2013-2015年鄞州区新生儿DDH发病情况及Ⅱa型DDH发育异常高危因素与转归分析

Prevalence of neonatal DDH and high-risk factors and prognoses of Graf Ⅱa DDH in Yinzhou District,Ningbo City,2013-2015

目的了解宁波市鄞州区新生儿髋关节异常(developmental dysplasia of hip,DDH)发病情况,Ⅱa型DDH高危因素和临床表现,并随访其自然转归。方法使用Mylab50彩色多普勒超声诊断仪于2013年7月-2015年7月对宁波市鄞州第二医院出生新生儿在一周内行髋关节超声检查,对其中检查出为Ⅱa型于6~7周龄时免费来院检查,仍异常者予髋关节操和宽尿布法干预到12~14周龄再次复查。并分析Ⅱa型髋关节异常危险因素。结果在行髋关节超声检查2 225例新生儿中,按Graf法分型,发现Ⅱa型392例,Ⅱc型21例,Ⅲ型6例,Ⅳ型4例,初筛阳性率为19.01%(423例)。其中女326例,男97例,女孩发病率为29.74%,男孩的为8.59%,差异有统计学意义(χ2=161.61,P<0.05)。Ⅱa型DDH患儿中仅24例(6.12%)有明显高危因素,17例(4.34%)有临床阳性特征,最常见的高危因素是臀位产,最常见的临床特征是双侧臀纹不对称。Ⅱa型患儿于6~7周和12~14周复查时,大部分自然好转,且男孩比女孩好转率高。结论2013-2015年DDH在宁波市鄞州区新生儿中发病率很高,尤其女孩发病显著高于男孩。Ⅱa型高危因素及临床表现不显著,因此超声筛查尤为重要,对早期诊断和治疗起决定作用。随着生长发育,Ⅱa型大部分可自行好转,但是女孩需要治疗的发生率高于男孩。应当重视对新生女婴的髋关节超声筛查及随访。

Objective To investigate the prevalence of neonatal developmental dysplasia of hip （DDH） in Yinzhou Distict, Ningbo City, and to analyze the high-risk factors, clinical manifestations and natural outcomes of Graf IIa DDH. Methods The first-week newborns in Yinzhou District No.2 Hospital, Ningbo City were examined by Mylab50 color doppler ultrasonic diagnostic instrument to screen hip abnormalities from July, 2013 to July, 2015. The newborns diagnosed with Graf IIa DDH would undergo ultrasound reexamination at 6-7 weeks of age freely, and then the anomalies would be intervened by hip joint gymnastics and wide diaper method and rechecked at 12-14 weeks of age. The high-risk factors of Graf IIa DDH were also analyzed. Results Among the 2,225 newborns underwent hip ultrasound examination, there were 392 Graf IIa DDH, 21 Graf IIc DDH, 6 Graf III DDH, and 4 Graf IV DDH. The positive rate of initial screening was 19.01% （423/2,225）, including 326 girls and 97 boys. The prevalence rates of the girls and the boys were 29.74% and 8.59% respectively, with statistically significant differences （χ^2=161.61,P〈0.05）. Only 24 （6.12%） of the newborns with Graf IIa DDH had significant high-risk factors and 17 （4.34%） got clinical manifestations. The most common high-risk factor was breech delivery, and the most common clinical feature was the asymmetry of bilateral hip. Most of the newborns with Graf IIa DDH resumed normal at 6-7 weeks or 12-14 weeks of age, and the good prognosis rate of the boys was higher than that of the girls. Conclusions The prevalence rate of DDH in the newborns in Yinzhou District, Ningbo City during 2013-2015 is very high, especially in the girls. No significant high-risk factors and clinical manifestations of Graf IIa DDH are found in these newborns; and hence, ultrasound examination plays an important role in the screening, early diagnosis and treatment. With the growth and development, most of Graf IIa DDH newborns will switch back, but the occurrence rate of therapy is higher in girls than in boys. More attention should be paid to hip ultrasound screening and follow-up in girls.