Incidence and Treatment of Developmental Hip Dysplasia in Mongolia: A Prospective Cohort Study

BackgroundIn Mongolia, adequate early diagnosis and treatment of developmental hip dysplasia (DDH) have been unavailable and its incidence was unknown. We determined the incidence of ultrasonographic DDH in newborns and established adequate procedures for diagnosis and treatment of DDH at the largest maternity hospital in Ulaanbaatar, Mongolia. Methodology/Principal FindingsDuring one year (Sept 2010 – Aug 2011) we assessed the hips newborns using ultrasound and Graf’s classification of DDH. 8,356 newborns were screened; median age at screening was 1 day. We identified 14,873 Type 1 (89.0%), 1715 Type 2a (10.3%), 36 Type 2c (0.2%), 70 Type D (0.4%), 14 Type 3 (0.08%), and 4 Type 4 hips (0.02%). Children with Type 1 hips (normal) were discharged. Children with Type 2a hips (physiologically immature) received follow-up ultrasounds at monthly intervals. Children with Type 2c to 4 (DDH; deformed or misaligned hip joint) hips were treated with a Tubingen hip flexion splint and also followed up. The hip abnormalities resolved to mature hips in all children who were followed up. There was no evidence for severe treatment related complications. Conclusion/SignificanceThis study suggests that the incidence of DDH in Mongolian neonates is comparable to that in neonates in Europe. Early ultrasound-based assessment and splinting treatment of DDH led to mature hips in all children followed up. Procedures are feasible and will be continued.

背景 在蒙古国，发育性髋关节发育不良（developmental hip dysplasia, DDH）的规范化早期诊断与治疗长期缺位，其发病率亦尚未明确。本研究旨在明确新生儿超声筛查检出的DDH发病率，并在蒙古国乌兰巴托最大的妇产医院建立标准化的DDH诊疗流程。方法与主要结果 本研究于2010年9月至2011年8月的12个月周期内，采用超声检查结合Graf髋关节分型标准对新生儿髋关节进行评估。共计筛查8356名新生儿，筛查中位年龄为1日龄。最终共检出14873例1型髋关节（占89.0%）、1715例2a型髋关节（占10.3%）、36例2c型髋关节（占0.2%）、70例D型髋关节（占0.4%）、14例3型髋关节（占0.08%）以及4例4型髋关节（占0.02%）。其中，分型为1型（正常髋关节）的新生儿直接出院；分型为2a型（生理性发育不成熟）的新生儿需接受每月1次的超声随访；分型为2c型至4型的患儿（即DDH，表现为髋关节畸形或对位不良），则采用图宾根髋关节屈曲支具进行治疗并定期随访。所有接受随访的患儿髋关节异常均恢复为成熟髋关节，且未出现与治疗相关的严重并发症。结论与意义 本研究显示，蒙古国新生儿DDH的发病率与欧洲新生儿群体相当。早期基于超声的髋关节评估与DDH支具治疗，可使所有随访患儿的髋关节发育成熟。该诊疗流程具备临床可行性，后续将持续推行。