头耻距对婴儿发育性髋关节发育不良的诊断价值

Value of pubo-femoral distance in the diagnosis of infants with developmental dysplasia of the hip

目的探讨屈髋内收横切面股骨头与耻骨骨化中心间距离(头耻距)在婴儿发育性髋关节发育不良(DDH)超声诊断中的应用价值。方法选取2022年2月至2023年6月于首都医科大学附属北京积水潭医院小儿骨科就诊行临床检查及髋关节超声检查的931例DDH患儿及正常婴儿,同时进行Graf法髋关节超声检查及头耻距测量,对各型髋关节的头耻距测值进行统计学分析。结果GrafⅠ型髋关节1359髋,GrafⅡa型274髋,GrafⅡb型166髋,GrafⅡc型31髋,Graf D型7髋,GrafⅢ型13髋,GrafⅣ型12髋,其头耻距分别为(0.34±0.07)cm、(0.35±0.08)cm、(0.35±0.08)cm、(0.51±0.11)cm、(0.67±0.09)cm、(0.95±0.26)cm、(1.27±0.30)cm。GrafⅠ型、GrafⅡa型与GrafⅡb型头耻距测值两两比较差异无统计学意义(均P>0.05),余各型间头耻距测值差异有统计学意义(均P<0.05)。头耻距诊断髋关节稳定性的ROC曲线下面积(AUC)为0.959,最佳诊断阈值为0.435 cm,敏感性、特异性分别为88.9%、90.4%。结论屈髋内收横切面头耻距可反映髋关节的稳定性,最佳诊断阈值为0.435 cm。

Objective To discuss the value of pubo-femoral distance(PFD)in the diagnosis of infants with developmental dysplasia of the hip(DDH).Methods Nine hundred and thirty-one infants with DDH and normal infants diagnosed by clinical examination and ultrasonography were involved from February 2022 to June 2023 in Beijing Jishuitan Hospital.The ultrasonographic examination included Graf method and pubo-femoral distance measurement.Statistical analysis was made on the measurements of PFD of different types of hips.Results Among all the hips,1359 hips were Graf typeⅠ,274 hips were Graf typeⅡa,166 hips were Graf typeⅡb,31 hips were Graf typeⅡc,7 hips were Graf type D,13 hips were Graf typeⅢ,and 12 hips were Graf typeⅣ.The PFD of these hips were(0.34±0.07)cm,(0.35±0.08)cm,(0.35±0.08)cm,(0.51±0.11)cm,(0.67±0.09)cm,(0.95±0.26)cm,(1.27±0.30)cm,respectively.There was no significant difference in PFD between hips of GrafⅠ,GrafⅡa and GrafⅡb(P>0.05),but there was significant difference in PFD between hips of the other Graf types(P<0.05).The area under curve(AUC)of the PFD for the diagnosis of stability of the hips in infants was 0.959 with the cut-off value of 0.435 cm,the sensitivity and specificity were 88.9%and 90.4%,respectively.Conclusions The PFD has great value in the evaluation of the stability of hip joint,and the cut-off value is 0.435 cm.