头耻距和股骨头直径评估婴儿DDH及髋关节稳定性的临床价值

Clinical value of pubo-femoral distance and femoral head diameter in evaluating DDH and hip joint stability in infants

目的:评估头耻距和股骨头直径超声测值对早期筛查婴儿髋关节发育不良(DDH)及髋关节稳定性的临床价值。方法:应用高频超声检查临床疑似DDH婴儿的髋关节,Harcke法评估髋关节稳定性;测量头耻距和股骨头直径,分别比较DDH髋关节与正常髋关节及不稳定髋关节与稳定髋关节之间头耻距、股骨头直径的差异;利用受试者工作特征曲线(ROC)评估头耻距、股骨头直径及两指标联合对婴儿DDH和不稳定髋关节的诊断价值。结果:DDH髋关节较正常髋关节头耻距增大,股骨头直径减小,不稳定髋关节较稳定髋关节头耻距增大,股骨头直径减小,差异有统计学意义(P<0.05)。头耻距及股骨头直径诊断婴儿DDH的曲线下面积分别为0.846、0.880,Cut-off分别为3.275 mm、12.35 mm(P<0.05)。头耻距及股骨头直径诊断婴儿不稳定髋关节的曲线下面积分别为0.883、0.853,Cut-off值分别为3.275 mm、12.15 mm(P<0.05)。两者联合诊断婴儿DDH及不稳定髋关节的敏感度均高于两者单独诊断(P<0.05)。结论:超声测量头耻距及股骨头直径可用于婴儿DDH及髋关节稳定性早期筛查,两者联合可以提高诊断敏感度及诊断效能,具有一定临床价值。

Objective:To evaluate the clinical value of pubo-femoral distance and femoral head diameter in early screening of developmental dislocation of the hip(DDH)and hip joint stability in infants.Methods:The hip joints of clinically suspected DDH infants were examined with high-frequency ultrasound.Harcke method was used to evaluate the stability of hip joint.The pubo-femoral distance and femoral head diameter were measured.The diagnostic value of pubo-femoral distance,diameter of femoral head and combination of two indexes in infant DDH and unstable hip joint were evaluated by subject working characteristic curve.Results:Compared with normal hip joint,pubo-femoral distance of DDH hip joint increased,diameter of femoral head of DDH hip joint decreased,and the differences were statistically significant(P<0.05).Compared with the stable hip joint,pubo-femoral distance of the unstable hip joint increased,the diameter of the femoral head of the unstable hip joint decreased,and the differences were statistically significant(P<0.05).The ROC area of pubo-femoral distance for the diagnosis of infant DDH was 0.846,and the best cut-off value was 3.275 mm(P<0.05),and the ROC area of pubo-femoral distance for the diagnosis of unstable hip joint was 0.883,and the best cut-off value was 3.275 mm(P<0.05).The ROC area of the diameter of the femoral head for the diagnosis of DDH was about 0.880,and the best cut-off value was 12.35 mm(P<0.05),and the ROC area of the diameter of the femoral head for the diagnosis of unstable hip joint was about 0.853,and the best cut-off value was 12.15 mm.The sensitivity of combined diagnosis of infant DDH and unstable hip joint was higher than that of single diagnosis(P<0.05).Conclusion:Ultrasonic measurement of pubo-femoral distance and femoral head diameter can be used for early screening of infant DDH and hip joint stability,and the combination of the two index can greatly improve the diagnostic sensitivity and diagnostic efficiency,which has a certain clinical value.