新生儿与婴幼儿髋关节发育不良的院内筛查

Screening of developmental dysplasia of the hip in infants and young children in hospital

目的总结近期院内0-36个月的新生儿与婴儿髋关节发育不良（developmental dysplasia of the hip,DDH）筛查情况,形成规范的新生儿与婴儿DDH筛查流程。方法我院出生新生儿由产科医师进行DDH的初步筛查,儿内科0-36个月住院患儿及儿外科0-36个月的门诊就诊患者分别由儿科医师、儿外科医师进行DDH的初步筛查,可疑或异常者转诊至我院儿童骨科复筛,由儿童骨科医师对转诊儿童再次进行临床检查,并行双髋关节B超或者X线片进一步检查,可疑者定期复查直至确诊或排除。结果 2012年1月至2014年12月,共筛查婴幼儿22 396例,2699例行髋关节B超筛查,B超检查可疑和异常591例（755髋）转诊到儿童骨科。可疑患儿中61例（89髋）Ortolani或Barlow试验阳性,94例（131髋）骨盆正位X线片显示髋臼发育不良,最终76例（121髋）确诊为DDH。其中男21例（29髋）,女55例（92髋）;左91髋,右30髋;1-6个月13例（其中新生儿3例）1.95‰（13/6676）,7-18个月49例7.09‰（49/6909）,19-36个月14例1.59‰（14/8811）,76例明确诊断DDH患儿中,7-18个月者49例,占64.47%;DDH的发病率为3.39‰（76/22 396）。结论本次筛查对象是0-36个月的新生儿与婴幼儿,这种筛查模式实现了对儿童DDH的早发现、早诊断,形成了符合本地区实际情况的规范筛查流程。

Objective To summary developmental dysplasia of the hip（ DDH） screening in 0- 36 months children in our hospital, and formulate normative screening procedure of DDH in children. Methods Newborn infants were initially DDH screened by obstetrist with clinical physical examination（ functional examination to double hip, abduction test, Ortolani or Barlow test） in our hospital. Children from 0 to 36 months in pediatrics department and outpatient clinic underwent initial screening by pediatrist and pediatric orthopedics doctors, and suspected and abnormal infants were transferred to pediatric orthopedics to be re-screened. Clinical physical examination, B ultrasound or DR were chosen for DDH fi nal diagnosis or deplete. Results A total of 22 396 children were DDH screened from January 2012 to December 2014, and 2699 children were examined with colour ultrasound. Totally 591 suspected and abnormal children（ 755 hips） were transferred to pediatric orthopedics. Among suspected and abnormal children, 61 children（ 89 hips） were positive with Ortolani or Barlow test, 94 children（ 131 hips） were dysplasia of the hip, 76 children（ 121 hips） were fi nally diagnosed as DDH. Among them, male 21 cases（ 29 hip）, female 55 cases（ 92 hip）; left hip 91, right hip 30; 1 to 6 months, 13 cases（ 3 newborn cases）, 1.95‰（ 13 / 6676）; 7- 18 months, 49 cases, 7.09‰（ 49 / 6909）; 19- 36 months, 14 cases, 1.59‰（ 14 / 8811）; 76 cases were diagnosed as DDH, 7 to 18 months in 49 cases, accounting for 64.47%. Disease incidence of DDH was 3.39‰（ 76 / 22 396）. Conclusions We fi nish early DDH screening to children from 0 to 36 months, and realize early discovering and diagnosis following screening mode,and formulate normative screening procedure of DDH in children based on our region actuality.