大连地区婴幼儿发育性髋关节发育不良初步筛查及高危因素分析

目的分析大连地区发育性髋关节发育不良(developmental dysplasia of the hip,DDH)的高危因素,探讨符合本地区特点的早期筛查方法和模式。方法自2013年1月1日至2014年12月31日由大连市区县妇幼机构和大连市妇女儿童保健中心、大连市儿童医院共计筛查14 736例婴幼儿髋关节发育情况,运用SPSS19.0软件对患者的临床资料进行单因素分析和多因素Logistic回归分析,观察DDH的危险因素。结果共计14 736例婴幼儿,可疑患儿472例(32.03‰,472/14736),专科检查后确诊患儿56例(3.80‰,56/14736)(69髋)。男童9例(11髋),女童47例(58髋),男女比1∶5.22;左侧45髋(65.22%),右侧24髋(34.78%),左右侧别比1.87:1。经过多因素非条件Logistic回归分析,结果显示臀位产、家族史、合并畸形、襁褓捆绑、羊水少、臀纹不对称为DDH发病的危险因素(P0.05)。结论大连市采取对婴幼儿进行初筛-复筛确诊的模式,可以早期发现和确诊DDH,本地区DDH高危因素包括臀位产、家族史、合并畸形、襁褓捆绑、羊水少、臀纹不对称,建议建立完备的筛查体系,推广DDH的早期筛查工作。     

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。     

三维超声在筛查新生儿发育性髋关节异常中的探索性应用

目的 探索三维高频超声髋关节检查技术在诊断新生儿发育性髋关节异常(DDH)中的应用价值.方法 2010年6月至2010年12月,采用PHILIPS IU22超声诊断仪,二维加三维高频线阵探头,对768例新生儿行髋关节超声筛查.新生儿7d内行超声波髋关节筛查,采用Graf法及股骨头覆盖率比值测量髋关节,并结合三维成像图评判髋关节发育情况.结果 本组受检新生儿768例(1 536髋),其中女婴398例,男婴370例,新生儿平均受检时间为出生后5.8d.正常的髋关节共1 412髋,占91.92％;髋关节不稳定共99髋,占6.45％;髋关节发育不良19髋、半脱位4髋、脱位2髋,共占1.63％.结论 Graf的髋关节额状面成像技术,可以对新生儿髋关节进行清晰的超声成像,并进行了定性、定量分析,诊断DDH,但标准图像的获得是测量和诊断的关键,它会受操作者的技术影响.三维超声成像技术,可观察髋关节空间结构,旋转X、Y、Z轴,更可从不同角度观察髋关节的发育情况,提供髋关节解剖形态和关节功能的信息,并能早期显示髋关节解剖结构,这点是传统X线片不能比拟的优势,图像更加直观,加上高频超声波检查的无放射性损害,重复性强,因此二维和三维超声二者相结合诊断发育性髋关节异常,更符合临床上治疗髋臼发育不良的时间越早越好的需求.     

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。     

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。     

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.     

婴幼儿发育性髋关节异常的早期诊断

目的 报道采用超声波髋关节检查技术诊断新生儿和小婴儿发育性髋关节异常(DDH)和早期处理的初步经验。方法 2002年4月～2002年9月，391例临床怀疑DDH，年龄小于l岁的婴幼儿在上海儿童医学中心接受了超声波髋关节检查，其中男193例(49．4％)，女198例(50．6％)。最小年龄5d，最大年龄354d。其中新生儿24例(6．14％)，2个月婴儿52例(13．30％)，3个月婴儿54例(13．81％)，4～6个月婴儿164例(41．94％)，6～12个月婴儿97例(24．81％)。参照Graf等分类方法，检查者被分为五类，其中髋关节发育不良、髋关节半脱位和髋关节全脱位者定为DDH。髋关节发育不成熟者采取随访观察。年龄小于6个月的DDH接受了早期Pavlik吊带治疗，并采用超声波跟踪，决定治疗的终止或改动。结果 300例超声波检查正常，91例超声波检查阳性，其中42例诊断为DDH。接受随访的35例髋关节发育不成熟病例中，29例自行恢复。Pavlik吊带治疗在小于6个月DDH婴幼儿中成功率为91．67％。结论 采用超声波髋关节诊断技术可以早期发现新生儿和小婴儿DDH，并施行早期治疗，可以提高DDH在儿童期的治愈率，减少漏诊病例，简化治疗，提高疗效。     

婴儿早期髋关节发育异常的X线片特征

发育性髋关节异常(developmental dysplasia ofthe hip,DDH)包含髋臼发育不良、髋关节半脱位及全脱位,是小儿最常见的髋关节疾患,致残率高.DDH的早期诊断和及时治疗已成为共识.国外从1980年代开始应用临床检查和B超的方法在新生儿期实施DDH的筛查.受患儿的年龄和检查者的经验影响并非所有的DDH经临床检查常用的Ortolani 和Barlow试验得到确诊[1].B超筛查明显降低了延迟就诊率,但也存在争议.     

