Treatment of bilateral developmental dysplasia of the hip joint with an improved technique:A case report

BACKGROUND Developmental dysplasia of the hip(DDH)is a common osteoarticular deformity in pediatric orthopedics.A patient with bilateral DDH was diagnosed and treated using our improved technique"(powerful overturning acetabuloplasty)"combined with femoral rotational shortening osteotomy.CASE SUMMARY A 4-year-old girl who was diagnosed with bilateral DDH could not stand normally,and sought surgical treatment to solve the problem of double hip extension and standing.As this child had high dislocation of the hip joint and the acetabular index was high,we changed the traditional acetabuloplasty to"powerful turnover acetabuloplasty"combined with femoral rotation shortening osteotomy.During the short-term postoperative follow-up(1,3,6,9,12,and 15 months),the child had no discomfort in her lower limbs.After the braces and internal fixation plates were removed,formal rehabilitation training was actively carried out.CONCLUSION Our"powerful overturning acetabuloplasty"combined with femoral rotational shortening osteotomy is feasible in the treatment of DDH in children.This technology may be widely used in the clinic.

Effects of different pelvic osteotomies on acetabular morphology in developmental dysplasia of hip in children

Developmental dysplasia of hip seriously affects the health of children,and pelvic osteotomy is an important part of surgical treatment.Improving the shape of the acetabulum,preventing or delaying the progression of osteoarthritis is the ultimate goal of pelvic osteotomies.Re-directional osteotomies,reshaping osteotomies and salvage osteotomies are the three most common types of pelvic osteotomy.The influence of different pelvic osteotomy on acetabular morphology is different,and the acetabular morphology after osteotomy is closely related to the prognosis of the patients.But there lacks comparison of acetabular morphology between different pelvic osteotomies,on the basis of retrospective analysis and measurable imaging indicators,this study predicted the acetabular shape after developmental dysplasia of the hip pelvic osteotomy in order to help clinicians make reasonable and correct decisions and improve the planning and performance of pelvic osteotomy.

Developmental Dysplasia of the Hip (DDH) in Saudi Arabia: Time to Wake up. A Systematic Review (1980-2018)

The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. Methods: A systematic review was performed for all the published articles in the English language literature on DDH in Saudi Arabia. Data sources were PubMed Medline (1980-2018) (http://www.ncbi.nlm.nih.gov/pubmed/), Ovid Medline (1980-2018), EMBASE MEDLINE (1980 to May 2018), EMBASE (1991 to May 2018), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, the Science Citation Index (1966 to May 2018), published data from the Saudi Medical Journal (1985-2018) and Annals of Saudi Medicine (1985-2018). The author independently reviewed articles and abstracted the data. The key words used were Saudi Arabia developmental dysplasia of the hip ORDDH, congenital hip dislocation or congenital subluxation of the hip, and congenital dysplasia of the hip. Results: The authors identified 18 potentially relevant articles published in the last 38 years, and 10 met the inclusion criteria. The 10 studies analyzed included 2037 studies of infants diagnosed with DDH;and they gave an average incidence of 10.46/1000. Two studies (303 subjects) did not report the affected gender;in the remaining 338 were boys and 1396 were girls and one study did not report the side of affection. The majority presented after 12 months of age. The right side was affected in 532 (27.2%) affected, 734 (37.6%) were left side and 687 (35.2%) infants were affected bilaterally. Consanguinity, breech presentation, and family history were found to be the risk factors in 32.9%, 17.3%, and 23.6% of the patients, respectively. Conclusions: There is paucity of available literature on DDH in Saudi Arabia. New strategies have to be developed that include mandatory screening programs in all hospitals (private and public) so that more children can be treated by nonsurgical methods.

Developmental dysplasia of the hip: What has changed in the last 20 years?

Developmental dysplasia of the hip(DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Different screening programs for DDH were implicated. The suspicion is raised based on a physical examination soon after birth. Radiography and ultrasonography are used to confirm the diagnosis. The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined; however, extensive research is underway on this subject. Treatment depends on the age of the patient and the reducibility of the hip joint. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. If this fails, closed reduction and spica casting is usually done. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades.

