臨床整形外科48巻12号

2013年12月発行

連載 特別講義　整形外科の歴史・8【最終回】

「先天性」股関節脱臼の治療史―CDHからDDHへ

著者： 小野啓郎¹

所属機関： ¹大阪大学

ページ範囲：P.1220 - P.1227

新生児～乳幼児の股関節検診と啓発活動が拓いた世界

■新生児検診は意味があるのか？

　新生児検診が普及するにつれ，その功罪を問う議論も高まった．脱臼誘発テストの信頼度，補助診断法としてのX線診断の不確かさと放射線被曝の問題，加えて新生児における脱臼の治療と大腿骨頭の阻血性壊死の結びつき(因果関係)が無視できなくなったからだ．

　欧米で新生児の股関節検診を担当するのは小児科医や家庭医も多いから，スクリーニングをすべきか否か，股関節の異常を発見した新生児に，直ちに厳格な外転装具を装着すべきか否か，ためらう医師が少なくなかった．数日間の観察期間を置く，緩やかな外転装具で様子をみる……多くが3カ月検診，6～7カ月目のX線撮影という安全策に逃れた．

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