新生儿及婴儿发育性髋关节异常早期筛查及早期治疗的探讨

目的通过对新生儿及婴儿发育性髋关节异常的早期筛查,结合临床检查与超声检查诊断的评价,推动新生儿及婴儿发育性髋关节异常的早期诊治。方法对本院出生的1213例新生儿及866例年龄6个月以下婴儿进行临床及超声早期筛查（Graf方法）,以明确诊断,及时治疗。结果新生儿早期疑诊45例,最终确诊5例,婴儿确诊3例,经用Pavlik吊带治疗6例痊愈,1例6个月后行闭合复位石膏固定治疗。结论新生儿期超声检查髋关节不稳定率偏高（Graflla型髋）,发育性髋关节异常的早期筛查,特别是低于6个月的超声检查检出率高,各科医师合作有利于DDH的早期诊治。     

Pavlik吊带早期治疗发育性髋关节脱位的疗效观察

目的 报道Pavlik吊带早期治疗发育性髋关节脱位(developmental dislocation of the hip,DDH)的临床效果.方法 2005～2007年,应用Pavilk吊带早期治疗发育性髋关节脱位78例,57例资料完整,随访超过1年.其中,男19例,女38例,单侧34例,双侧23例,总共80例异常髋关节(左侧44髋,右侧36髋),平均诊断时间66.8d(5～122d).超声波分型:Graf Ⅱa/b17髋,Ⅱc 34髋,Ⅲ及以上29髋.治疗采用Pavlik吊带,定期超声波观察及吊带调整,至超声波正常后维持4周.若Pavlik吊带3周,超声波指标未好转,改用石膏治疗.随访最少至1岁,摄片评价髋关节发育情况及股骨头骨骺变化.结果 Pavlik吊带应用最短3周,最长5个月.21例(28髋)Pavlik吊带治疗直至超声指标正常,26例(38髋)Pavlik吊带使用超过年龄8个月后,继续使用支具治疗;4例(5髋)Pavlik吊带治疗超过年龄6个月后,改换石膏治疗;6例(9髋),3周后中断Pavlik吊带治疗,改换石膏固定.Pavlik吊带治疗总有效率82.46%.无股骨头AVN发生.7例(10髋)随访时髋臼指数大于25°;3例(4髋)随访至18个月,因AI大于25°,Shenton线连贯欠佳,接受了囊外Salter骨盆截骨手术治疗,手术治疗比率为5.26%.结论 Pavlik吊带早期治疗DDH显示,初始病变严重、治疗年龄超过7周将影响预后.超声波监测是做好早期治疗工作的重要保障.     

超声筛查婴儿发育性髋关节异常的临床价值

目的探讨超声检查在婴儿发育性髋关节异常（DDH）早期诊断及早期干预治疗中的应用及对预后的价值。方法对6个月内临床提示有臀纹不对称或髋外展及其它具有DDH高危因素的患儿进行超声检查。采用Graf测量方法对2150例新生儿和婴儿（4300个髋关节）进行测量;采用Graf制定的诊断标准并结合近几年国内外的实际使用标准将受检髋关节分为六大类（正常髋关节,髋关节位于临界状态,髋关节发育欠佳,髋关节发育不良,髋关节半脱位,髋关节脱位）;对超声检查非正常的患儿在经过相应的临床治疗后进行跟踪随访。结果4300个受检髋关节中正常髋关节约占85．53％,位于临界状态的髋关节约占3．05％,发育欠佳的髋关节约占6．93％,发育不良的髋关节约占3．10％,半脱位及脱位的髋关节约占1．39％。2150例受检者中阳性患儿共465例,其中112例接受了超声复查,105例患儿（93．75％）首次超声复查即提示病情明显好转,7例继续治疗;未接受超声复查的353例患儿中,绝大部分由于复查时年龄超过6个月而直接接受X线柃查,小部分失去随访。结论超声检查能对髋关节进行准确的定性和定量评估,可以在婴儿出生后6个月内进行,是婴儿发育性髋关节异常的有效筛查手段。     