Developmental dysplasia of the hip in the newborn: A systematic review

Developmental dysplasia of the hip(DDH) denotes a wide spectrum of conditions ranging from subtle acetabular dysplasia to irreducible hip dislocations. Clinical diagnostic tests complement ultrasound imaging in allowing diagnosis, classification and monitoring of this condition. Classification systems relate to the alpha and beta angles in addition to the dynamic coverage index(DCI). Screening programmes for DDH show considerable geographic variation; certain risk factors have been identified which necessitate ultrasound assessment of the newborn. The treatment of DDH has undergone significant evolution, but the current gold standard is still the Pavlik harness. Duration of Pavlik harness treatment has been reported to range from 3 to 9.3 mo. The beta angle, DCI and the superior/lateral femoral head displacement can be assessed via ultrasound to estimate the likelihood of success. Success rates of between 7% and 99% have been reported when using the harness to treat DDH. Avascular necrosis remains the most devastating complication of harness usage with a reported rate of between 0% and 28%. Alternative non-surgical treatment methods used for DDH include devices proposed by LeD amany, Frejka, Lorenz and Ortolani. The Rosen splint and Wagner stocking have also been used for DDH treatment. Surgical treatment for DDH comprises open reduction alongside a combination of femoral or pelvic osteotomies. Femoral osteotomies are carried out in cases of excessive anteversion or valgus deformity of the femoral neck. The two principal pelvic osteotomies most commonly performed are the Salter osteotomy and Pemberton acetabuloplasty. Serious surgical complications include epiphyseal damage, sciatic nerve damage and femoral neck fracture.

Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes

Total hip arthroplasty(THA) in developmental dysplasia of the hip(DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient's unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH.

One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip:A case report

BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condition,and it is a complex challenge for surgeons to develop a treatment scheme.CASE SUMMARY We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month.Approximately 40 years ago,a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy.After the sinus healed,gradual pain occurred in the left hip for 40 years.Approximately one month prior,hip pain was sharply aggravated,and a drainage sinus reoccurred in the left hip.The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur,as well as an acetabular deformity.The results of Mycobacterium tuberculosis antibody and Xpert were positive.Therefore,the patient was diagnosed with advanced TH combined with Crowe type IV DDH.After 22 d of treatment with anti-tuberculosis chemotherapy,the sinus healed,and the patient underwent one-stage total hip arthroplasty(THA)surgery consisting of debridement,osteotomy,and joint replacement.After surgery,the patient received anti-tuberculosis chemotherapy drugs for nine months,with no recurrent infection.After one year of follow-up,the Harris score of the patient increased from 21 pre-THA to 86.CONCLUSION Although drainage sinuses are a contraindication to one-stage THA,one-stage THA is still an effective and safe surgical method after the sinus heals.

Seasonal variation in adult hip disease secondary to osteoarthritis and developmental dysplasia of the hip

AIM To determine if there was a seasonal variation in adults undergoing total hip arthroplasty for end stage hip disease due to osteoarthritis(OA) or sequelae of developmental dysplasia of the hip(DDH).METHODS The total hip registry from the author's institution for the years 1969 to 2013 was reviewed. The month of birth,age,gender,and ethnicity was recorded. Differences between number of births observed and expected in the winter months(October through February) and non-winter mo(March through September) were analyzed with the χ2 test. Detailed temporal variation was mathematically assessed using cosinor analysis.RESULTS There were 7792 OA patients and 60 DDH patients who underwent total hip arthroplasty. There were more births than expected in the winter months for both the DDH(P < 0.0001) and OA(P = 0.0052) groups. Cosinor analyses demonstrated a peak date of birth on 1st October. CONCLUSION These data demonstrate an increased prevalence of DDH and OA in those patients born in winter.

Diagnosis of Developmental Dysplasia of the Hip Using Sound Transmission in Neonates

The developmental dysplasia of the hip disease is in 1% of newborns, and it is a risk factor for dislocation of the hip;only 1 from 7000 newborns develops dislocation of the hip. Newborns were selected from public and private hospitals in Celaya, Guanajuato. Parents were asked to sign informed consent. Clinical maneuvers were applied for diagnosis of developmental dysplasia of the hip, on three consecutive occasions, two by the same investigator and the third by a different observer: Ortolani, Barlow, Piston, Galeazzi, Peter Baden, the comparative sound transmission test, and comparative sound transmission with extension/flexion test were applied. The diagnosis was confirmed with ultrasound of hip, technique Graf, I healthy hip, II functionally immature, III subluxation, and IV dislocation. Sample size was 8 affected hips and 56 healthy hips. Kappa for intra observer and inter observer reliability were measured;the validity was measured by sensitivity, specificity, positive and negative predictive values, using the ultrasound diagnosis as the gold standard. The sample consisted of 78 neonates hips with female’s predominance. With comparative sound transmission test was obtained Kappa intra observer 0.80, Kappa inter observer 0.93, sensitivity 45.45%, specificity 96.27%, positive predictive value 66.67% and negative predictive value 91.49%;with comparative sound transmission with extension/flexion, was 0.83, 0.92, 72.73%, 95.52%, 72.73%, and 95.52%, respectively. The tests compared the sound transmission help better diagnose developmental dysplasia disease of the hip.

