超声评价异常体征合并发育性髋关节发育不良高危因素婴儿的髋关节发育状况

目的 :应用Graf髋关节超声诊断技术评价有异常体征合并发育性髋关节发育不良(DDH)高危因素婴儿髋关节的发育状况。方法:对我院488例临床体检提示有臀纹或大腿纹不对称、下肢长度差异、髋外展受限等异常体征同时合并其他DDH高危因素(女性、胎位为臀位、家族史或伴有其他骨骼肌肉畸形等)的婴儿行髋关节超声检查。采用Graf法和Graf髋关节病理分型对筛查结果进行统计和分析。结果:976个受检髋关节中,Ⅰ型髋关节914个,占93.6%;Ⅱ型49个,占5.0%,其中ⅡA型25个,ⅡB型13个,ⅡC型11个;D型4个,占0.4%;Ⅲ型7个,占0.7%;Ⅳ型2个,占0.2%。其中不成熟髋和DDH髋62个,检出率6.4%。结论 :超声能对有异常体征合并DDH高危因素婴儿髋关节的发育状况进行准确的定性评价,并能比较不同高危因素婴儿之间DDH发病率的差异性。     

兰州市0～6月龄婴儿髋关节发育不良筛查现状分析

目的 :了解本地区0~6月龄婴幼儿髋关节发病情况,明确早期超声筛查在发育性髋关节发育不良(DDH)诊断中的重要意义。方法:选取0~6月龄的婴儿共10 139例,行髋关节超声检查。采用Graf标准作为诊断分型标准。结果:10 139例中DDH 1 372例(1 576侧髋),男579例(42.2%),女793例(57.8%),其中Ⅱ型1 527侧髋(96.9%),Ⅲ型31侧髋(2.0%),Ⅳ型18侧髋(1.1%)。Logistic多因素回归分析显示,DDH患病率无明显性别差异(P0.05),羊水过少、剖宫产及臀位均为DDH的危险因素(均P0.05)。结论 :婴儿出生后42 d~3个月行髋关节超声检查,有利于DDH的早期诊断和治疗。     

超声波筛查在婴儿发育性髋关节异常早期诊断中的临床意义

目的探讨超声波筛查在婴儿发育性髋关节异常(developmengtal dysplasia of the hip,DDH)早期诊断中的临床意义。方法利用Graf法扫描200例正常婴儿髋关节及200例疑似DDH患儿,观察其髋臼窝的骨性结构、髋臼窝的骨性缘、髋臼软骨纤维盂唇形态,并测量髋关节α角、β角,计算股骨头骨性髋臼覆盖率。结果超声检查能够清楚显示髋关节及其周围组织的解剖结构。与髋关节正常(n=328)相比,髋关节异常(n=72)患儿髋关节α角明显减少(49.3±5.8vs 62.4±7.2),β角明显增大(56.0±7.3vs 45.1±6.2),股骨头骨性髋臼覆盖率显著降低(41.5±8.2vs 61.4±5.9),P0.05,差异有统计学意义。结论超声波筛查具有操作简便、安全实用等特点,能够为DDH的早期诊断提供可靠的理论依据,值得临床推广。     

5227例婴儿发育性髋关节发育异常筛查结果的回顾性分析

目的 :评估产次、胎位、分娩方式对婴儿发育性髋关节发育异常(DDH)发病的影响。方法 :回顾性分析于我院行DDH超声筛查婴儿5 227例(10 454个髋关节),记录其性别、年龄、胎次、胎位、分娩方式,依据Graf分类法将超声筛查结果分为正常和异常髋关节(发育不良、半脱位、脱位),并行统计分析。结果:5 227例,共10 454个髋关节,其中第1胎DDH的检出率为4.47%(284/6 350)高于第2胎(3.05%,125/4 104)(χ~2=15.08,P0.01);臀位DDH检出率9.05%(42/464)较头位(3.67%,366/9 968)明显高(χ~2=34.15,P0.01);剖宫产DDH检出率5.33%(196/3 678)高于自然分娩(3.14%,213/6 776)(χ~2=27.51,P0.01)。结论 :产次、胎位、分娩方式均是影响DDH的因素,而臀位的影响更显著,可提示DDH的超声筛查。     

婴幼儿发育性髋关节异常的早期X线诊断

目的 探讨婴幼儿发育性髋关节异常( developmental dysplasia of hip,DDH)的早期X线诊断.方法 临床可疑DDH婴幼儿185例,分别摄髋关节正位与Von Rosen's位,通过在X 线片上绘制Perking's方格,Rosen's 线,Shenton's线,测量髋臼指数等方法判断髋关节发育情况.结果 185例临床可疑DDH患儿,正常范围171例,发现单侧异常12例,双侧异常2例.结论 用髋关节正位结合Von Rosen's位摄片可以早期诊断婴幼儿发育性髋关节异常.     

