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...     

Femoral anteversion in infants: a method using ultrasound

Objective To design a reproducible method to measure femoral anteversion in children under 1 year old.Design and patients We conducted a prospective, observational study to determine intra- and inter-observer reproducibility of the sonographic measurement of femoral anteversion in infants. The method involves imaging of the proximal femur using a vertical transducer with the infant in the lateral position. Anterior femoral anteversion is measured using a vertical baseline and a line tangential to the anterior femoral head and the trochanter (anterior anteversion). We similarly measured true femoral anteversion using a line passing through the centre of the femoral head and the femoral neck (true anteversion). Anteversion measurements were taken at the time of routine ultrasound screening for developmental dysplasia of the hip when infants were an average of 10.4 weeks old. Anteversion measurements were made in 74 hips (37 infants).Results Our results showed that for the anterior anteversion measurements intra-observer repeatability was ±6.2° and inter-observer repeatability was ±7.8°. For true anteversion measurements intra-observer repeatability was ±9.5°, but inter-observer repeatability was ±23.5°.Conclusions Our results have shown that our method for measuring "anterior femoral anteversion" has an acceptable level of inter- and intra-observer agreement. The method used to determine "true anteversion", however, proved to have an unacceptable level of inter-observer variability.     

超声在婴幼儿胃肠疾病诊断中的价值

目的：探讨超声对婴幼儿胃肠疾病的诊断及鉴别诊断价值。方法回顾性分析120例患儿的腹部超声结果,其中40例患儿同时接受了腹部X线检查,与术后或治疗后结果进行比较。结果120例患儿中超声诊断阳性患儿61例,阳性率50．8％,X线阳性结果诊断病种86例,阳性率71.7%,单纯肠系膜淋巴结炎症或单纯肠间隙少量积液（深度＜10 mm）不合并其他阳性表现的视为阴性结果。结论高频超声对婴幼儿胃肠病变有重要诊断及鉴别诊断价值。     

基层医院高频超声及X线诊断婴儿发育性髋关节发育不良的应用价值

＿目的：探讨基层医院高频超声及X线诊断婴儿发育性髋关节发育不良（DD H ）的应用价值。方法：选择本院确诊为DDH 的患儿共35例（58髋）。对比分析患儿的超声与X线检查的一致性,统计分析独立使用α角、β角以及综合Graf法结果诊断 DDH 的敏感度、特异度、符合率、阳性预测值、阴性预测值。结果：X 线检查诊断为 DDH 的符合率为72．2％,比超声检查的86．1％低,但差异无统计学意义（χ2＝2．105,P＝0．147）;但两者联合诊断DDH 的符合率达100％,较X线或超声单独诊断均高。X线和超声检查结果的kappa值为0．794,可见两种检查结果基本一致。超声Graf法诊断DDH 的敏感度、特异度、符合率、阳性预测值和阴性预测值分别为86．1％、100％、91．7％、100％、82．8％,而用超声 Graf法测量的α角和β角独立诊断DDH 的敏感度、特异度、符合率、阳性预测值和阴性预测值分别为83．3％、100％、90．0％、100％、80．0％和77．8％、100％、86．7％、100％、75．0％。结论：对于婴儿DDH 的诊断符合率,超声检查较X线高,而两者联合应用可达100％。两项检查各有特点,需要临床医师结合婴儿及设备等情况合理选择。     

婴儿发育性髋关节发育不良早期筛查的情况分析

目的分析临床结合超声检查对婴儿发育性髋关节发育不良(developmental dysplasia of the hip,DDH)进行早期筛查的结果,为DDH早期干预提供科学依据,降低DDH的致残率。方法对我院筛选DDH体征阳性4896例患儿行超声进一步检查。结果体格检查可疑阳性婴儿4896例,经过超声检查,正常髋关节3591例,占73.3%(3591/4896),可疑异常髋关节1196例,占24.5%(1196/4896),异常髋关节109例,占2.2%(109/4896),其中脱位型髋关节7例,占0.14%(7/4896)。对确诊患儿进行临床治疗,106例异常髋关节转为Graf I型髋关节,治愈率达97.2%(106/109)。结论对婴儿髋关节进行早期筛查对提高婴儿DDH检出率有重要意义,对确诊患儿给予早期干预可促使发育异常的髋关节结构向正常的髋关节转化,改善婴儿髋关节功能,具有重要的经济意义与社会意义。     

螺旋CT在儿童髋关节发育不良Salter手术前后的对照分析

目的:应用螺旋CT定量分析儿童髋关节发育不全(DDH)Salter手术前后髋关节的变化.材料和方法:临床及骨盆平片诊断为DDH并行Salter手术的患儿25名,比较其术前及术后半年股骨颈前倾角、髋臼前倾角及轴向髋臼指数等CT资料,并经统计学检验.结果:应用SAS配对t检验,手术前后股骨颈前倾角差值有显著意义,髋臼前倾角差值有明显的显著意义,轴向髋臼指数无显著意义.结论:CT能定量显示DDH患髋手术前后的变化情况,为观察手术疗效提供了切实的依据.     

