高频超声对婴幼儿发育性髋关节脱位继发性病理改变的诊断价值

Secondary pathological changes in infant with developmental dysplasia of the hip：the application value of high frequency ultrasound

目的探讨高频超声检查在婴幼儿发育性髋关节脱位（DDH）继发性病理改变诊断中的应用价值。方法利用高频超声检查DDH患儿34例共36个脱位髋关节，其中单侧32例，双侧2例，观察髋关节盂唇的形态改变、髋臼内脂肪组织增生情况、关节囊厚度变化以及股骨头骨化中心的发育情况。其中盂唇形态改变和髋臼内脂肪组织增生以MRI表现为金标准，将超声检查结果与其相对照。结果超声诊断盂唇内翻敏感性为82％，特异性为100％，诊断盂唇内翻和外翻的符合率为83％；超声可较清晰地显示31个脱位髋关节内增生的脂肪组织；患侧髋关节囊与健侧髋关节囊厚度分别为（2．8±0．6）mm、（1．7±0．4）mm，两者比较差异有统计学意义（P〈0．001）。34例患儿双侧股骨头骨化中心显示情况分为4种：①患侧较健侧小（22／34）；②患侧未显示，健侧显示（7／34）；③双侧未显示（4／34）；④双侧发育小（1／34）。结论超声作为一种简便、快速、无损伤的检查手段，可对DDH发生的继发性病理改变作出客观分析，并为临床治疗提供重要的参考依据。

Objective To investigate the clinical value of high frequency ultrasound in discovering secondary pathological changes in infant with developmental dysplasia of the hip （DDH）. Methods Thirty- four infants with 36 dislocation hips were involved. Among them, 32 were with unilateral dislocation of hip joint,2 were with bilateral dislocation of hip joint. High frequency ultrasound were used to observe the morphological changes of hip glenoid labrum, adipose hyperplasia in acetabulum, thickness variation of articular capsule, and development of the ossification center of the femoral head. Besides, the morphological changes of hip glenoid labrum and adipose hyperplasia in acetabu｜ were compared with those from MRI. Results The sensitivity and specificity of ultrasound in diagnosing glenoid labral introversion were 82% and 100%respectively. The coincidence rate of diagnosing glenoid labral introversion and glenoid labral extroversion were both 83%. Adipose hyperplasias in acetabul were clearly seen in 31 hips using ultrasound. The thickness of articular capsule in the affected hip and in the healthy hip was （2.8± 0.6）mm versus （1.7 ±0.4）mm, and the difference was obviously significant （ P 〈0.01 ）. The ossification center of the femoral head in the 34 infants were classified as the following four types：① which was smaller in the affected side than in the healthy side （22/34） ;② which was shown in the healthy side （7/34） but not in the affected side; ③ which in both sides were not shown （4/34）;④ which in both sides were small（1/34）. Conclusions Ultrasound is a method of simple, rapid, non-invasive in diagnosing DDH, and it can be used to discover secondary pathological changes in infant with DDH, which provide important reference for clinical diagnosis and treatment.