JAMA子刊:“髋关节发育不良”新生儿的发病率与筛查策略有关,有必要用超声筛查吗?

2022-08-20 liangying MedSci原创

普遍筛查可能会导致初始过度治疗,而不会降低后期发现和手术治疗的比率。

发育性髋关节发育不良(DDH)包括以下新生儿髋关节发现:“clicky”髋关节、临床不稳定、临床可逆和不可逆脱位、不成熟的超声表现以及动态超声检查的潜在脱位。自1980年Graf引入髋关节超声分类以来,超声在诊断和筛查中的作用有所增加。尽管在随机临床试验中,通用超声筛查DDH在降低晚期发现病例(年龄≥12周)率方面缺乏益处,但它已越来越受欢迎。

本研究的目的是报告英文科学文献中报道的DDH发病率,并比较不同DDH筛查策略下的迟发病例率。

研究者搜索了PubMed、Scopus和Web of Science数据库。搜索中未使用时间过滤器。纳入所有报道早期发现或晚期发现(年龄≥12周)DDH的观察性研究,提取筛查的新生儿数量和检出率,荟萃分析使用随机或固定效应模型计算了每1000名新生儿DDH的合并发病率(95%CI)。本研究根据PRISMA和MOOSE指南进行报告。

共确定了1899项研究,评估了203篇全文,其中16项共901079名婴儿纳入最终分析。临床筛查的早期检出率为每1000名新生儿中8.4名患有DDH,选择性超声筛查的早期发现率为每千名新生儿中4.4名患DDH,通用超声筛查的新生儿中23.0名患DDH。非手术治疗的比率为临床筛查的每1000名新生儿5.5次治疗,选择性超声筛查的每千名新生儿3.1次治疗,以及通用超声筛查的9.8次治疗。

通过筛选策略分层的个体研究中髋关节发育不良手术治疗的发生率

在临床筛查中,迟发性DDH的发生率为每1000名新生儿中有0.5名新生儿患有DDH,在选择性超声筛查中每1000名婴儿中有0.6名婴儿患有DDH;在通用超声筛查中,每千名新生儿中0.2名婴儿患有DDH手术治疗的相应发生率为临床筛查每1000名新生儿0.2次手术,选择性超声筛查每1000例新生儿0.5次手术,通用超声筛查每千名新生儿0.4次手术。

这项荟萃分析发现,普遍筛查的早期发现率和非手术治疗更高。普遍筛查的晚期发现率和手术治疗率与选择性和临床筛查的新生儿相似。基于这些结果,普遍筛查可能会导致初始过度治疗,而不会降低后期发现和手术治疗的比率。

参考文献:

Kuitunen I, Uimonen MM, Haapanen M, Sund R, Helenius I, Ponkilainen VT. Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening StrategyA Systematic Review and Meta-analysisJAMA Netw Open. 2022;5(8):e2227638. doi:10.1001/jamanetworkopen.2022.27638

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    2022-08-20 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0

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