脑白质损伤早产儿颅脑超声的动态变化

目的探讨脑白质损伤早产儿颅脑超声的动态变化。方法观察组为脑白质损伤早产儿35例,对照组为健康早产儿36例。分别于生后第1天,第7天,第14天行颅脑超声检查,数据经SPSS13．0统计软件分析,比较两组差别。结果观察组第1天颅脑超声异常率97％．显著高于对照组（P〈0．01）,观察组第7天颅脑超声异常率86％,显著高于对照组（P〈0．01）1）,观察组第14天颅脑超声异常率83％,显著高于对照组（P〈0．01）。结论颅脑超声可作为早产儿脑白质损伤早期诊断和预后评估有力的依据。     

Hip ultrasound

In newborns, US has an established role in the detection and management of developmental dysplasia of the hip. Later in childhood, when the limping child is a major diagnostic dilemma, US is extremely helpful in the identification of the varied disease processes underlying this condition, as transient synovitis, septic arthritis, Perthes disease and slipped femoral capital epiphysis. In adolescent practicing sporting activities, US is an excellent means to identify apophyseal injures about the pelvic ring, especially when avulsions are undisplaced and difficult-to-see radiographically. Later on, in the adulthood, US is an effective modality to diagnose tendon and muscle injuries about the hip and pelvis, identify effusion or synovitis within the hip joint or its adjacent bursae and guide the treatment of these findings. The aim of this article is to provide a comprehensive review of the most common pathologic conditions about the hip, in which the contribution of US is relevant for the diagnostic work-up.     

2岁以下小儿发育性髋关节发育不良髋关节软骨T2 mapping分析

目的探讨2岁及2岁以下发育性髋关节发育不良(DDH)患儿股骨头软骨及髋臼软骨T2值的变化规律。方法回顾性收集2岁及2岁以下行髋关节MR T2 mapping检查的幼儿59名,其中临床和MR检查异常并确诊DDH的患儿34例(年龄5~24个月),同期MRI检查正常且临床明确除外DDH的正常幼儿25名(年龄5~24个月)。全部幼儿按年龄分为3组:组1,年龄≤6个月(DDH 7例,对照7名);组2,6个月<年龄≤12个月(DDH 4例,对照6名);组3,12个月<年龄≤24个月(DDH 23例,对照12名)。在T2 mapping横断面影像上将股骨头软骨分为8个亚区(F1~F8),髋臼软骨分为6个亚区(A1~A6),在每个亚区选取兴趣区(ROI)并测量其T2值。DDH患儿和对照者间的T2值比较采用独立样本t检验。3组DDH患儿各软骨亚区间T2值比较采用单因素方差分析,组间两两比较采用SNK法。采用Spearman相关分析DDH患儿软骨T2值与年龄的相关性。结果与正常对照者软骨T2值比较,组1中DDH患儿A1、A3亚区的T2值较高(均P<0.05);组2中DDH患儿F3~F5亚区及A1、A3、A4亚区T2值较高(均P<0.05);组3中DDH患儿F1~F8亚区及A1~A4亚区T2值较高(均P<0.05);其他各软骨亚区T2值在正常幼儿与DDH患儿间的差异均无统计学意义(均P>0.05)。3组DDH患儿各软骨亚区间T2值比较差异均有统计学意义(均P<0.05),股骨头软骨中F3~F6亚区的T2值在组2最高,其余4个亚区的T2值均为组1最高(均P<0.05);髋臼软骨各亚区T2值均为组1最高(均P<0.05)。DDH患儿股骨头软骨和髋臼软骨各亚区T2值与年龄呈中度或高度负相关。结论应用T2 mapping成像可定量评价DDH患儿的股骨头软骨及髋臼软骨的生长发育情况,为髋关节软骨的评估提供重要指导。     