婴幼儿髋关节发育不良的超声筛查临床分析

目的 探讨婴幼儿髋关节发育不良的超声检查的临床价值。方法 选取105例婴幼儿(210侧髋关节)行超声检查，分析髋关节发育不良的发病影响因素。结果 本组105例婴幼儿，共210侧髋关节，其中异常的髋关节12侧，占5.71%(12/210);其余均为正常关节。双侧均无异常的患儿95例，至少有一侧异常患儿10例，诊断为髋关节发育不良12侧，占5.71%(12/210)。在被检者有临床体征29例中检出异常髋关节4例，占13.79%(4/29),其余则从无异常体征者中检出，占比6.90%(2/29);髋关节发育不良患儿的α角、股骨头覆盖率均低于正常髋关节，β角高于正常髋关节，差异有统计学意义(P<0.05);在异常髋关节中6.67%(7/105)位于左侧，4.76%(5/105)位于右侧，不同侧别检出异常髋关节的几率相比差异无统计学意义(P>0.05);本组被检者中男性检出异常髋关节的几率为6.12%(3/49)明显低于女性12.5%(7/56),二者比较差异有统计学意义(P<0.05)。结论 应用高频彩色多普勒超声检查能够有效评估髋关节发育状况，可作为早期筛查的主要手段。     

超声对先天性肌性斜颈伴发育性髋关节异常的诊断价值

目的 :探讨超声对先天性肌性斜颈(CMT)伴发育性髋关节异常(DDH)的诊断价值。方法 :回顾性分析176例CMT患儿超声检查时双侧胸锁乳突肌(SCM)厚度、髋关节Graf分型及临床相关资料,将其分为CMT+DDH组和CMT组进行对照分析。结果:CMT+DDH占11.4%(20/176);2组性别比、两者发病方向差异均无统计学意义(均P0.05);CMT+DDH组双侧SCM厚度差值和双侧SCM厚度比率均明显高于CMT组(均P0.05);分别以双侧SCM厚度差值≥0.74 cm和双侧SCM厚度比率≥0.24为临界值,预测DDH的敏感度分别为50.0%和45.0%,特异度分别为77.6%和83.3%。结论:CMT和DDH有一定共存比例,超声显示双侧SCM厚度差值和厚度比率对CMT伴DDH具有预测价值,是早期诊断CMT与DDH的重要依据。     

新生儿及婴儿早期髋脱位及髋发育不良的X线诊断应用研究

目的探讨婴儿髋关节脱位(CDH)及髋关节发育不良(DDH)的早期X线诊断方法。方法经临床随访证实的26例CDH及DDH婴儿47个患髋和30例正常婴儿60个正常髋关节用X线对照的方法寻求婴儿早期CDH及DDH诊断方法,统计学卡方检验。结果(1)婴儿早期正常髋臼形态为清晰的“一”字形,模糊“一”字形或形态不清应视为异常,敏感度为100%,特异度为91.59%,准确度为85%。统计学比较显示P<0.05;(2)3个月以内婴儿正常髋臼指数应<30°;(3)研究组的47个患髋中闭孔线阳性18髋(其中10髋为CDH),阴性29髋,对照组30例60个正常髋闭孔线阳性2髋,阴性58髋,敏感度为38.3%,特异度为96.7%,准确度为71.1%。统计学比较显示P<0.05;(4)研究组26例47个患髋股骨颈轴线阳性10髋(后均证实为CDH),可疑17髋(后证实13髋为DDH),阴性20髋,对照组30例60个正常髋股骨颈轴线阳性1髋,可疑0髋,阴性59髋,敏感度为57.45%,特异度为98.33%,准确度为80.37%。统计学比较显示P<0.001。结论闭孔线结合股骨颈轴线可诊断新生儿及婴儿早期CDH;髋臼形态异常可提示DDH。     

