Ali BİLGE, Gökhan Ragıp ULUSOY, Bilgehan ÇATAL, Sefer ÜSTEBAY, Döndü ÜSTEBAY

Kars’da Gelişimsel Kalça Displazi Tarama Sonuçları ve Ortalama Maliyet Analizi

Giriş ve Amaç: Gelişimsel kalça displazisi (GKD) 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 ve bölgesel bazda hastaneye başvuran ve başvurmayan bebeklerin insidansı değerlendirildi. Bu değerlendirme sonuçları ile amacımız GKD insidansını belirlemek ve tedavi edilen ve edilemeyen hastaların tedavi masraflarının ortalama maliyet analizini yapmaktı. Metod: Çalışmamıza Haziran 2012 ve Haziran 2015 tarihleri arasında Kafkas Üniversitesi ve Kars Harakani Devlet Hastanesine başvuran 4 haftalıktan büyük 6 aylıktan küçük ultrasonografi yapılmış 2554 bebek alındı. Bu tarihler arasında medikal ve cerrahi tedavi almış hastalar listelendi. Bulgular: Haziran 2012 ve Haziran 2015 tarihleri arasında Kars bölgesinde 13910 yaşayan bebek mevcut idi. Ultrasonografi yapılan bebek sayısı 2554 idi. USG sonuçlarına göre 5108 kalça Graf sınıflamasına göre değerlendirildiğinde 4586 ( %89.8) kalça tip I, 347 ( % 6.8) kalça tip IIa, 130 ( % 2.6) kalça tip IIb, 26 ( % 0.5 ) kalça tip IIc, 8( % 0.2 ) kalça tip D ve 11( % 0.2 ) kalça tip III-IV olarak tespit edildi. Maliyet analizinde rutin taramanın ortlama iki kat daha fazla karlı oluğu görüldü. Sonuç: Kars bölgesinde yaşayan bebek oranı ve hastaneye başvuran ve USG yapılan bebek oranları ve sonuçlarına bakılınca gelişimsel kalça displazisinin gözden kaçırılmaması ve tedavi başarısının artırılmasında kalça USG’sinin önemli olduğu saptanmıştır. Bölgesel sonuçlarımız ile ülkemizde USG ile rutin tarama yapılması önerilebilir

Anahtar Kelimeler:

Gelişimsel kalça displazisi, Kalça ultrasonografisi, Graf sınıflaması

Results of Developmental Hip Dysplasia and Average Cost Analysis in Kars

Aim: Developmental hip dysplasia (DHD) is an anomaly that is frequently seen in our country and if diagnosed and cured earlysuccessful results can be gained. In our study the diagnose of developmental hip can facts by applying hip ultrasound (USG) in infanthood, supplying early treatment and the incidence of babies who have and haven’t applicated hospital in regional base are evaluated. With these results we aim to define DHD incidence and analyse the average cost of patients who have and haven’t been treated.Material and Method: 2554 infants more than 4 months and less than 6 months old who applicant Kafkas University and KarsHarakani State Hospital on the date from June 2012 to June 2015 have been taken to our study. Patients who had medical and surgical treatment have been listed on these days.Results: 13910 babies were living in Kars region in between June 2012 and June 2015. The number of babies that have been applied ultrasound was 2554. According to USG results when 5108 hips were evaluated according to Graf classification it was determined that 4586 (89.8%) hip type 1, 347 (6.8%) hips type 2a, 130 (%2.6) hips type 2b, 26 (0.5%) hips 2c, 8 (0.2%) hips type D and 11 (0.2%) hips type 3–4. In the average cost it was seen that routine scan is two times more profitable when the following patients and treatment of babies are considered, the efficacy, success and advantage of USG on the diagnosis of DHD is resulted.Conclusion: When examined, the ratio of infants who lives in Kars region and applicate the hospital, the ratio of babies who havebeen applied USG and their results, it is stated that hip US is important in not skipping DHD and increasing the success of treatment. With our regional results, routine seen with USG can be suggested in our country.

