超声检查对婴幼儿髋关节发育不良的产前高危因素筛选研究

Screening of prenatal high-risk factors in infants with developmental dysplasia of the hip by ultrasonography

目的通过应用Graf法髋关节超声检查,探讨可能影响婴幼儿髋关节发育不良(DDH)的产前高危因素。方法选择2015年1月至2016年12月在首都医科大学附属北京妇产医院儿科与儿保科门诊经临床体格检查高度可疑DDH的2 124例婴幼儿进行Graf法超声检查,共4 248例髋关节,观察婴幼儿髋关节形态,测量α、β角并进行分型,对婴幼儿母亲妊娠期间合并高危因素与α角度关系进行分析,探讨患儿DDH发病高危因素。结果4 248例髋关节中,婴幼儿母亲合并产前高危因素主要有高龄(>35岁)720例(16.9%),妊娠期高血压792例(18.6%),妊娠期糖尿病1 836例(43.2%),单纯低甲状腺素血症1 188例(27.9%),胚胎移植(IVF-ET)术后900例(20.9%),多胎468例(11.0%)等。共有正常髋关节4 187例(98.6%),异常髋关节61例(1.4%),其中髋关节Ⅰ型4 187例(98.6%);Ⅱa型46例(0.69%),Ⅱb型髋关节6例(0.21%),Ⅱc型3例(0.05%);Ⅲ型髋关节4例(0.03%);Ⅳ型髋关节2例(0.03%)。分析显示,母亲产前合并妊娠期高血压、单纯低甲状腺素血症的婴幼儿α角度明显低于未合并组,两者差异有统计学意义,说明母亲产前合并两高危因素的婴幼儿患DDH风险更大;其余各因素阳性、阴性组α角度差异无统计学意义;母亲产前合并妊娠期高血压、单纯低甲状腺素血症的婴幼儿DDH发病率均高于未合并组,差异有统计学意义。结论 Graf法可以对髋关节进行分型诊断;可对相关高危因素进行筛选。各产前高危因素中,妊娠期高血压、单纯低甲状腺素血症可能是DDH发病的危险因素。

Objective To investigate prenatal high-risk factors in developmental dysplasia of the hip （DDH） incidence using the Graf ultrasound method. Methods 2 124 infants, who were highly suspected as DDH based on clinical examination, were examined by Graf uhrasound method. All cases came from outpatients of Pediatrics and child Care clinic, Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University, from January 2015 to December 2016. A total of 4 248 hip jonits were observed in morphology, α and 13 angle were measured, and maternal risk factors during pregnancy were explored. Results High-risk factors of mothers included age 〉 35 years （720 cases, 16.9%）, gestation hypertension （792 cases, 18. 6%）, gestational diabetes mellitus （1 836 cases, 43. 2%）, hypothyroidism （ 1 188 cases,27.9% ）, embryo transplantation after operation （IVF-ET, 900 cases, 20.9% ） , multiple pregnancies （468 cases,11. 0% ）. 4 187 of them （98.6%） were normal among 4 248 hips, abnormal hip accounts for 1.4% （61 cases）. The sub-types included hip joint type Ⅰ （4 187, 98.6% ） ;Ⅱ a （46 cases,0. 69% ）, Ⅱ b （6 cases, 0.21%）,Ⅲc （3 cases, 0. 05%）; Ⅲ （4 cases, 0. 03%）; Ⅳ （2 cases, 0. 03%）. Babies whose mother with hypothyroidism and gestation hypertension had lower α angle, there were no statistical difference of α angle between babies whose mother with other risk factors or not. Prevalence of DDH was higher in babies whose mother with gestation hypertension and hypothyroidism. Conclusion Graf hip ultrasound method can be used for classification the diagnosis of hip joint, and for screening high risk factors. Among all the prenatal high-risk factors, pregnancy hypertension and hypothyroidism may be the risk factors of DDH.