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

OZET Amac: Gelisimsel kalca displazisi (GKD) onemli bir halk sagligi problemidir. Tani ve tedavide gecikme artmis tedavi maliyeti ve sakatliga yol acabilmektedir. Bu baglamda calismamizin amaci klinigimize basvuran GKD’li hastalarda tani ve tedavide gecikme nedenlerinin sunulmasidir. Gerec ve Yontem: Ocak 2017 - Ocak 2020 yillari arasinda 3-12 aylik arasindaki klinigimize basvuran ve GKD tanisi konan 44 hasta calismaya alindi. Hastalarin yas, cinsiyet, kacinci dogum oldugu, aile oykusu, kundaklama oykusu, tanida gecikme sebep ve sureleri, uygulanan eski tedavi sekilleri ile sosyodemografik ozellikleri retrospektif olarak toplanarak analiz edildi. Bulgular: Calismaya alinan 44 hastanin 4 (%9,1) u erkek, 40 (%90,9) i kiz cocuktu. Ortalama yas 5,44 ay (mean 3,5-12) idi. 19 hasta (%43,2) ailelerin birinci cocuklari idi. 11 hasta da (%25) pozitif aile oykusu, 22 (%50) hasta anamnezinde kundaklama uygulamasi vardi. Calismadaki GKD’li hastalardan; 6 hastanin (%13,6) normal raporlanmis kalca USG nedeniyle, 8 hasta (%18,2) sosyal nedenlerle ihmal, 2 hasta (%4,5) yeterli bilgilendirilmeme, 28 hasta (%63,6) coklu ara bezi tedavisi nedenleri ile gec basvuru yaptiklari tespit edildi. Hastalarda ortalama 2,34 ay (aralik: 0,5-9) dogru tani ve tedaviye ulasmada gecikme tespit edildi. Gecikme sureleri ile gecikme nedenleri arasinda istatiksel olarak anlamli bir farklilik bulunmazken, (p=0,538), gecikme suresi ile yapilan tedavi sekli arasinda anlamli bir farklilik tespit edildi (p=0,006). Sonuc: GKD gecikmis tani ve tedavinin en onemli ayagini yanlis kalca usg degerlendirmesi ve kalca usg sonucununda uygun tedavi protokolunun izlenmemesi olusturmakta idi. 3 aydan buyuk GKD’li cocuklarda Coklu ara bezi kullaniminin devam ettirilmesi tedavi yaklasimini olumsuz etkilemektedir. Doktorlarin ve ailelerin bilgilendirilmesi icin calismalarin artirilmasi onem arz etmektedir. Anahtar kelimeler: Gelisimsel kalca displazisi; tedavi gecikmesi, tani gecikmesi, kundaklama, coklu ara bezi kullanimi, kalca 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.