新生儿期髋关节外展操及排气操的被动锻炼对髋关节发育的影响

Influence of Active Exercises of Hip Joint Abduction and Exhaust Exercises on Hip Joint Development in Neonatal Period

目的了解新生儿期髋关节被动锻炼与发育性髋关节发育异常(DDH)的关系。方法回顾性分析厦门市妇幼保健院2023年2—8月内接受髋关节筛查的242名儿童的临床资料,其中男113名,女129名,按照髋关节超声检查结果分为正常组(210例,86.8%)及异常组(DDH)(32例,13.2%),分别统计性别、年龄、胎次、是否双胎、早产、生产方式、臀位、出生体重、羊水过少、出生1月内有无行排气操及外展操11项变量回归分析了解其对髋关节发育的影响。结果单因素分析结果显示:新生儿期有无行排气操及外展操等被动训练、胎次、双胎、早产、生产方式、出生体重在髋关节超声筛查中与DDH的检出结果之间的差异无统计学意义(P>0.05);年龄(P<0.001)、性别(P=0.060)、臀位(P<0.001)及羊水过少(P=0.007)为DDH的影响因素,代入多因素Logistic回归分析提示,女孩(P=0.043)、年龄(P<0.001)、臀位(P=0.010)是DDH的独立危险因素,羊水过少(P=0.109)并非DDH的独立危险因素。结论不推荐对新生儿推广开展髋关节外展训练,其仅适用于经髋关节超声证实的头臼关系良好的轻微髋臼发育不良的患儿。新生儿在除外DDH后规范开展排气操是安全的。在髋关节超声筛查中,女孩和臀位为独立危险因素,病变随年龄有改善的趋势。

Objective To investigate the correlation between the passive hip exercise and the developmental dysplasia of hip(DDH)in neonatal period.Methods The clinical data of 242 children who received hip joint screening in Xiamen Maternal and Child Health Hospital from February to August 2023 were retrospectively analyzed,including 113 males and 129 females,and were divided into normal group(210 cases)and abnormal group(DDH)(32case)according to the ultrasonography results of hip joint.11 variables including sex,age,parity,twins,preterm birth,mode of delivery,breech position,birth weight,oligohydria,exhaust exercises and abduction exercises within 1 month of birth were analyzed to figure out what their effects on hip joint development.Results The results of univariate analysis showed that there was no significant difference(P>0.05)in passive hip training,parity,twin,preterm birth,mode of delivery and birth weight to whether a DDH or not by hip ultrasound test.Age(P<0.001),genders(P=0.060),breech(P<0.001)and oligohydramnios(P=0.007)were the influencing factors of DDH.Multivariate Logistic regression analysis showed that,girls(P=0.043),age(P<0.001)and breech(P=0.010)were independent risk factors for DDH,but oligohydramnios(P=0.109)were not.Conclusions Passive hip abduction training is not recommended for all neonates.It is only suitable for children with mild acetabular dysplasia with good head-acetabular concentricity confirmed by hip ultrasound.It is safe for newborns to perform standardized exhaust exercises after excluding DDH.In hip ultrasound screening,girly and breech position were independent risk factors,and the lesions tended to improve with age.