Sonographic measurement of the thymus in infants

A new method of measuring the size of the thymus in infants less than 1 year of age is presented. The width of the thymus was measured in a transverse image while the area of the largest lobe was assessed in a longitudinal image. The thymic index was then defined as the product of these two values. Intra-and interobserver variation analysis were performed in 23 infants. Each infant was scanned alternately by both of two radiologists, and later the same day the measurements were repeated. The mean differences between the first and second measurements (intraobserver variation) were –0.25 (2 SD 7.56) and –1.13 (2 SD 10.80), respectively, for the two observers. The mean difference between the first measurements of the two observers (interobserver variation) was 1.47 (2 SD 9.39). In a postmortem study of 12 infants the thymic index measured by sonography showed an acceptable correlation to the actual volume (c = 0.80) and weight (c = 0.87) of the thymus. In conclusion, our sonographic estimate of the volume of the thymus, the thymic index, in infants under 8 months of age seems to be easy, reliable and reproducible. Correspondence to: H. Hasselbalch     

发育性髋关节脱位髋臼前倾角的CT研究

目的:研究发育性髋关节脱位髋臼前倾角的变化,为手术选择和判断预后提供依据。方法:选择手术前发育性髋关节脱位DunnⅠ型28髋,DunnⅡ型19髋,DunnⅢ型22髋。选取手术后为优的17髋。正常髋关节12髋。采用多层螺旋CT扫描,然后行髋臼三维重建,测量通过两侧Y形软骨中心O点的横断面测量髋臼前倾角。结果:髋臼前倾角度数正常组<术后相似文献   

髋关节MR造影检查对发育性髋关节发育不良病人髋臼盂唇损伤程度的评价

目的评价髋关节MR造影检查对发育性髋关节发育不良(DDH)病人髋臼盂唇损伤的诊断价值。方法选取2015年12月—2016年10月进行髋关节MR造影检查的DDH病人16例,其中男3例,女13例,年龄10~20岁,平均(14.88±2.60)岁。对每例病人的患侧髋臼行超声引导下髋关节MR造影检查,分别对前、外上及后盂唇进行观察,由2名影像诊断医师评价盂唇损伤的部位及程度,并以术中诊断结果作为金标准进行对比。采用Kappa检验计算髋关节MR造影检查与术中诊断的一致性。结果 16例病人共48处盂唇,无撕裂37处(0期32处,Ⅰ期损伤5处),髋臼实质部撕裂3处,髋臼盂唇-软骨连接区撕裂8处。术中所见无撕裂38处,髋臼实质部撕裂3处,髋臼盂唇-软骨连接区撕裂7处。髋关节MR造影诊断髋臼盂唇撕裂的敏感度为100%,特异度为97.37%,阳性预测值为90.91%,阴性预测值为100%。MR髋关节造影检查与术中诊断的一致性较好(Kappa=0.939,P0.001)。髋关节MR造影显示盂唇肥大、内翻2例,均为前盂唇,与术中所见相吻合。结论髋关节MR造影检查对DDH病人髋臼盂唇损伤诊断的敏感性和特异性均较高,可作为术前常规检查手段。     

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.     

Bilateral Asymmetry in Balance Control During Gait in Children with Treated Unilateral Developmental Dysplasia of the Hip

IntroductionAbout 1% of the newborn population has developmental dysplasia of the hip (DDH), altering joint biomechanics, gait performance and balance control. Pemberton's osteotomy is used in early treatment but it remains unclear whether it will help the patient regain normal balance control during gait. The current study aimed to identify the changes of the whole-body balance control during level walking in children treated for unilateral DDH during toddlerhood, in terms of inclination angles (IA) of the line joining the body’s center of mass (COM) and center of pressure (COP), and the rate of change of IA (RCIA).Materials and MethodsTwelve girls (DDH group; age: 7.1 ± 2.1 years) who had been treated with Pemberton’s osteotomy for unilateral DDH during toddlerhood and twelve healthy controls (Control group; age: 7.6 ± 2.1 years) walked at their preferred walking speed while IA, RCIA and temporal-spatial parameters were calculated from measured kinematic and forceplate data, and were compared using independent t-tests.ResultsCompared to the Control group, the DDH group showed significantly decreased sagittal IA (p = 0.042) but increased range of sagittal RCIA during SLS on the unaffected side (p = 0.006), and increased peak sagittal RCIA during DLS (p < 0.008). In the frontal plane, the altered COM-COP control occurred mainly during stance phase of the affected side, showing a decreased range of RCIA during SLS (p = 0.033) followed by decreased IA (p = 0.045) with an increased peak value of RCIA (p = 0.023) during terminal DLS.ConclusionsThe children with treated unilateral DDH showed compromised, bilaterally different balance control strategies with altered COM-COP control during gait, not only during stance in the frontal plane as expected, but even more so during swing in the sagittal plane. It is thus suggested that routine assessment of the morphological changes and/or altered balance control of both the unaffected and affected hips is equally important for early identification of any signs of insidious hip problems, deteriorating balance control or increased risk of loss of balance.     