Role of Ultrasound in Evaluation of Developmental Dysplasia of the Hip in Infants

Background/Aim: The present study was directed to investigate the accuracy of ultrasound (USG) in early detection of developmental dysplasia of the hip (DDH) to prevent permanent complications. Material & Methods: A total of 276 infants was investigated;their ages range from 1 - 6 months. Patients referred from the clinic based on clinical assessment (mainly Barlo & Ortolani maneuvers). Then the patient’s hips were examined by expert radiologists in USG scan. After that, dynamic (coronal and transverse) & static ultrasound views evaluated by the same radiologist using Graf’s criteria. Infants with abnormal ultrasound findings suggestive of DDH were followed up after 4 - 6 weeks by the same investigator to monitor the progress. At the same time, the patient referred to a specialist for conservative management from the first positive findings. Results: Among the 276 referred patients, infants with normal stable hips (Graf Type I and Type II a+) were 221 (80%), 155 of them were female and 66 male infants. Infants with unstable hips based on Graf’s criteria (Type II a-, II b, II c and Type III a) were 55 (20%). Out of 55 with abnormal findings, the affected hips on both sides, right and left were: 5 cases (1.8%), 7 (2.5%) and 43 hips (15.5%) consecutively. Out of 55 infants affected;3 referred to tertiary centers for further surgical management while 52 managed conservatively. Conclusion: Delayed treatment rates of DDH and complications could be reduced by the usage of the USG after the first month of life. In addition to physical assessment, USG for high-risk infants will provide more accurate diagnosis and minimize complications.

Developmental Dysplasia of the Hip: Management of Graf IIa Dysplastic Hip

Developmental Dysplasia of the Hip (DDH) describes a wide range of anatomic abnormalities of the growing hips which might result in permanent abnormal gait. Therefore, early detection and management is crucial to improve the outcome and minimise the risk of osteoarthritis in later life. Hip ultrasound is used to evaluate DDH based on Graf classification. Graf score is a widely used ultrasound grading score to evaluate DDH in infants. There is conflicting evidence regarding the management of the developmentally immature Graf type IIa hip. Some physicians adopt watchful waiting for natural maturation of hips while other early treatment. This article will provide an evidence-based review on the management modalities of the Graf type IIa hip.

Total Hip Arthroplasty in Neglected Developmental Dysplasia Hip, a Case Report

Developmental dysplasia of hip is a disorder of abnormal development of the hip joint resulting early osteoarthritis of the hip. In late stage of disease, total hip arthroplasty is the option to reduce pain. Total hip arthroplasty in development dyplastic hip is a very challenging procedure in view of abnormal anatomy and biomechanic of the hip. A proper pre-operative planning is important of successful surgery. We report a case of a 60-year-old woman with neglected DDH with severe hip pain, who underwent total hip replacement with good result.

Revision of Outcomes and Complications Following Open Reduction, and Zigzag Osteotomy Combined with Fibular Allograft for Developmental Dysplasia of the Hip in Children