超声在小儿发育性髋关节异常筛查及吊带治疗中的应用

目的探讨超声筛查小儿发育性髋关节异常(DDH)和在吊带治疗疗效评估方面的应用价值。方法选取本院收治的DDH患儿68例为研究组,患儿初诊及吊带治疗后均行超声检查,另纳入同期疑似DDH经超声检查的正常小儿68例为对照组;对比初诊时2组骨顶角(α)、软骨顶角(β)的大小,统计研究组患儿的Graf分型结果,对比研究组吊带前后α、β角及左右股骨头内侧缘与耻骨联合中点间隔长度的差值(d),分析研究组患儿吊带的疗效情况。结果研究组患儿的α角比对照组小儿更小,β角则更大,差异有统计学意义(P<0.05);研究组68例患儿共计患髋75个,Ⅱa型22个、Ⅱb型30个、Ⅱc型9个、Ⅱd型12个Ⅲ和Ⅳ型各1个。与治疗前相比,研究组患儿吊带后α角明显变大,β角明显变小,d值也明显变小,差异有统计学意义(P<0.05)。研究组患儿经吊带治疗后,69个患髋转为Ⅰ型,治愈率为92%。结论超声不仅对小儿发育性髋关节异常筛查有重要作用,在经吊带治疗后患儿的随访监测中也有较高的临床意义。     

高频超声Graf法与Terjesen法对发育性髋关节发育不良诊断一致性研究

目的 探讨Graf超声检查法和Terjesen超声检查法在发育性髋关节发育不良(DDH)诊断中的诊断一致性.方法 回顾性分析2019年1月至6月,在我院超声科行DDH检查的婴幼儿共108例,其中男孩41例,女孩67例,共216个髋关节.每位进行DDH检查患儿均进行双侧髋关节扫查.参照Graf方法,测量α角度及β角度,再...     

Initial results from an ultrasound screening program for the detection of developmental dysplasia of the hip in girls

Purpose

To determine the value of US screening for detection of developmental dysplasia (DDH) in girls in the setting of a multi-disciplinary program in pediatric orthopedics.

Materials and methods

Systematic US evaluation of the hips using the Couture technique was performed at 1 month in all girls with normal physical examination at birth over a 1 year period. The examinations were classified as normal or abnormal (DDH [acetabular depth > 6 ], asymmetrical pelvis, borderline hips). Results were correlated with risk factors and clinical outcome. Girls with abnormal hips were immediately treated.

Results

One thousand one hundred and sixty-six girls were screened. A total of 4.7% of ultrasound examinations were abnormal. The rate of pathological hip was 3.7% in the absence of risk factors and 8.9% in the presence of risk factors. A total of 63.6% of girls with abnormal ultrasound examination had no risk factor. Two risk factors were correlated to the presence of DDH: family history (RR = 3.12) and clinical abnormalities (RR = 2.55). The rate of pathological hip that were referred for treatment was 3.1%. All hips were normal at 5 months.

Conclusion

Ultrasound screening evaluation of the hip in girls at 1 month, in the setting of a multi-disciplinary program in pediatric orthepedics clinic, is feasible. A total of 74 abnormal hips undetected at the initial clinical evaluation in girls without risk factor were detected and treated. Systematic screening of girls for DDH must be further assessed to better determine its impact on the incidence of delayed diagnosis of DDH.     

Ultrasound in the diagnosis of developmental dysplasia of the hip in newborns. The European approach. A review of methods, accuracy and clinical validity

Based on soft evidence that ultrasound screening tends to reduce the rate of late developmental dysplasia of the hip (DDH) and the need for surgical interventions, different screening strategies including universal or selective ultrasound screening have been established in several European countries and centres during the last decade. We performed an extensive search for articles on ultrasound diagnosis of developmental dysplasia of the hip over the last 26 years. A few studies reported an adequate repeatability for the static [Graf, Morin, modified Morin (Terjesen)] and for the combined static/dynamic methods [modified Graf (Rosendahl)], while no such reports were found for the dynamic (Harcke) ultrasound techniques. The effect of newborn ultrasound screening on late DDH have been addressed in two randomised trials (RCTs), both concluding that both selective and universal ultrasound screening tend to reduce the prevalence of subluxed or dislocated DDH, thus without reaching statistical significance. Finally, several observational studies have shown that morphologically normal hips tend to remain normal with or without a co-existing instability, and 97% of sonographically immature hips tend to normalise spontaneously within 3 months. Two studies report on a similar pattern for mildly dysplastic, but stable hips. From the data available we suggest that selective ultrasound screening is worthwhile in areas with a high prevalence of late cases, given a well-organised, high-quality service can be provided.     