Pavlik吊带治疗发育性髋关节发育不良终止时机的选择

目的探讨运用Pavlik吊带治疗发育性髋关节发育不良(developmental dysplasia of the hip, DDH)的终止时机。方法收集2014年至2019年广州市妇女儿童医疗中心采用Pavlik吊带治疗并达到超声或X线检查痊愈标准的45例(54髋)DDH患儿的临床资料。其中, 男6例(9髋), 女39例(45髋);年龄为(11.5±5.9 )周, 范围为1.4～25.7周;患侧为左侧占55.6% (25/45 ), 右侧占24.4 %(11/45), 双侧占20.0 % (9/45 );随访时间为(23.9±12.9)个月, 范围为12.0～61.5个月, Pavlik吊带治疗时长(3.2±0.7 )个月, 范围为2～6个月。所有患儿均接受Pavlik吊带治疗, 去除吊带时根据其接受的检查结果和达到的痊愈标准情况, 将患儿分为A组和B组, A组为Graf法超声检查提示髋关节恢复至Graf-Ⅰ型的患儿, 共35例(42髋);B组为X线检查提示髋关节恢复正常的患儿, 共10例(12髋)。观察患儿在去除吊带6个月后和末次随访时在髋关节X线正位片上测量的髋臼指数(aceta...     

新生儿发育性髋关节异常筛查结果分析

目的 探讨新生儿发育性髋关节异常(DDH)的发病情况.方法 选取2008年6月-2009年7月在本院住院和门诊就诊的762例足月新生儿(男382例,女380例).患儿均采用Graf法和Morin法相结合的超声检查手段进行髋关节测量.参照Graf分类方法将髋关节发育不良、髋关节半脱位和髋关节全脱位者定为DDH.对髋关节发育不良患儿采取随访观察,而对髋关节半脱位和髋关节全脱位的DDH患儿行早期Pavlik吊带治疗,同时采用超声跟踪随访6个月,以进一步决定治疗方案.结果 1.143例DDH新生儿中髋关节脱位的发病率为0.52%,髋关节发育不良的发病率为18.25%;2.健康新生儿619例髋关节超声测量指标α角、β角、股骨头覆盖率的正常值分别为(60.19±6.92)度、(45.25±7.29)度、(62.85±6.38)%,DDH患儿分别为(44.52±7.53)度、(58.45±10.36)度、(37.65±7.74)%,二组超声测量指标比较差异均有统计学意义(Pa<0.05);3.性别、胎位、分娩产式、左侧等均为髋关节脱位的高危因素.结论 1.超声检查是新生儿DDH筛查的首选方法.2.明确新生儿髋关节发育的指标、DDH的发病率及相关高危因素,有利于减少DDH发生,同时早期发现DDH、尽早治疗,可改善患儿预后.     

新生儿发育性髋关节异常的超声波筛查

目的报告新生儿超声波髋关节筛查的发病率调查结果。方法对上海某区3143例新生儿出生3～7d接受了超声波髋关节筛查，髋关节不稳定的患儿在出生28d时接受了复查，采用GrafR静态超声波髋关节检查方法和简化的分类标准对所有筛查结果进行了统计和分析。结果3143例新生儿，男1666例，3332例髋关节，占53．01％，女1477例，2954例髋关节，占46．99％。新生儿中检查正常的髋关节3002例，占新生儿总数95．51％，髋关节不稳定35例，占1．11％，最终被诊断为DDH新生儿106例，占3．37％，其中髋关节发育不良95例，髋关节半脱位8例，髋关节脱位3例。结论新生儿DDH超声波检查发病率为重视和开展早期防治提供了基本资料。     

婴幼儿发育性髋关节发育不良早期筛查和治疗

目的探讨开展婴幼儿发育性髋关节发育不良(DDH)的早期筛查和治疗的意义。方法选取2010年4月-2011年10月在本院进行婴幼儿体检时发现以大腿皮纹不对称为主要临床表现的18个月以下婴幼儿1 429例(男684例,女745例)进行严格的分组后,采用影像学检查方法对病例资料进行分析;同时对筛查检出的异常病例积极进行早期个体化干预治疗。结果初诊0～6个月婴儿检出的髋关节异常率为2.4%,对异常病例积极应用pavlik吊带保守治疗平均4个月后,治愈率达98.1%;初诊6～12个月婴儿检出的髋关节异常率为5.9%,早期应用个体化的治疗方法进行保守治疗,治愈率为64.7%;初诊年龄12～18个月的婴儿检出的髋关节异常率为52.9%,应用个体化方案保守治疗后,髋关节复位效果不满意,需要进一步行手术治疗。结论开展婴幼儿DDH早期筛查,并对DDH患儿进行早期个体化干预治疗具有重要的意义。     

