GELİŞİMSEL KALÇA DİSPLAZİSİ HASTALARINDA TANI VE TEDAVİDE GECİKME NEDENLERİNIİN ARAŞTIRILMASI: TEK MERKEZLİ ÇALIŞMA An Investigation of the Causes of Delay in the Diagnosis and Treatment of Patients with Developmental Hip Dysplasia: A Single-Centre Study
Abstract
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.
Gereç ve 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. Doktorların ve ailelerin
bilgilendirilmesi için çalışmaların artırılması önem arz etmektedir.
Anahtar kelimeler: Gelişimsel kalça displazisi; tedavi gecikmesi, tanı gecikmesi, kundaklama, çoklu ara bezi
kullanımı, kalça ultrasonografisi.
ABSTRACT
Aim: 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 and 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. It is important to increase the studies to inform physicians and families.
Keywords: Delayed diagnosis; delayed treatment; developmental hip dysplasia; hip ultrasonography;
multiple diaper use; swaddling.
References
- 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 Orak, Tolga Onay. Ultrasonographic evaluation in developmental dysplasia of the hip. TOTBİD Dergisi 2014; 13:381–9. 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;22:185–8. 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):61-9. 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: 290-4. 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.
Abstract
References
- 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 Orak, Tolga Onay. Ultrasonographic evaluation in developmental dysplasia of the hip. TOTBİD Dergisi 2014; 13:381–9. 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;22:185–8. 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):61-9. 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: 290-4. 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.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Publication Date | June 8, 2020 |
| Published in Issue | Year 2020 Volume: 10 Issue: 2 |