 20: 201-16.
Teanby DN, Paton RW. Ultrasound Screening for Congenital Dislocation of the Hip: A Limited Targeted Programme. J Pediatr Orthop 1997; 17: 202-4.
Graf R. The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg 1980; 97: 117-33.
Lauen J, Hofem R. Pediatricsonography. Orthopade 2006; 35: 596, 598-9.
Eidelman M, Katzman A, Freiman S, Peled E, Bialik V. Treatment of true developmental dysplasia of the hip using Pavlik's method. J Pediatr Orthop B 2003; 12: 253-8.
Smergel E, Losik S, Rosenberg HK. Sonography of hip dys- plasia. Ultrasound Q 2004; 20: 201-6.
Azzoni R, Cabitza P. Ultrasound monitoring of the orthopae- dic treatment of congenital hip dysplasia carried out within the first 6 months of life. Minerva Pediatr 2003; 55: 143-8.
Doğruel H, Atalar H, Yavuz OY, Uraş İ, Günay C, Şaylı U. An evaluation of developmental hip dysplasia frequency and screening programs in Turkey: review. Turkiye Klinikleri J Med Sci 2008; 28: 357-60.
Wirth T, Stratmann L, Hinrichs F. Evolution of Iate presenting developmental dysplasia of the hip and associated surgical procedures after 14 years of neonatal ultrasound screening J Bone Joint Surg Br 2004; 86: 585-9.
Krolo I, Viskovic K, Kozic S, et al. The advancement in the early diagnostics of developmental hip dysplasia in infants-- the role of ultrasound screening. Coll Antropol 2003; 27: 627- 34.
Minagava Y, Sekiya M, Tsurumaki M, Kazama K, Sekikawa T, Iga T, Tasai DY. Ultrasonographic study of the hip joint in infants. Nippon Hoshasen Gijutsu Gakkai Zasshi 2005; 61: 868-73.
Pashapour N, Golmahammadlou S. Study on the diagnosis time of developmental dysplasia of the hip. East Mediterr Health J 2007; 13: 465-9.
Treiber M, Tomazic T, Tekauc-Golob A, et al. Ultrasound screening for devolopmental dysplasia of the hip in the new- born: a population-based study in the Maribor region, 1997- 2005. Wien KlinWochenschr 2008; 120: 31-6.
Lowry CA, Donoghue VB, Murphy JF. Auditing hip ultrasounda screening of infants at increased risk of developmental dysplasia of the hip. Arch Dis Child 2005; 90: 579-81.
Partenheimer A, Scheler-Hofmann M, Lange J, et al. Correlation betweeb sex, intrauterine position and familial predisposition and neonatal hip ultrasound results. Ultraschall Med 2006; 27: 364-7.
Mincan A, Yıldız A, Ayan İ, Öztuna V, Kuyurtar F. The importance of ultrasonographic examination in the dianosis of developmental hip dysplasia: a preliminary study of 95 new- borns. Turkiye Klinikleri J Med Sci 2004; 24: 12-6.
Uslu HS, Karatekin G, Uslu A, Kadıoğlu A, Nuhoğlu A. Evaluation of risk factors for developmental dysplasia of the hip in neonatal period. T Klinikleri J Pediatr 2002; 11: 139-43.
Songür M, Akel İ, Karahan S, Kuzgun Ü, Tümer Y. Türkiye’de 6 ay-14 yaş arası çocuklarda karşılaşılan tedavi edilmemiş kalça çıkığı sıklığı. Acta Orthop Traumatol Turc 2011; 45: 215-20.
Holen KJ, Tegnander A, Bredıand T, Johansen OJ. Universal or selective screening of the neonatal hip using ultrasound? J Bone Joint Surg Br 2002; 84: 886-90.
Timmler T, Wierrusz-Kozlowska M, Markuszewski J, Wozni- ak W. The hip joints preterm neonates in sonographic evaluation. Chir Narzadow Ruchu Ortop Pol 2005; 70: 301-5.
Sionek A, Czubak J, Kornacka M, Grabowski B. Evaluation of risk factors in developmental dysplasia of the hip in children from multiple pregnancies: results of hip ultrasonography using Graf’s method. Ortop Traumatol Rehabil 2008; 10: 115- 30.
Czubak J, Mazela JL, Majda W, Wozniak W. Is twin pregnan- cy a risk factor for devolopmental dysplasia of the hip – retro- spective analysis using ultrasonography. Ortop Traumatol Re- habil 2003; 5: 712-6.
Gray A, Elbourne D, Dezateux C, King A, Quinn A, Gardner F. Econumic evaluation of ultrasonography in the diagnosis and management of developmental hip dysplasia in the United Kingdom and Ireland. J Bone Joint Surg Am 2005; 87: 2472- 9.