超声筛查新生儿发育性髋关节异常

Ultrasonographic screening of neonatal developmental dysplasia of hip

目的探讨Graf法髋关节超声诊断在婴儿发育性髋关节异常(DDH)筛查和随访中的作用。方法对662名6月龄以内婴儿(1324髋)行Graf法髋关节超声筛查。通过观察骨性髋臼、骨性髋臼外侧缘、软骨性髋臼形态及测量α角、β角,对髋关节进行Graf分型。对性别、侧别、胎位、襁褓方式等DDH发病影响因素进行评价。对需要跟踪观察或治疗的发育不成熟、发育不良及脱位病例进行超声随访。结果本组选择性超声筛查DDH的检出率为7.42%。性别、妊娠胎位是DDH发病的影响因素。27例发育不良与5例髋关节脱位在治疗中接受了超声随访,13例发育不良病例经外展操锻炼超声指标达到正常,14例因改善不明显接受Pavlik吊带治疗,5例脱位经Pavlik吊带治疗无效而接受闭合复位加外固定手术治疗。结论超声检查能对婴儿髋关节发育情况进行客观评估,监测DDH治疗过程并指导临床治疗方案,可作为婴儿DDH早期筛查与随访的主要手段。

Objective To assess the role of hip ultrasonography in the early screening and following up of developmental dysplasia of the hip（DDH）.Methods A total of 1324 hips of 662 infants younger than 6 months underwent ultrasonography with Graf method.The sonographic appearances of bony roof,superior bony rim,cartilaginous roof,as well as α and β angle measurements were classified according to the Graf method.Risk factors such as gender,sides,fetal position,and swaddling used were assessed.Following up were performed with ultrasonography in the cases of immaturity,dysplasia and dislocation that needed to be monitored or treated.Results Detection rate of selective ultrasound in screening of DDH of the hip was 7.42%.Both gender and fetal position was the risk factor of DDH.Twenty-seven infants with dysplasia hip and five with dislocation hip were followed-up with ultrasonography during treatment process.Thirteen infants with dysplasia turned to normal after abduction exercises,while other fourteen received treatment in Pavlik harness for no improvement in ultrasonography.All infants of dislocation received operation eventually because of failing to Pavlik harness.Conclusion Ultrasonography can objectively assess the development of DDH,monitor the course of following-up and treatment of DDH,and serve as a main tool in the early screening and following up of DDH in infants.