超声改良Morin法在婴儿发育性髋关节发育不良筛查中的应用

Value of ultrasound for screening infant developmental dysplasia of the hip using the method of modified morin

目的：评估改良 Morin 超声测量法在婴儿髋关节发育不良（DDH）筛查中的作用。方法分别运用改良 Morin、Graf 超声测量法对4318名6月龄以内婴儿8636侧髋进行筛查。采用一致性检验、Kappa 系数检验筛查 DDH 的效果；统计5名主治医师和5名住院医师测量10例可疑 DDH 的股骨头覆盖率（FHC），通过组内相关系数了解不同经验水平的超声医师运用改良 Morin 法是否存在差异。结果①运用改良 Morin、Graf 法 DDH 检出率分别为0．8‰、1．3‰。改良 Morin 法筛查出正常与异常髋关节（松弛、半脱位、脱位）比例为99．92％、0．08％；Graf 法筛查出正常（Ⅰ、Ⅱa 型）与异常髋关节（Ⅱb、ⅡC、D、Ⅲ、Ⅳ型）比例为99．87％、0．13％。②两种筛查方法筛查 DDH 的效果一致性好。③不同经验者运用 Morin 法可靠性接近。结论改良 Morin 法以百分数的表达方式、简单的分型标准，达到传统 Graf法筛查婴儿 DDH 的效果，不同经验者均可进行诊断，可以作为筛查婴儿 DDH 的首选简便手段。

Objetive To assess the role of ultrasonography in screening the infant developmental dyspla-sia of the hip（DDH）by using the modified Morin method. Methods 8 636 hips of 4 318 infants younger than 6 month were examined sonographically using the methods of modified Morin and Graf.Kappa statistics was adopted to compare the effect between the two methods.In an inter-observer study,5 physicians and 5 res-idents evaluated 10 suspicious DDH images to learn the differences between the different experiences.Results①Detection rate of DDH with modified Morin and Graf methods was 0.8‰、1.3‰.According to modified Mor-in method,99.92% of hips were normal and 0.08% were abnormal（laxsity,subluxation,dislocation）,com-pared with 99.87% and 0.13%（type Ⅱb、ⅡC、D、Ⅲ、Ⅳ）according to Graf.②Kappa statistics indicated a fair agreement between the two methods in screening infant DDH.2.Inter-observer test showed nearly equal reli-ability for FHC in physician group and resident group. Conclusions As a percentage of expression,simple classification,equal reliability in different experiences,comparing with the Graf,the modified Morin method can be adopted as an easier way to screen infant DDH.