Background: Reports of the efficacy of open reduction and Zigzag Osteotomy combined Fibular Allograft (ZOFA) for developmental dysplasia of the hip. The purposes of this study were to evaluate the long-term outcomes and complications after surgery. Methods: We performed a retrospective match-controlled study in which 158 patients had 181 hips with developmental dysplasia of the hip. Radiographs were found of acetabular index, height of dislocation, T&ouml;nnis grade, abduction angle in the spica cast, and Severin grade. At final follow-up, deformity of femoral head or neck or acetabulum was evaluated according to the Severin. Avascular necrosis was rated according to Kalamchi. Clinical evaluation was made according to modified McKay criteria. Results: Between 2009 and 2012, 133 girls (84.2%) and 25 boys (15.8%) with developmental dysplasia of the hip underwent open reduction and ZOFA;135 (85.4%) were unilateral, and 23 (14.6%) were bilateral. Patients were divided into 2 groups: group 1 included 54 patients (62 hips) aged 12 months - ≤18 months and group 2 included 84 patients (119 hips), aged >18 months - ≤36 months. According to T&ouml;nnis system: type 3 appeared in 127 hips (70.2%), and Type 4 in 54 hip (29.8%). The anterior approach was used to expose inner table of the ilium and ZOFA in all cases. Acetabular index was improved;preoperation was 42.95°, and latest follow-up 17.26°. The Kirschner Wires (KW) were not used to fix the fibular allograft at the pelvic osteotomy site. All of the fibular allografts were completely incorporated in mean time of 14 weeks (range, 12 weeks - 17 weeks) post-surgery. Clinical evaluation according to modified McKay criteria: satisfactory result (excellent and good) was achieved in 141 hips (77.9%). Avascular Necrosis (AVN) happened in 61 hips (33.7%), redislocation in 18 hips (9.9%), coxa vara in 4 hips (2.2%), trendelenburg gait in 4 hips (2.2%), and supracondylar femoral fractures in 2 hips (1.1%). Conclusions: On the basis of this study, ZOFA was strength and graft was not resorption, graft problems;without medial displacement of the distal fragment. Acetabular index was improved, without KW problem. Surgical technique with ZOFA did not expose outer table of the illium, limiting abductor muscle injury with negative trendelenburg gait;on the other hand, the blood loss from this procedure is acceptable. Some complications have been seen in this study: AVN, redislocation, coxa magna, coxa vara, trendelenburg gait, and distal femoral fracture.

CroweⅢ-Ⅳ型DDH患者全髋关节置换术后不满意及相关因素分析

目的:探讨全髋关节置换术的CroweⅢ-Ⅳ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者的满意度及造成不满意的相关因素。方法:回顾性分析2013年3月至2018年3月行全髋关节置换术的169例CroweⅢ-Ⅳ型DDH患者,通过微信进行调查问卷,调查患者对手术总体满意度、10项日常功能满意度和患者认为对自己日常生活影响比较大的前5个问题。手术前后采用髋关节Harris评分进行功能评价。结果:收到完整调查问卷145份,所有患者获随访,时间1~5(3.23±1.22)年。145例患者分成两组,其中对手术疗效满意的118例,不满意的27例,手术总体满意率81.38%(118/145)。患者认为对生活影响比较大的前5个问题分别是术后髋部疼痛,肢体明显不等长、行走、上下楼梯、蹲起。两组术前Harris评分比较,差异无统计学意义(P>0.05),不满意组术后Harris评分较低。术后髋关节疼痛、肢体不等长是影响手术不满意的直接因素。结论:采用全髋关节置换术治疗CroweⅢ-Ⅳ型DDH患者手术难度大;术后髋关节疼痛(轻度以上),肢体不等长(>2 cm)是术后不满意的独立危险因素。

自体股骨头结构植骨重建髋臼辅助THA在改良CROWE Type ⅣB型DDH中的临床疗效分析

目的:分析和总结自体股骨头结构植骨重建髋臼辅助全髋关节置换术(total hip arthroplasty,THA)治疗改良Crowe TypeⅣB型成人髋关节发育不良性脱位(developmental dysplasia of the hip,DDH)患者的临床疗效。方法:按照改良Crowe分型,选取山东大学齐鲁医院德州医院关节外科2015年8月至2023年3月收治的TypeⅣB型DDH患者26例,其中男25例,女1例,采用自体股骨头结构植骨重建髋臼辅助THA,记录患者手术时间、术中失血量、术中术后输血量、术后血红蛋白、手术相关并发症和骨愈合时间等,并行骨盆正位X线片了解假体位置、假体骨长入、假体松动以及骨愈合情况等,采用视觉模拟评分表(visual analogue scale,VAS)评价髋关节的疼痛不适,采用髋关节Harris评分和Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)来评价髋关节功能及临床疗效。结果:所有患者的平均随访时间(9.73±8.35)个月,术中出血平均为(715.38±143.37) mL,术中平均输血(415.38±282.41) mL,手术时间平均为(118.62±18.27) min,术后平均输血为(192.31±236.51) mL。所有患者转子下骨端、自体股骨头和假臼之间均骨愈合良好。髋关节VAS评分从术前6.73±0.45,至术后末次随访时VAS评分1.73±0.53,差异有统计学意义(P=0.000),髋关节活动度均较术前明显改善,髋关节Harris评分从术前24.27±1.66,至术后末次随访时Harris评分74.77±2.89,差异有统计学意义(P=0.000),WOMAC术前术后评分分别为130.08±5.72和67.85±3.23,差异均有统计学意义(P=0.000)。结论:自体股骨头结构植骨重建髋臼辅助THA治疗改良Crowe TypeⅣB型DDH,具有操作相对简单、固定牢固、手术相对安全和疗效确切的优点。