Keywords:

Developmental hip dysplasia, Hip ultrasound,

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1. Committee on Quality Improvement, American Academy of Pediatrics Clinical practice guidelines: early detection of developmental dysplasia of the hip. Pediatrics 2000;105:896905.
2. Mahan ST, Kasser JR. Does swaddling influence developmental dysplasia of the hip? Pediatrics 2008;121:177–8.
3. 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.
4. Harcke HT, Clarke NM, Lee MS, Borns PF, MacEwen GD. Examination of the infant hip With real-timeultrasonography. J Ultrasound Med 1984;3:131–137.
5. Morin C, Harcke HT, MacEwen GD. The infant hip: realtime US assessment of acetabular development. Radiology 1985;157:673–677.
6. Tachdjian MO. Pediatric orthopedics 2nd ed. Philadelphia: W. B. Saunders 1990:214–215.
7. Graf R. Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg 1984;102:248–255.
8. Tunacı A, Yekeler E. Pediatrik Ultrason, 1. Baskı, 1997;302.
9. Uçar DH, Işıklar ZU, Kandemir U, Tümer Y. Treatment of the developmental dysplasia of the hip with Pavlik harness: Prospective study in Graf Type Iıc or more severe hips. J Pediatr Orthop B 2004;13:70–74.
10. Schilt M.: Hip sonography for newborn screening. Schweiz Rundsch Med Prax 2004 Apr 7;93(15):591.
11. [No authors listed]. Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. American Academy of Pediatrics. Pediatrics 2000;105:896–905.
12. Bialik V, Bialik GM, Blazer S, Sujov P, Wiener F, Berant M. Developmental dysplasia of the hip: a new approach to incidence. Pediatrics 1999;103:93–99.
13. 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.
14. Clarke NMP. Congenital dislocation of the hip. Current Orthopaedics 2004;18:256–261.
15. Kutlu A, Memik R, Mutlu M, Kutlu R, Arslan A. Congenital dislocation of the hip and its relation to swaddling in Turkey. J Pediatr Orthop 1992;12:598–602.
16. Dogruel H, Atalar H, Yavuz OY, Uraş İ, Günay C, Şaylı U.: An evaluation of developmental hip dysplasia fequency an screening programs in Turkey: review. Türkiye Klinikleri J Med Sci 2008, 28:357–360.
17. Çuhacı ÇB, Çakır HT, Kibar AE, Arhan E, Cansu A, Yakut Hİ.:300 bebeğin gelişimsel kalça displazisi açısından ultrasonografi ile taranması.
18. Dogruel H, Atalar H, Yavuz OY, Saylı U.: Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 2007 Mar 1.
19. Nimityongskul P, Hudgens RA, Andersob LD, Melhem RE, Green AE Jr, Saleeb SF. Ultrasonography in the management of developmental dysplasia of the hip (DDH). J Pediatr: Orthop 1995: Nov-Dec; 15(6):741–6.
20. Wirth T, Stratmann L, Hinrichs F.: Evolution of late presenting developmental dysplasia of the hip and associated surgical procedures after 14 years of neonatal ulstrasound screening Journal of Bone and Joint Surgery; May 2004;86, 4;Health&Medical Complete pg 585.
21. Graf R.: The use of ultrasonography in developmental dysplasia of the hip. Acta Orthop Traumatol Turc 2007;41 Suppl 1:6–13.
22. Ihme N, Altenhofen L, von Kries R, Niethard FU.: Hip ultrasound screening in Germany. Results an comparison with other screening procedures. Orthopade 2008 Jun; 37(6):541–6,548–9.
23. Treiber M, Tomazic T, Tekauc-Golob A, Zolger J, Korpar B, Buria S, takac I, Sikosek A.: Ultrasound screening for developmental dysplasia of the hip in the newborn: a population-base study in the Maribor region, 1997–2005. Wien Klin Wochenschr 2008;120(1–2):31–6.
24. Von Kries R, Ihme N, Oberie D, Lorani A, Stark R, Altenhofen L, Niethard FU.: Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany. Lancet 2003 Dec 6;362(9399):1883–7.
25. 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 Nov; 87(11):2472–9.
26. Brown J, Dezatuex C, Karnon J, Parnaby A, Arthur R.: Efficiency of alternative polcy options for screening for developmental dysplasia of the hip in the United Kingdom. Arch Dis Child 2003 Sep; 88(9):760–6.
27. Schilt M.: Hip sonography for newborn screening. Schweiz Rundsch Med Prax 2004 Apr 7;93(15):597–614.
28. Lauen J, Hofem R.: Pediatric sonography. Orthopade 2006 Jun; 35(6):596, 598–9.
29. Azzoni R, Cabitza P. Ultrasound monitoring of the orthopaedic treament of congenital hip dysplasia carried out within the first 6 month of life. Minerva Pediatr 2003;Apr; 55(2):143–8.