Oportunidad diagnóstica de la displasia de la cadera en desarrollo: Diferencia entre el sistema de seguridad social en salud contributivo y los sistemas de medicina prepagada y particular en Bogotá
Palabras clave:
Luxación congénita de la cadera, Métodos de osteotomíaResumen
Introducción: El objetivo principal del estudio es determinar si existe diferencia en la oportunidad diagnóstica de la displasia de la cadera en desarrollo (DHD) entre pacientes pertenecientes al sistema general de seguridad social contributivo (SGSS-RC), los afiliados a empresas promotoras de salud (EPS) y los pacientes que acuden a consultorios privados con seguros de medicina prepagada, empresas y pacientes particulares (MPPP).
Materiales y métodos: Se realizó un estudio de corte transversal en pacientes que asisten a la consulta de ortopedia infantil y a quienes se les diagnostica por primera vez DHD en el Hospital Infantil Universitario de San José y en tres consultorios particulares de ortopedistas infantiles. Se evalúa y compara la prevalencia de diagnóstico oportuno teniendo en cuenta la edad del paciente al momento de la toma de la primera radiografía de caderas y la edad del diagnóstico ortopédico.
Resultados: Se halló una diferencia amplia y estadísticamente significativa entre los pacientes con EPS (88,7 % de diagnóstico tardío) y aquellos provenientes de los consultorios privados (35 % de diagnóstico tardío). El riesgo de diagnóstico tardío fue 14,6 veces mayor en los pacientes con EPS versus los pacientes de consultorio privado (OR de 14,6; IC 95 % de 5,3 a 40,5).
Discusión: Con base en la evidencia científica publicada puede considerarse que los pacientes de las EPS estarían más expuestos a tratamientos más riesgosos y costosos, así como a resultados menos satisfactorios y a un peor pronóstico
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1. Ponseti IV. Growth and development of the acetabulum in the normal child: anatomical, histological and roentgenographic studies. J Bone Joint Surg Am 1978; 60: 575.
2. Ortolani M. Congenital hip dysplasia in the light of early and very early diagnosis. Clin Orthop 1976; 119: 6.
3. Palmen K. Preluxation of the hip joint: diagnosis and treatment in the newborn and the diagnosis of congenital dislocation of the hip joint in Sweden during the years 1948-1960. Acta Paediatr Scand Suppl 1961; 129: 1.
4. Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg Br 1962; 44: 292.
5. MacNicol MF. Results of a 25-year screening programme for neonatal hip instability. J Bone Joint Surg Br 1990; 72: 1057.
6. Hadlow V. Neonatal screening for congenital dislocation of the hip: a prospective 21-year survey. J Bone Joint Surg Br 1988; 70: 740.
7. Hansson G, Nachemson A, Palmen K. Screening of children with congenital dislocation of the hip joint on the maternity wards in Sweden. J Pediatr Orthop 1983; 3: 271.
8. Kamath SU, Bennet GC. Re-dislocation following open reduction for developmental dysplasia of the hip. Int Orthop 2005; 29(3): 191-4.
9. Tonnis D. Normal values of the hip joint for the evaluation of x-rays in children and adults. Clin Orthop 1976; 119: 39-47.
10. Severin E. Contribution to the knowledge of congenital dislocation of the hip joint. Late results of closed reductions and arthrographic studies of recent cases. Act Cir Scandinavica 1941; 84: 63.
11. Ponseti I. Causes of failure in the treatment of congenital dislocation of the hip. J Bone Joint Surg 1944; 26: 795-802.
12. Arthrex Inc. TigthRope syndesmosis fixation. Arthrex Inc; 2008.
13. Arthrex Inc. Arthroscopic stabilization of acute acromioclavicular joint dislocation using the TightRope system. Arthrex Inc; 2009.
14. Hernegger GS, Kadletz R. TightRope: the revolutionary anatomical fixation in acromioclavicular joint dislocation. Tech Shoulder Elbow Surg 2006; 7(2): 86-8.
15. FiberWire™ collective summary of strength and biocompatibility testing data comparisons of polyester and polyblend sutures. Study presented from in-house testing, 2001; LA 0235.