髋臼内陷技术对成人DDH全髋关节置换术髋臼杯生物力学影响的有限元分析

目的 探讨髋臼内陷技术对成人发育性髋关节发育不良(developmental dysplasia of the hip, DDH)髋关节置换术后髋臼假体的生物力学效应。方法 获取1名成人单侧DDH患者双侧髋关节CT图像数据,进一步构建患侧半骨盆有限元模型。在此基础上,建立臼杯不同内陷水平的有限元模型,对比分析原位组和不同水平内移组之间的生物力学差异。结果 在模拟拔出试验中,原位组最大抗拔出载荷强度为1 166 N;相比原位组,4 mm和8 mm内移组抗拔出载荷强度分别增加了45.8%和57.1%;原位组髋臼假体在步态周期站立位相载荷工况下臼杯-骨界面最大微动为166.4μm,内移4 mm及8 mm组相对原位组分别减少了46.2%和62.1%。对于臼杯植入后髋臼周围即刻应力分布,不同组别之间的差异并不显著;而在步态周期站立位相载荷工况下,原位组髋臼周围平均应力及峰值应力均最小,平均应力随内移程度的增加而增大,内移4 mm组峰值应力最高。结论 相较原位植入假体,髋臼内陷技术可以提高假体初始稳定性,稳定性和内移程度成正比。但内移程度不足导致骨覆盖面积不足时,臼杯-骨界面边缘应力显著增加,可能会导致假体相关并发症风险的升高。

3D打印模型及模拟手术在DDH全髋关节置换术中的应用效果

目的观察3D打印模型及模拟手术在发育性髋关节发育不良(developmental dysplasia of the hip,DDH)全髋关节置换术(total hip arthroplasty,THA)中的应用效果。方法以2020年8月至2022年10月联勤保障部队第九二二医院骨一科收治的60例DDH患者作为研究对象,采用随机数字表法进行分组,每组各30例。A组按照常规操作完成THA术,B组采用3D打印技术制作患髋实体模型进行手术方案设计和模拟手术。A组男13例,女17例;年龄36~69岁,平均(54.81±7.03)岁。B组男10例,女20例;年龄35~70岁,平均(52.09±7.44)岁。比较两组手术指标、术后恢复指标、术前及术后假体匹配率、术中股骨劈裂骨折发生率、术后髋臼-股骨联合前倾角、并发症发生率、术前及术后4周髋关节功能[Harris髋关节评分(Harris hip score,HHS)]。结果B组术中出血量较A组少,手术时间、术后下地时间、住院时间较A组短(P<0.05);B组术前、术后假体匹配率(90.00%)较A组(30.00%)高,术中股骨劈裂骨折发生率(0.00%)较A组(50.00%)低(P<0.05);术后4周,两组HHS评分均较术前上升(P<0.05),组间对比差异无统计学意义(P>0.05);两组术后髋臼-股骨联合前倾角比较差异无统计学意义(P>0.05);两组患者术后均未出现股神经及坐骨神经损伤、假体松动及脱位、肺栓塞、下肢深静脉血栓、假体周围骨折、关节感染等并发症。结论3D打印模型及模拟手术应用于DDH患者THA术中效果确切,能提高假体匹配率,降低术中股骨劈裂骨折发生率,缩短手术时间,减少术中出血量,促进康复,值得临床推广应用。