婴儿髋关节发育异常的超声诊断

婴儿发育性髋关节发育不良（Developmental Dysplasia of the Hip , DDH）是儿童骨科的常见问题,国外报道发病率为0．2‰～2‰,我国各地发病率不同,南方较低,北方较高,为0．07‰～1．75‰。早期诊断、早期治疗已成为共识。早期正确诊断是早期正确治疗的前提。对于小于6个月,尤其是3个月以下的病例,由于髋关节大部分为软骨成分,X线检查提供诊断的依据很少,     

应用高分子绷带与Pavlik挽具治疗新生儿先天性膝关节脱位

目的介绍利用高分子绷带与Pavlik挽具治疗新生儿先天性膝关节脱位的方法。方法2004年6月～2005年6月收治6例(8膝)新生儿先天性膝关节脱位,其中4例(5髋)并有发育性髋关节脱位,均采用闭合复位、阶段性高分子绷带固定与Pavlik挽具治疗。结果6例(8膝)膝关节过伸消失、屈曲功能完全恢复,平均屈曲120°。结论本法对新生儿先天性膝关节脱位,尤其是合并有发育性髋关节脱位的患儿,疗效满意。     

脑性瘫痪并发育性髋关节异常59例

目的探讨脑性瘫痪（CP）患儿并发育性髋关节异常（DDH）的发生率,提高CP的康复治疗效果。方法对2003年1月～2006年12月本科确诊的CP468例患儿进行常规双髋关节的X线正位摄片,由放射科专业医师作出诊断报告,有髋关节异常者,由外科协助治疗,并对患儿进行随访,每6个月行1次X线正位片检查。结果468例CP患儿的髋关节异常率达12.6%,痉挛型CP患儿中并DDH59例（19.8%）,其中发育不良22例（7.38%）,髋关节脱位或半脱位37例（12.4%）。1岁以内的15例患儿予外展支具治疗,均治愈;〉2岁行手术治疗后,其治疗效果仍在随访。结论CP患儿存在发生DDH内在因素,对其应重视髋关节发育情况。超声波检查是早期发现髋关节发育异常的重要手段。     

Developmental dysplasia of the hip: Risk markers, clinical screening and outcome

Background: Early detection, diagnosis and treatment of developmental dysplasia/dislocation of hip (DDH) are essential in preventing further disability and quality of life impairment in children. DDH risk markers and association between the age of clinical screening and outcome, were evaluated.
Methods: Clinical screening at ages birth, 6 and 13 weeks was performed in 8145 infants by pediatricians. Infants suspected for DDH were referred to the community hospital clinic for clinical evaluation by a pediatric orthopedic surgeon, imaging procedures and follow up. Demographic and perinatal characteristics of the children with suspected ( n = 77) and diagnosed DDH ( n = 51) were compared to matched controls ( n = 154).
Results: The rate of suspected DDH was 0.95% and that of diagnosed DDH was 0.63%. Female gender, firstborn child and breech presentation were significantly more frequent among cases versus controls (odds ratio [OR]: 4.3, 2.7, and 6 respectively; P < 0.05). The highest positive predictive value (95.5%) in physical evaluation was any evidence of a dislocatable hip. The proportion of DDH among infants referred from the newborn department was significantly higher (OR, 4.4). DDH diagnosis after 6 weeks of age was associated with a higher likelihood of subsequent surgery and motor disability. Untoward outcome was significantly associated with increasing age of referral both at ages of 6 and 13 weeks ( P < 0.05).
Conclusions: Children with DDH have certain specific demographic and perinatal risk markers. Clinical screening targeted towards early diagnosis may lessen the need for surgical intervention and the risk of disability or motor handicap.     

高频超声对疑似发育性髋关节异常患儿髋关节发育的评估价值

目的 探讨常规静态超声在诊断临床疑似发育性髋关节异常患儿中的应用价值.方法对612名疑似发育性髋关节异常患儿的1 224个关节进行超声检查,依据 Graf法分型、Morin法评价关节的稳定性并动态追踪最终的发育结果.结果 临床疑似病例中,87.4%分类为I型形态学正常的髋关节,9.8%分类为Iia型生理不成熟型关节,8...     