Pubo-femoral distance: an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip

Objectives

To propose an easy and reproducible sonographic screening test able to avoid late presentation of developmental dysplasia of the hip (DDH).

Methods

The pubo-femoral distance (PFD) cut-off point was determined on 980 infants who underwent ultrasonography of the hips in comparison with the final diagnosis, based on clinical, ultrasound data and follow-up. PFD reproducibility was tested on 52 hips by both an experienced and an inexperienced radiologist. After teaching this screening method to general radiologists, its impact was evaluated by analysing the rate of late diagnosis in an entire administrative area.

Results

An abnormal PFD threshold above 6 mm gave a sensitivity of 97.4 % for the diagnosis of DDH (271 hips) and a specificity of 84 %. Sensitivity increased to 100 % when taking into consideration children of 1 month or older. The PFD measurement stayed reproducible even in inexperienced hands (k?=?0.795). For 3 years, following the extension of screening to all female infants, there was no late diagnosis of DDH in girls in amongst a catchment area of 1 million inhabitants.

Conclusions

PFD measurement with a threshold for abnormality of 6 mm at the age of 1 month, without asymmetry above 1.5 mm, could eradicate DDH late diagnosis.

Key Points

? Late diagnosis of developmental dysplasia of the hip (DDH) should be avoidable ? Pubofemoral distance (PFD) is a reproducible measurement of hip instability ? PFD > 6 mm or a difference > 1.5 mm should lead to expert referral ? Universal screening using PFD at 1 month could eradicate DDH late diagnosis     

Anterior dynamic ultrasound and Graf's examination in neonatal hip instability

Background: Discrepancy between neonatal hip morphology and stability has been reported in the literature. Comparative ultrasound studies on this issue are limited.

Purpose: To compare neonatal hip instability, as assessed by dynamic ultrasound and clinical examination, with acetabular morphology, as assessed by Graf's method.

Material and Methods: 536 newborn infants with clinical signs of hip instability, ambiguous findings at clinical hip examination, or positive risk factors for DDH were investigated with two ultrasound methods, the Graf method and anterior dynamic ultrasound, at an average age of 12 days. The hips were allocated to three groups according to the Graf result: A, normal (type Ia and b); B, borderline or immature (type IIa); and C, pathologic (type IIc and worse). Graf examination was compared with two diagnostic tests for instability, namely clinical examination by senior pediatric orthopedists and anterior dynamic ultrasound.

Results: According to Graf's method, 77% of the hips were normal, 20% borderline/immature, and 3% pathologic. On clinical hip examination, 82% were stable, 14% unstable, and 4% dislocatable. The dynamic ultrasound outcome was 88% stable hips, 10% unstable, and 2% dislocatable. Of the hips considered unstable or dislocatable on dynamic ultrasound, 21% had normal (type I) and 66% immature acetabular morphology according to the Graf method. Of the hips that were stable on dynamic ultrasound, only one (0.1%) was dysplastic according to the Graf method. Graf's examination showed the smallest number of normal hips, but also the fewest pathologic hips, with many indeterminate results that needed follow-up.

Conclusion: Acetabular morphology correlated better to stability as assessed by dynamic ultrasound than to the clinical examination results, with fair to moderate agreement. Graf's examination resulted in a large number of indeterminate results that needed follow-up, but when used as the sole criterion for deciding treatment did not lead to a higher treatment rate than when the decision was based on clinical hip examination.     

Echography of the hip in the newborn. 1507 cases

The authors report the data relative to 1507 infants studied with clinical and US examination, in the neonatal period, in order to exclude hip dysplasia or dislocation. US examination was carried out according to Graf's technique and the newborns were classified according to US hip type, to clinical examination and to possible risk factors. The patients were included in a protocol including orthopedic and US controls. Seventeen treated infants were considered as pathologic. Ten of them had IIc or D hips at birth; the other 7, with IIa hips at birth, presented a X-ray pathologic hip after the 4th month of life. At about one year of age all infants could normally walk, except for one who was being treated with harness. No statistically significant differences were observed between the number of pathologic infants in the risk group (1.7%) and that in the no-risk group (0.8%). Clinical examination of the newborn has low sensitivity in detecting pathologic hips. On the basis of their results, the authors believe US examination of the newborn to be a valuable screening method to diagnose hip dysplasia/dislocation. Moreover, Graf's morphologic method is the best one for US screening of the hip in the neonatal period.     