DDH患儿不同体位超声PFD测量及其应用价值

目的探讨髋关节发育不良(DDH)患儿不同体位超声耻骨-股骨距(PFD)测量及其应用价值。方法前瞻性选取2019年5月至2022年5月长安医院收治的102例DDH患儿作为观察组,同时选取80例健康体检者作为对照组。所有受检者均经超声检查,测量并比较两组受检者的PFD值、骨缘覆盖率、基线与骨顶线的夹角α,比较两组受检者不同性别的左、右髋部PFD差值(ΔPFD);同时比较观察组单侧、双侧DDH患儿的ΔPFD情况;采用受试者工作特征曲线(ROC)评估α角、骨缘覆盖率、PFD各指标对DDH患儿的诊断价值。结果观察组患儿中双侧患病38例,单侧病患64例,共145患髋;女性121髋,男性24髋;左侧88髋,右侧57髋;根据超声检查可知GrafⅡa型42髋,GrafⅡb型17髋,Graf C型18髋,Graf D型20髋,GrafⅢ型25髋,GrafⅣ髋23髋。观察组患儿的PFD为(6.33±1.54)mm,明显大于对照组的(3.28±0.27)mm,差异有统计学意义(P<0.05)。观察组患儿的α角(51.25±6.87)°、骨缘覆盖率(36.32±10.36)%,明显小(低)于对照组的(69.45±10.18)°、(65.45±9.15)%,差异均具有统计学意义(P<0.05)。观察组患儿的ΔPFD为(3.43±0.78)mm,明显高于对照组的(0.58±0.17)mm,差异有统计学意义(P<0.05);观察组中男性和女性患儿ΔPFD分别为(3.43±0.54)mm、(3.58±0.97)mm,明显高于对照组[男性(0.53±0.14)mm、女性(0.58±0.17)mm],差异均有统计学意义(P<0.05),而观察组中男性与女性患儿的ΔPFD比较差异无统计学意义(P>0.05)。观察组单侧患儿的ΔPFD为(3.46±0.45)mm、双侧患儿为(3.28±1.07)mm,明显高于对照组的(0.58±0.17)mm,差异均有统计学意义(P<0.05),而观察组中单侧与双侧DDH患儿的ΔPFD比较差异无统计学意义(P>0.05)。经ROC分析结果显示,α角、骨缘覆盖率、PFD诊断DDH患儿的特异性分别为91.3%、88.2%、99.3%,敏感性分别为78.2%、69.6%、90.6%(P<0.05)。结论不同体位超声PFD测量有助于DDH患儿的筛查诊断,且髋PFD差值与患儿性别相互独立,可为DDH疾病诊疗提供客观指导。

Graf法婴儿髋关节超声检查规范解读进展

发育性髋关节发育不良(developmental dysplasiaof the hip,DDH)是最为常见的骨关节畸形之一,它是指婴儿出生时就存在或者生后继续发育表现出来的一系列髋关节异常的总称:包括髋臼发育不良的稳定髋关节、髋关节半脱位、髋关节完全脱位但可以复位、完全脱位且不能复位[1],奥地利小儿骨科教授Reinhard Graf开创了发育性髋关节发育不良超声检查的静态方法,具有可重复性、规范化、标准化及参考指标客观等优点,因此在全世界被广泛采用。Graf法超声检查的应用使DDH的检查时间窗提前,可以在更早发现此病,从而进行更早期干预,使患者恢复健康,不留后遗症。但由于对Graf法认识不透彻,出现了一些“改良Graf法”,影响诊断准确性及检查可重复性,2013年Graf更新了最新的检查质控要求及操作诀窍和技巧,同时归纳了常见错误原因[2]。本文旨在对Graf法婴儿髋关节超声检查规范解读进行综述。

双轨正性暗示在发育性髋关节发育不良患者手术室等候期间的应用研究

目的 探讨双轨正性暗示在发育性髋关节发育不良(DDH)患者手术室等候期间的应用效果。方法 选取医院2021年8月-2023年10月拟行手术治疗的DDH患者108例,以随机数字表法分为对照组(54例)、观察组(54例);对照组于手术室等候期间行常规护理,研究组基于对照组行双轨正性暗示护理;对比两组生理应激反应、焦虑程度、心理等候时间及满意度。结果 观察组麻醉成功时心率(HR)、平均动脉压(MAP)较对照组低,差异有统计学意义(P<0.05);观察组入手术室时、术后1d焦虑自评量表(SAS)评分较对照组低,差异有统计学意义(P<0.05);观察组心理等候时间较对照组短,总满意度较对照组高,差异有统计学意义(P<0.05)。结论 DDH患者手术室等候期间采用双轨正性暗示护理可减轻生理应激反应,改善焦虑程度,缩短心理等候时间,提高满意度。