Aggiornamento monografico
La displasia evolutiva dell’anca
DEVELOPMENTAL DYSPLASIA OF THE HIP
GIUSEPPE ATTI, PATRIZIA FARINA, PIERFIORENZO VARNI1
Centro “Marino Ortolani” per la diagnosi e la terapia precoce della LCA, Divisione Pediatrica, Arcispedale S. Anna, Ferrara
1Divisione Pediatrica, Ospedale di Sassuolo
Settembre 1998 - pagg. 431 -438
Abstract
Developmental dysplasia of the hip (DDH)
describes a wide range of hip abnormalities,
from a shallow acetabulum to a dislocated
hip. The abnormality can be present
at birth but also occur at later stages.
Without therapy, patients with completely
dislocated hips develop gait disturbance
and those with subluxation develop degenerative
joint disease. Early diagnosis and
treatment of DDH ensure the best chances
of achieving successful results. Clinical and
ultrasound examination (but not X rays) are
helpful for early diagnosis of DDH. Treatment
is required for patients with clinical
dislocated or dislocating hips and for those
with hip ultrasound abnormalities type C,
D, 3 and 4, according to Graf criteria. Therapy
of DDH consists of three steps: reduction,
immobilization and anatomic recovery.
Abduction devices as pillows, Milgram
and Pavlik harness and casts are
used for DDH therapy.
Late diagnoses are reduced by DDH screening.
When late diagnoses are more than
0.4% of newborns and patients require hospitalization
for treatment, general ultrasound
screening can be cost-effective.
Classificazione MeSH
Bibliografia
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6. Tonnis D, Storch K, Ulbrich H: Results of newborn screening for CDH with and without sonography and correlation of risk factors. J Pediatr Orthop 10, 145-152, 1990.
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8. Gardiner HM, Dunn PM: Controlled trial of immediate splinting versus ultrasonographic surveillance in congenitally dislocatable hips. Lancet 336, 1553-1556, 1990.
9. Graf R, Wilson B: Sonography of the infant hip and its therapeutic implications. Chapman & Hall, Weinheim, 1995.
10. Hensinger RN: Congenital dislocation of the hip: treatment in infants to walking age. Orthop Clin North Am 18, 597-602, 1987.
11. Ortolani M: Un segno poco noto e sua importanza per la diagnosi precoce di prelussazione congenita dell’anca. La Pediatria 2, 129- 136, 1937.
12. Harcke HT, Clarke NMP, Lee MS, Borns PF, McEwen GD: Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 3, 131-137, 1984.
13. Atti G, D’Eramo C, Baronciani D, Biasini A, Bonfiglioli G, Zucchini A, Vasina A, Baruzzi M, Vullo C: Diagnosi di lussazione congenita dell’anca: confronto fra esame clinico ed indagine ecografica. Riv Ital Pediatr 18, 612-18, 1992.
14. Baronciani D, Atti G, Andiloro F, Bartesaghi A, Gagliardi L, Passamonti C, Petrone M, and Collaborative Group: Screening for developmental dysplasia of the hip: from theory to practice. Pediatrics 99(2), 247, 1997.
15. Hansson G, Nachemson A, Palmen K: Screening of children with congenital dislocation of the hip joint on the maternity wards in Sweden. J Ped Orthop 3, 271-279, 1983.
16. Clarke NMP, Clegg J, Al-Chalabi AN: Ultrasound screening of hips at risk for CDH. J Bone Joint Surg 71-B, 9-12, 1989.
17. Walter RS, Donaldson JS, Davies CL, Shkolnik A, Binns HJ, Carrol NC, Brouillette RT: Ultrasound screening of high-risk infants. AJDC 146, 230-234, 1992.
18. Rosendahl K, Markestad T, Lie RT, Sudmann E, Geitung JT: Cost-effectiveness of alternative screening strategies for developmental dysplasia of the hip. Arch Pediatr Adolesc Med 149, 643-648, 1995.
2. Aronsson DD, Goldberg MJ, Kling TF Jr, Roy DR: Developmental dysplasia of the hip. Pediatrics 94, 201-208, 1994.
3. Mac Kenzie IG, Wilson JG: Problems encountered in the early diagnosis and management of congenital dislocation of the hip. J Bone Joint Surg 63, 38-42, 1981.
4. Standing Medical Advisory Committee and the Standing Nursing and Midwifery Advisory Committee. Screening for the detection of congenital dislocation of the hip. Arch Dis Child 61, 921-926, 1986.
5. Dunn PM, Evans RE, Thearle MJ, Griffiths HED, Whiterow PJ: Congenital dislocation of the hip: early and late diagnosis and management compared. Arch Dis Child 60, 407-414, 1985.
6. Tonnis D, Storch K, Ulbrich H: Results of newborn screening for CDH with and without sonography and correlation of risk factors. J Pediatr Orthop 10, 145-152, 1990.
7. Barlow TG: Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg 44-B, 292-301, 1962.
8. Gardiner HM, Dunn PM: Controlled trial of immediate splinting versus ultrasonographic surveillance in congenitally dislocatable hips. Lancet 336, 1553-1556, 1990.
9. Graf R, Wilson B: Sonography of the infant hip and its therapeutic implications. Chapman & Hall, Weinheim, 1995.
10. Hensinger RN: Congenital dislocation of the hip: treatment in infants to walking age. Orthop Clin North Am 18, 597-602, 1987.
11. Ortolani M: Un segno poco noto e sua importanza per la diagnosi precoce di prelussazione congenita dell’anca. La Pediatria 2, 129- 136, 1937.
12. Harcke HT, Clarke NMP, Lee MS, Borns PF, McEwen GD: Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 3, 131-137, 1984.
13. Atti G, D’Eramo C, Baronciani D, Biasini A, Bonfiglioli G, Zucchini A, Vasina A, Baruzzi M, Vullo C: Diagnosi di lussazione congenita dell’anca: confronto fra esame clinico ed indagine ecografica. Riv Ital Pediatr 18, 612-18, 1992.
14. Baronciani D, Atti G, Andiloro F, Bartesaghi A, Gagliardi L, Passamonti C, Petrone M, and Collaborative Group: Screening for developmental dysplasia of the hip: from theory to practice. Pediatrics 99(2), 247, 1997.
15. Hansson G, Nachemson A, Palmen K: Screening of children with congenital dislocation of the hip joint on the maternity wards in Sweden. J Ped Orthop 3, 271-279, 1983.
16. Clarke NMP, Clegg J, Al-Chalabi AN: Ultrasound screening of hips at risk for CDH. J Bone Joint Surg 71-B, 9-12, 1989.
17. Walter RS, Donaldson JS, Davies CL, Shkolnik A, Binns HJ, Carrol NC, Brouillette RT: Ultrasound screening of high-risk infants. AJDC 146, 230-234, 1992.
18. Rosendahl K, Markestad T, Lie RT, Sudmann E, Geitung JT: Cost-effectiveness of alternative screening strategies for developmental dysplasia of the hip. Arch Pediatr Adolesc Med 149, 643-648, 1995.