16. Deakin M, Stubbs D, Goldberg J, Bruce W, Gillies RM, Walsh WR. Effect of suture type, anchor and testing orientation of the static properties of suture anchors. A Poster Presentation, #1536; 50th Annual Meeting of the Orthopaedic Research Society.
17. Wedge JH, Thomas SR, Salter RB. Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip. J Bone Joint Surg Am 2008; 90 Suppl 2 Pt 2: 238-53.
18. Lalonde FD, Frick SL, Wenger DR. Surgical correction of residual hip dysplasia in two pediatric age-groups. J Bone Joint Surg Am 2002; 84(7): 1148-56.
19. Crawford AH, Mehlman CT, Slovek RW. The fate of untreated developmental dislocation of the hip: long-term follow-up of eleven patients. J Pediatr Orthop 1999; 19: 641-4.
20. Cooperman DR, Wallensten R, Stulberg SD. Acetabular dysplasia in the adult. Clin Orthop 1983; 175: 79-85.
21. Thomas S, Wedge J, Salter R. Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip. J Bone Joint Surg Am 2007; 89(11): 2341-50.
22. Sankar WN, Young CR, Lin AG, Crow SA, Baldwin KD, Moseley CF. Risk factors for failure after open reduction for DDH: a matched cohort analysis. J Pediatr Orthop 2011; 31(3): 232-9.
23. Tabatabaei1 S, Dashtbozorg A, Shalamzari S. Redislocation following operations to reduce hip or treating dysplasia in developmental dysplasia of the hip. Pak J Med Sci 2010; 26(1): 171-5.
24. Macnicol MF, Bertol P. The salter innominate osteotomy; should it be combined with concurrent open reduction? J Pediatr Orthop B 2005; 14(6): 415-21.
25. Barrett WP, Staheli LT, Chew DE. The effectiveness of the salter innominate osteotomy in the treatment of congenital dislocation of the hip. J Bone Joint Surg 1986; 68-A: 79-87.
26. Chindambaram S, Abd Halim AR, Yeap JK, Ibrahim S. Revision surgery for developmental of the hip. Med J Malaysia 2005; 60 Suppl C: 91-8.
27. Gardner E, Gray D. Prenatal development of the human hip joint. Am J Anat 1950; 87: 163.
28. Walker JM. Histological study of the fetal development of the human acetabulum and labrum: significance in congenital hip disease. Yale J Biol Med 1981; 54: 255.
29. Portinaro NM, Murray DW, Benson MK. Microanatomy of the acetabular cavity and its relation to growth. J Bone Joint Surg Br 2001; 83(3): 377-83.
30. Harrison TJ. The growth of the pelvis in the rat: a mensoral and morphological study. J Anat 1958; 92: 236.
31. Berkeley ME, Dickson JH, Cain TE, Donovan MM. Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg 1984; 66-A: 412-20.
32. Malvitz TA, Weinstein SL. Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J Bone Joint Surg 1994; 76-A: 1777-92.
33. Wilkinson J, Carter C. Congenital dislocation of the hip. The results of conservative treatment. J. Bone Joint Surg 1960; 42-B(4): 669-88.
34. Wenger D, Miyanji F, Mahar A, Oka R. The mechanical properties of the ligamentum teres: a pilot study to assess its potential for improving stability in children's hip surgery. J Pediatr Orthop 2007; 27(4): 408-10.
35. Michaels G, Matles AL. The role of the ligamentum teres in congenital dislocation of the hip. Clin Orthop 1970; 71: 199-201.
36. Bache CE, Graham HK, Dickens DRV, Donnan L, Johnson MB, Nattrass G, et al. Ligamentum teres tenodesis in medial approach open reduction for developmental dislocation of the hip. J Pediatr Orthop 2008; 28(6): 607-13.
37. Dodds MK, Lee J, McCormack D. Transarticular stabilization of the immature femoral head: assessment of a novel surgical approach to the dislocating pediatric hip in a porcine model. J Pediatr Orthop 2008; 28(1): 36-44
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