Neonatal hip instability: a prospective comparison of clinical examination and anterior dynamic ultrasound

Background: Ultrasound is increasingly being used to complement the clinical examination in assessing neonatal hip instability. The clinical examination, although highly sensitive in detecting hip instability, can lead to considerable overtreatment.

Purpose: To compare anterior dynamic ultrasound and clinical examination in the assessment of neonatal hip instability and regarding treatment rates.

Material and Methods: 536 newborn infants (out of a population of 18,031) were selected, on the basis of a combination of risk factors, clinical signs of hip instability or ambiguous clinical findings, to undergo an anterior dynamic ultrasound examination of the hip, by a method developed by our group. This examination, performed by one out of seven experienced examiners, was compared with the standard clinical hip examination conducted by one of four pediatric orthopedic surgeons. The clinical examination was carried out both prior to and within a few hours after the ultrasound examination.

Results: The clinical examination diagnosed 81.7% of the hips as normal, 14.5% as unstable, and 3.8% as dislocatable or dislocated. With the dynamic ultrasound method, the corresponding figures were 87.8%, 10.4%, and 1.8%, respectively. Use of the criteria of the clinical examination resulted in treatment of 147 infants. Using the dynamic ultrasound examination as a criterion meant that 87 infants would receive treatment. The calculated treatment rate was 0.85% when based on the clinical stress test and 0.49% when based on the dynamic ultrasound.

Conclusion: The dynamic ultrasound results reduced the treatment rate by over 40% when used as a basis for the decision regarding treatment.     

Developmental hip dysplasia and hip ultrasound frequency in a large American payer database

Developmental dysplasia of the hip (DDH) is an important contributor to musculoskeletal morbidity, but effective strategies to screen for DDH remain controversial. The current utilization of hip ultrasound (US) screening for DDH in the United States is not defined. This study utilized Optum's de-identified Clinformatics® Data Mart, a large commercial and Medicare Advantage claims database. The frequency of DDH and hip US utilization was estimated using billing data on an average of 2.9 million relevant beneficiaries included annually from 2007 through 2017. A total of 6806 DDH cases were identified with an average annual prevalence of 1.7 per 1000 infants, which was stable during the study period. Girls were more likely to be screened and diagnosed with DDH, comprising 72% of DDH cases with an OR of 2.55 (95% CI 2.42–2.69), p < 0.001. Hip US screening was employed in 0.9% of the infant population on average but increased substantially from 2007 (0.4%) to 2017 (2.2%). Most common billing diagnoses included hip deformity (27.4%), breech delivery (20.4%), and physical exam abnormality (17.7%). The average imaging costs per patient for all screened children was $108.94. Insurance claims reflect the current American practice of selective hip US with relative adherence to American Academy of Pediatrics guidelines based on reported diagnoses. While hip US utilization increased during the study period, prevalence of DDH diagnoses did not increase. Our results suggest that expansion of hip US screening may not effectively increase DDH detection although further investigation is needed to ascertain optimal screening strategies to improve patient outcomes.     

成人重度髋关节发育不良继发性骨关节炎的CT表现

目的:探讨成人重度髋关节发育不良继发性骨关节炎的CT表现.方法:对23例41个髋成人重度髋关节发育不良继发性骨关节炎的CT资料进行回顾性分析,男2例,女21例,年龄46～72岁,平均约52.2岁.结果:23例41个髋成人重度髋关节发育不良继发性骨关节炎的CT表现为41髋可见明显的髋臼发育不良(100%);其继发性骨关节炎表现为骨质增生硬化、软骨下假囊肿、关节间隙狭窄(100%);36髋可见髋关节再塑型(87.8%),即:发育不良的髋臼边缘骨质再生形成新髋臼,股骨头变形对应再生髋臼.所有病例均伴发邻近部位骨关节炎.结论:成人重度髋关节发育不良继发性骨关节炎的CT影像表现典型,髋关节再塑型是其特征性表现,反映了其生物力学的改建.