婴儿髋关节发育不良筛查及超声检查在早期诊断中的价值

Clinical and ultrasonographic screening for early diagnosis of infant developmental dysplasia of hip joints

目的观察婴儿髋关节发育不良(DDH)筛查结果以及评价超声检查技术在早期诊断中的价值。方法选取2014年9月-2016年6月该院1 500例健康体检婴儿(3 000个髋关节),观察髋关节发育不良高危因素(单双胎、胎位不正、长期捆绑及难产等)、大腿皮纹或臀纹、外展试验等临床筛查内容、超声检查结果以及Graf法分型等。结果临床筛查发育不良378例,发育不良率25.20%;超声检查结果发育不良者22例(髋关节44个),发育不良率5.82%。女婴发育不良率高于男婴,左髋异常率高于右髋发育不良率,差异有统计学意义(P<0.05)。临床筛查发育不良中捆绑双下肢因素所占比例最高,与其他因素比较,差异有统计学意义(P<0.05),其次为DDH阳性家族史,差异有统计学意义(P<0.05),超声诊断发育不良率,与临床筛查一致。α角与年龄呈正相关(r=0.104,P<0.050),β角与年龄呈负相关(r=-0.116,P<0.050)。结论加强婴儿DDH筛查,有助于掌握本地区该病流行病学资料、早期开展干预,降低致残率,且在筛查中,超声检查能提高婴儿发育性髋关节发育不良诊断率,可作为临床常规的筛查手段,值得推广。

Objective To observe the results of developmental dysplasia of the hip in infants and evaluate the value of ultrasonography in the early diagnosis. Methods A total of 1,500 healthy infants（3,000 hips）were selected from September 2014 to June 2016. The risk factors of developmental dysplasia of the hip（single and twin, malposition, long term, dystocia, etc.）, thigh or hip striae, outreach test and other clinical screening, ultrasound examination results, and Graf classification were analysed. Results Abnormality rate was25.20%（378 cases） in clinical screening and 5.82%（22 abnormal cases, 44 cases of hip joint） in ultrasonic screening. The abnormality rate of female infants was significantly higher than that of the male infants（P〈0.05）. The abnormality rate of left hips was significantly higher than that of the right hips（P〈0.05）. The risk factor of the highest percentage was binding double-limbs in patients in abnormal clinical screening（P〈0.05）,followed by positive family history of DDH（P〈0.05）. Abnormal ultrasound diagnosis was consistent with clinical screening. Angle α was positively correlated with age（r = 0.104, P〈0.05）, and Angle β was negatively correlated with age（r =-0.116, P〈0.05）. Conclusions Screening of developmental dysplasia of the hip for infants can be helpful to obtain the epidemiological data in local areas, to carry out early intervention and to reduce the morbidity. Ultrasound can significantly improve the diagnosis of DDH, which can be used as a routine screening method.