儿童发育性髋关节发育不良发生危险因素及预测模型构建

Development risk factors and prediction model construction of children with developmental hip dysplasia

目的探讨儿童发育性髋关节发育不良(DDH)发生危险因素并构建相关预测模型,旨在为临床筛查防治工作提供更多信息。方法回顾性纳入2018年1月—2023年12月于延安大学附属医院诊治DDH患儿62例,并以1∶1匹配纳入同期体检健康儿童62例作为对照;对儿童DDH发生情况及其危险因素进行分析。结果纳入的62例DDH患儿中右侧30例,左侧32例;Graf分型Ⅱa(+)型、Ⅱa(-)型、Ⅱb型、Ⅱc型、D型、Ⅲ型及Ⅳ型分别为15例、22例、7例、6例、5例、6例、1例。单因素分析结果显示,性别、分娩胎位、是否早产儿、有无包被绑腿习惯及家族遗传史均可能与儿童DDH发生有关(P<0.05)。Logistic多因素分析结果证实,女性、臀位分娩、非早产儿、有包被绑腿习惯及家族遗传史均是儿童DDH发生的独立危险因素(P<0.05)。利用回归模型的独立影响因素以及P值预测概率对儿童DDH发生风险进行预测,约登指数分别为37.50%、14.83%、81.42%、25.00%、8.69%、82.42%。结论女性、臀位分娩、非早产儿、存在包被绑腿习惯及家族遗传史的儿童更易出现DDH;利用以上5个因素构建的数据模型对于患者的死亡预测显示出良好的效能,值得在工作中深入分析。

Objective To explore the risk factors for developmental dysplasia of the hip(DDH)in children and construct a relevant prediction model,in order to provide more information for clinical screening,prevention,and treatment of DDH.Methods A retrospective study was conducted involving 62children with DDH diagnosed and treated at the Affiliated Hospital of Yan′an University from January 2018to December 2023.Additionally,62 healthy children undergoing physical examinations during the same period were matched at a 1∶1ratio as the control group.The occurrence of DDH in children was analyzed,and the risk factors were explored.Results Among the 62children with DDH included in this study,30had the affected hip on the right side,and 32on the left side.According to the Graf classification,there were 15cases of typeⅡa(+),22cases of typeⅡa(-),7cases of typeⅡb,6cases of typeⅡc,5cases of type D,6 cases of typeⅢ,and 1case of typeⅣ.Univariate analysis revealed that gender,fetal position during delivery,prematurity status,leg wrapping and leggings habits,and family history of DDH may be associated with the occurrence of DDH in children(P<0.05).Logistic multivariate analysis confirmed that female,breech delivery,non-prematurity,leg wrapping and leggings habits,and family history of DDH were independent risk factors for DDH in children(P<0.05).Using the independent influencing factors and P-value prediction probabilities from the regression model to predict the risk of DDH in children,the Youden indices were 37.50%,14.83%,81.42%,25.00%,8.69%,and 82.42%,respectively.Conclusions Children who are female,delivered in the breech position,non-premature,having leg wrapping and leggings habits and family history of DDH are more prone to developing DDH.The data model constructed using these five factors demonstrates good performance in predicting the occurrence of DDH in patients and is worthy of further analysis in clinical practice.