婴幼儿发育性髋关节异常的超声波筛查

Ultrasound screening for infant hip dysplasia and dislocation

目的研究超声波检查婴幼儿发育性髋关节异常(DDH)的发病率和超声波检查的重要性及应用范围。方法选择2008年10月～2009年8月婴幼儿4512例,其中男性2121例,女性2391例;年龄28天～6个月,平均年龄35d;9024个髋关节。予以出生史、家族史、其他畸形等危险因素调查。采用高频线阵探头按Graf方法进行检查及评估分析,于出生1个月做髋关节超声波检查,测α、β值;对于50°<α<60°的婴幼儿,于第4个月再次做患侧髋关节超声波检查,50°<α<60°仍然无改变的,定义为Ⅱb型髋。其中Ⅱb型、Ⅱc型、Ⅱd型、Ⅲ型(脱位髋)及Ⅳ型(脱位髋)髋均称为DDH髋。结果Ⅰ型髋占80.20%;Ⅱ型者19.28%,其中Ⅱa型髋占9.87%,Ⅱb型6.84%、Ⅱc型1.73%、Ⅱd型0.84%;Ⅲ型和Ⅳ型髋共占0.52%,其中出生1个月检查50°<α<60°的髋关节在发育中有变化,α在出生第4个月前后测量有差异,具有显著统计学意义(P<0.001)。出生1个月检查的Ⅱc型、Ⅱd型、Ⅲ型和Ⅳ型髋(家庭中均无家族病史)及第4个月复查50°<α<60°的Ⅱb型髋,皆认为患有DDH,占9.92%。结论髋关节超声波筛查是一种安全、有效的诊断方法,能够准确地对髋关节进行定性、定量评估,3个月后进行髋关节超声波检查的准确率会增高,假阳性率也会逐渐减小。

Objective To study the importance and application of ultrasonography in infant developmental dysplasia of hip（DDH）.Methods From October 2008 to August 2009,4 512 infants were enrolled,male 2 121,female 2 391;aged 28 days to 6 months,mean age 35 days and 9 024 hips were screened with ultrasound.The birth history,family history and other malformations were studied.The high frequency linear array probe according to Graf method of analysis was adopted,the infants of 1 month after birth were performed hip ultrasonography and measured α,β values.If 50°〈 α〈 60° ipsilateral hip should perform ultrasonography again in 4 months after birth,the results within the range of 50 °〈 α〈 60 ° were defined as Ⅱ b hip.The definition of DDH included type Ⅱ b,type Ⅱ c,type Ⅱd,type Ⅲ（dislocation of the hips） and type Ⅳ（dislocation of the hips）.Results Type Ⅰ hip accounted for 80.20 %;type Ⅱ were 19.28 %,type Ⅱa of hip accounted for 9.87 %,type Ⅱb 6.84 %,type Ⅱc 1.73 % and type Ⅱd 0.84 %;together of type Ⅲ and type Ⅳ of hip accounted for 0.52 % .In the infants with 50° 〈α〈 60° at 1 month examination,there were developmental changes of hip joints.The results showed significant difference（P〈 0.001） in α around 4 months after birth.The infants were defined as DDH in those of type Ⅱc,type Ⅱd,type Ⅲ and Ⅳ（without family history of such disorders） in 1 month examination or Ⅱb hip with 50°〈 α〈 60° in examination around 4 months after birth.All of these infants accounted for 9.92 %.Conclusion Ultrasound screening of hip is a safe and effective diagnostic method that can evaluate infants hip disorders accurately with qualitative and quantitative assessment in hip.The ultrasound examination of hip will increase its diagnostic accuracy rate and decrease false positive rate in infants after 3 months.