Screening for developmental dysplasia of the hip: Results of a 7-year follow-up study

BACKGROUND: Screening for developmental dysplasia of the hip (DDH) is widely recommended for all infants to prevent disability from late diagnosis of dislocation of the hip. The present study evaluates the results of screening for developmental dislocation of hip in a clinic in Turkey over the course of 7 years. METHODS: Hospital records of 5798 infants who were examined regularly until walking age at Gazi University well child clinics between January 1995 and December 2001 were reviewed. Infants with known risk factors for DDH such as breech presentation, family history of DDH or swaddling, and of infants with physical examination findings suggestive of DDH, were referred to orthopedic surgeons for diagnosis. Based on this final diagnosis, sensitivity, specificity, positive and negative predictive values of risk factors and physical examination findings were calculated. RESULTS: Of the 5798 infants, risk factors were detected in the medical history of 111 infants, and in 14 infants a musculoskeletal deformity was detected. In 606 infants the physical examination findings were suggestive of DDH. Ten patients were subsequently diagnosed with DDH. The sensitivity, specificity, positive predictive value and negative predictive values of having a risk factor for DDH in history were 10.0%, 98.1%, 0.9%, 99.8%, and having abnormal hip examination findings were 100.0%, 88.9%, 1.6% and 100.0%, respectively. CONCLUSIONS: A careful history and physical examination is the cornerstone of DDH screening. Serial hip examinations performed during health examination visits provide an opportunity to identify DDH cases. The sensitivity of risk factors in history and physical examination findings together is high enough to be accepted as a screening tool.     

Value of limited hip abduction in developmental dysplasia of the hip

BACKGROUND: Developmental dysplasia of the hip (DDH) continues to be missed by routine physical examination in up to 50% of cases. Ultrasound (US) supplementation is the best method of screening for DDH, but the resources required should not be underestimated. Limited abduction of the hip (LHA) in an infant triggers suspicion, and often an urge to treat, in most orthopaedic surgeons and pediatricians alike. This study aimed to document the value of unilateral LHA in the diagnosis and decision making of DDH, and the correlation between LHA and US. METHODS: In total, 464 infants referred from the pediatrics clinic with LHA, aged between 30 and 120 days, were included in the study. RESULTS: Physical examination revealed LHA in 186 (41%) infants, 26 of which were unilateral and 160 were bilateral. US examination showed that 13 (8.1%) patients in the bilateral LHA group and 18 (69.2) patients in the unilateral LHA group, had DDH (total number 31, 7%). CONCLUSION: Unilateral limitation of hip abduction was found to be a sensitive sign for developmental hip dysplasia, but US could be defined once again as the best golden standard before initiating treatment.     

Treatment and prevention of hip dysplasia in infants and young children

The diagnosis and treatment of developmental dysplasia of the hip in the infant are uniform, with consensus that diagnostic ultrasound and Pavlik harness management are standard procedures. Sequential procedures for failed early treatment, residual dysplasia and late diagnosis are dependent on the age and the severity of the dysplasia.     

Developmental dysplasia of the hip: a new approach to incidence

OBJECTIVE: The controversy over the incidence of developmental dysplasia of the hip (DDH) stems mainly from an ambiguity of criteria for defining a genuinely pathologic neonatal hip. In this study, we evaluate an algorithm we devised for the treatment of DDH, for its ability to identify those neonatal hips which, if left untreated, would develop any kind of dysplasia and, therefore, are to be included in the determination of DDH incidence. METHODS: Clinical and ultrasonographic examinations for DDH were performed on 18 060 consecutive neonatal hips at 1 to 3 days of life. Newborns with skeletal deformities, neurologic/muscular disorders, and neural tube defects were excluded. Hips that featured any type of sonographic pathology were reexamined at 2 or 6 weeks, depending on the severity of the findings. Only hips in which the initial pathology was not improved or had deteriorated were treated; all others were examined periodically until the age of 12 months. RESULTS: Sonographic screening of 18 060 hips detected 1001 instances of deviation from normal, indicating a sonographic DDH incidence of 55.1 per 1000. However, only 90 hips remained abnormal and required treatment, indicating a true DDH incidence of 5 per 1000 hips. All the others evolved into normal hips, and no additional instances of DDH were found on follow-up throughout the 12 months. CONCLUSIONS: The implementation of our protocol enables us to distinguish two categories of neonatal hip pathology: one that eventually develops into a normal hip (essentially sonographic DDH); and another that will deteriorate into a hip with some kind of dysplasia, including full dislocation (true DDH). This approach seems to allow for a better-founded definition of DDH, for an appropriate determination of its incidence, for decision-making regarding treatment, and for assessment of the cost-effectiveness of screening programs for the early detection of DDH.