A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns

Background

Although there is no clear consensus about the process of screening for developmental dysplasia of the hip (DDH), there are six common risk factors associated with DDH in patients less than 6 months of age (breech presentation, sex, family history, first-born, side of hip, and mode of delivery).

Methods

A meta-analysis of published studies was conducted to identify the relative risk ratio of the six commonly known risk factors. A total of 31 primary studies consisting of 20,196 DDH patients met the following inclusion criteria: (1) contained empirical data on at least one common risk factor, (2) were peer-reviewed from an English language scientific journal, (3) included patients less or equal to 6 months of age, and (4) identified method of diagnosis (e.g., ultrasound, radiographs or clinical examination).

Results

Fixed effect and random effects models with 95% confidence intervals were calculated for each of the six risk factors. Reported relative risk ratio (RR) for each factor in newborns was: breech presentation 3.75 (95% CI: 2.25–6.24), females 2.54 (95% CI: 2.11–3.05), left hip side 1.54 (95% CI: 1.25–1.90), first born 1.44 (95% CI: 1.12–1.86), and family history 1.39 (95% CI: 1.23–1.57). A non-significant RR value of 1.22 (95% CI: 0.46–3.23) was found for mode of delivery.

Conclusion

Results suggest that ultrasound and radiology screening methods be used to confirm DDH in newborns that present with one or a combination of the following common risk factors: breech presentation, female, left hip affected, first born and family history of DDH.     

Diagnostic sonographic changes in the kidneys of 20 infants with congenital nephrotic syndrome of the Finnish type

A renal ultrasonographic study was performed on 20 infants with congenital nephrotic syndrome of the Finnish type. Follow-up ultrasonographic data were obtained on 13 of these patients. The renal lengths increased after 2 months of age. Later, at the age of approximately 18 months, the renal size had decreased again, and was within 2 SD of the predicted mean value. During the first 2 months of life the renal cortex was hyperechogenic and corticomedullary differentiation was clearly visible. Between 2 and 12 months of age the renal cortex was still hyperechogenic in all kidneys, but corticomedullary differentiation had disappeared from 10 of the 26 kidneys examined. After 12 months of age the kidney parenchyma was hyperechogenic and most kidneys had lost corticomedullary differentiation. Thus, the sonographic follow-up is one of the main diagnostic indices f congenital nephrotic syndrome. Correspondence to: O. Koskimies     

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...     

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.     

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.     

Kinematic variability and local dynamic stability of gait in individuals with hip pain and a history of developmental dysplasia

BackgroundIndividuals with developmental dysplasia of the hip (DDH) often report hip pain and exhibit gait adaptations. Previous studies in this patient population have focused on average kinematic and acceleration measures during gait, but have not examined variability.Research questionDo individuals with hip pain and DDH have altered kinematic variability or local dynamic stability (LDS) compared to individuals without hip pain?MethodsTwelve individuals with hip pain and DDH and 12 matched controls walked for two minutes on a treadmill at three speeds: preferred, fast (25% faster than preferred), and prescribed (1.25 m/s). Kinematic variability of spatiotemporal measures, joint and segment angles, and LDS of the trunk were calculated for each speed.ResultsAt the prescribed speed, individuals with hip pain and DDH had more kinematic variability than controls at the hip, pelvis, and trunk as well as greater variability in spatiotemporal measures. LDS was not different between groups. Kinematic variability of the joints decreased and LDS of the trunk increased (i.e., increased gait stability) with increased speed.SignificanceIndividuals with hip pain and DDH had greater kinematic variability compared to individuals without hip pain when walking at the same prescribed speed, indicating either an adaptation to pain or reduced neuromuscular control. LDS of the trunk was not different between groups, suggesting that hip pain does not affect overall gait stability. Kinematic variability and LDS were affected by walking speed, but in different ways, emphasizing that these measures quantify different aspects of walking behavior.