本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.2404

摘要内容如下：

重要性

婴儿髋关节脱位的延迟诊断可能导致复杂的儿童期手术、家庭生活中断和过早骨关节炎。

目的

评估临床检查对婴儿髋关节脱位的诊断准确性。

数据源

系统检索CINAHL、EMBASE、MEDLINE和Cochrane图书馆，从每个数据库开始到2023年10月31日。

研究选择

纳入的9项研究报告了3个月或更小婴儿的临床检查（指数测试）和诊断性髋关节超声（参考测试）的诊断准确性。超声评估的Graf方法用于对髋关节异常进行分类。

数据提取与合成

合理临床检查量表用于分配证据等级，诊断准确性研究质量评估工具用于评估偏倚。使用单个髋关节作为分析单位提取数据；当3项或更多纳入研究对临床检查进行评估时，将数据合并。

主要成果和措施

计算识别髋关节脱位的敏感度、特异度和似然比（LR）。

结果

在5项临床检查和超声诊断筛查的婴儿中，髋关节脱位（n=37859髋）的发生率为0.94%（95%CI，0.28%-2.0%）。有8项研究（n=44827髋）评估了Barlow手法和Ortolani手法（脱位和重新定位不稳定的髋关节）的使用；手法的敏感性为46%（95%CI，26%-67%），特异性为99.1%（95%CI，97.9%-99.6%），阳性似然比为52（95%CI，21-127），阴性似然比为0.55（95%CI，0.37-0.82）。有3项研究（n=22472髋）评估了髋关节外展受限，其敏感性为13%（95%CI，3.3%-37%），特异性为97%（95%CI，87%-99%），阳性LR为3.6（95%CI，0.72-18），阴性LR为0.91（95%CI，0.76-1.1）。一项研究（n=13096髋）评估了滴答声，其敏感性为13%（95%CI，6.4%-21%），特异性为92%（95%CI，92%-93%），阳性LR为1.6（95%CI，0.91-2.8），阴性LR为0.95（95%CI，0.88-1.0）。

结论和相关性

在对所有婴儿髋关节进行发育性髋关节发育不良筛查的研究中，髋关节脱位的发生率为0.94%。Barlow和Ortolani手法的阳性LR是与髋关节脱位可能性增加最相关的发现。髋关节外展受限或咔哒声没有明确的诊断效用。

英文原文如下：

Abstracts

Importance  Delayed diagnosis of a dislocated hip in infants can lead to complex childhood surgery, interruption to family life, and premature osteoarthritis.

Objective  To evaluate the diagnostic accuracy of clinical examination in identifying dislocated hips in infants.

Data Sources  Systematic search of CINAHL, Embase, MEDLINE, and the Cochrane Library from the inception of each database until October 31, 2023.

Study Selection  The 9 included studies reported the diagnostic accuracy of the clinical examination (index test) in infants aged 3 months or younger and a diagnostic hip ultrasound (reference test). The Graf method of ultrasound assessment was used to classify hip abnormalities.

Data Extraction and Synthesis  The Rational Clinical Examination scale was used to assign levels of evidence and the Quality Assessment of Diagnostic Accuracy Studies tool was used to assess bias. Data were extracted using the individual hip as the unit of analysis; the data were pooled when the clinical examinations were evaluated by 3 or more of the included studies.

Main Outcomes and Measures  Sensitivity, specificity, and likelihood ratios (LRs) of identifying a dislocated hip were calculated.

Results  Among infants screened with a clinical examination and a diagnostic ultrasound in 5 studies, the prevalence of a dislocated hip (n = 37 859 hips) was 0.94% (95% CI, 0.28%-2.0%). There were 8 studies (n = 44 827 hips) that evaluated use of the Barlow maneuver and the Ortolani maneuver (dislocate and relocate an unstable hip); the maneuvers had a sensitivity of 46% (95% CI, 26%-67%), a specificity of 99.1% (95% CI, 97.9%-99.6%), a positive LR of 52 (95% CI, 21-127), and a negative LR of 0.55 (95% CI, 0.37-0.82). There were 3 studies (n = 22 472 hips) that evaluated limited hip abduction and had a sensitivity of 13% (95% CI, 3.3%-37%), a specificity of 97% (95% CI, 87%-99%), a positive LR of 3.6 (95% CI, 0.72-18), and a negative LR of 0.91 (95% CI, 0.76-1.1). One study (n = 13 096 hips) evaluated a clicking sound and had a sensitivity of 13% (95% CI, 6.4%-21%), a specificity of 92% (95% CI, 92%-93%), a positive LR of 1.6 (95% CI, 0.91-2.8), and a negative LR of 0.95 (95% CI, 0.88-1.0).

Conclusions and Relevance  In studies in which all infant hips were screened for developmental dysplasia of the hip, the prevalence of a dislocated hip was 0.94%. A positive LR for the Barlow and Ortolani maneuvers was the finding most associated with an increased likelihood of a dislocated hip. Limited hip abduction or a clicking sound had no clear diagnostic utility.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。