2009-2012年北京市2118例发育性髋关节发育不良筛查工作中体格检查的可靠性分析

The reliability study of physical examination in developmental dysplasia of the hip screening in 2009-2012:summary of 2 118 screening cases in Beijing

目的探讨体格检查在发育性髋关节发育不良（DDH）筛查工作中作为诊断依据的可靠性。方法 2118例就诊于北京儿童医院DDH筛查门诊的患儿纳入本研究,所有病例经过病史采集,体格检查以及影像学检查后做出确定诊断,分析体格检查、病史与DDH的关联,评估体格检查结果作为初筛转诊的依据是否可靠。结果 2118例患儿中,年龄〈6个月组DDH患儿126例,6个月-1岁组DDH患儿50例;〉1岁组DDH患儿10例。体格检查最常见的为双下肢皮纹不对称,其次主要有双髋外展不对称、双髋外展受限、双下肢不等长、髋关节外展弹响。3个年龄组中,体格检查阳性与最终确诊DDH存在一致性（P〈0.05）。结论体格检查结果作为DDH筛查工作的诊断依据是可靠的,但最终诊断需要根据患儿病史、体格检查、影像学检查结果综合判断。

Objective To investigate the reliability of the physical examination as a diagnostic tool for developmen- tal dysplasia of the hip（DDH） screening. Methods The data of 2 118 DDH screening outpatients were retrospective ana- lyzed. The diagnoses were based on medical history, physical examination and imaging examination. The differences between physical examination and the final diagnosis were analyzed to assess the reliability of physical examination. Results A total of 2 118 patients were divided into 3 groups according to age： less than 6 months group, 126 DDH cases were diagnosed; 6 months to 1 year old group, 50 DDH cases were diagnosed; older than 1-year group, 10 DDH cases were diagnosed. The most common physical examination included asymmetric lower limbs striae, followed by 10° or greater difference in side-to-side abduction, symmetric abduction of less than 60°, asymmetric leg length, Ortolani sign positive. The physical examination results were in accordance with DDH diagnosis. Conclusion Physical examination is a relatively reliable index in DDH screening, but doctors shoud make a comprehensive judgment based on medical history, physical examination and image result.