发育性髋关节发育不良的早期筛查及保守治疗现状

发育性髋关节发育不良(developmental dysplasia of the hip,DDH)是小儿最常见的髋关节疾病。早期筛查是发育性髋关节发育不良诊治的重要环节,在日益成熟的筛查体系下,通过体格检查、超声检查及X线检查等方法可尽早明确诊断,为早期治疗提供条件。保守治疗适用于1.5岁以内的DDH患儿,包括佩戴髋关节外展支具和闭合复位。本文将围绕发育性髋关节发育不良的早期筛查和保守治疗的近期研究成果进行综述。     

Graf Ⅱ型发育性髋关节脱位409例不同干预后转归的回顾性多中心研究

目的 比较3种干预方式(蛙式抱、Pavlik挽具,宽尿不湿及屈髋外展被动操)对发育性髋关节脱位(DDH) GrafⅡ型患儿的疗效,探讨超声随访与X线随访的关系.方法多中心、观察性临床研究,纳入中国7个城市7家儿童医院2011年1月至2015年12月409例Graf Ⅱ型DDH患儿的资料,对其临床表现、干预方式、诊治经过、影像结果等进行回顾性分析.采用单因素方差分析两两比较,评估3种不同干预方式对Graf Ⅱa型DDH患儿的转归.采用单因素方差分析,评估Pavlik挽具及非Pavlik挽具(蛙式抱、宽尿不湿以及屈髋外展被动操)对Graf Ⅱb型DDH患儿的转归.采用配对四格表Fisher确切概率法,比较超声检查发现异常的阳性率和X线检查的差异.结果 409例中,男124例,女285例;Graf Ⅱa型292例,Ⅱb型102例,Ⅱc型14例,Ⅱd型1例.Graf Ⅱa型DDH患儿分别采用3种干预方式干预后,正常转归时间分别为:Pavlik挽具,平均38 d;宽尿不湿及屈髋外展被动操,平均46 d;蛙式抱,平均56 d,差异有统计学意义(F=9.422,P=0.0001).Graf Ⅱb型DDH患儿采用Pavlik挽具与非Pavlik挽具干预正常转归时间分别为32 d和45 d,差异有统计学意义(F=5.566,P=0.001).超声检查和X线随访检查发现异常结果的阳性率分别为9.05％(18/199)和0.50％(1/199),差异无统计学意义(x2=10.106,P=0.09).结论 Graf Ⅱ型DDH均能用Pavlik挽具治愈.对Graf Ⅱa型、Ⅱb型DDH患儿,Pavlik挽具干预与宽尿不湿及屈髋外展被动操干预、单纯蛙式抱干预比较,治愈所需时间最短.所有409例临床随访均未发现髋关节异常;超声是随访评价Graf Ⅱ型DDH患儿有效的工具.     

Evaluation of risk factors in developmental dysplasia of the hip: results of infantile hip ultrasonography

In this study, risk factors of developmental dysplasia of the hip (DDH) were evaluated. History, clinical examination and risk factors for DDH of the babies were recorded. The hips were evaluated with ultrasonography. Infantile hip ultrasonography is one of the best methods for screening of DDH. Ultrasonography is easy, repeatable and provides visualization of the cartilage part of the hip joint. Graf's method of infantile hip ultrasonography was used to evaluate the hip in this study. Both hips of 371 babies and 32 unilateral hips of 32 babies were included in the study. In 403 babies, 14 (3.4%) had DDH. There were 5 type IIB, 7 type IIC, 1 type D, and 1 type IV hips. Physiological immaturity was present in 81 hips (19% of babies). According to risk factor analysis, the only risk factor in unilateral analysis was presence of oligohydramnios (odd ratio-OR: 11.8, confidence interval-CI: 2.7-52.7). In correlation analysis, there was a correlation between female gender and swaddling. There was overall increase in DDH in female babies who were swaddled compared to those who were not. The results of this study showed that the most important risk factor was oligohydramnios for DDH. Swaddling and female gender increased the risk of the disease, but further studies in larger series are necessary for the confirmation of these results.     

Effectiveness of ultrasound screening for developmental dysplasia of the hip

OBJECTIVE: To determine the effectiveness of ultrasound screening for developmental dysplasia of the hip (DDH) after the neonatal period. DESIGN: Prospective cohort study. SETTING: Child health care centres. PARTICIPANTS: Infants attending the child health care centres. INTERVENTIONS: The intervention group (n = 5170) was screened by ultrasound at 1, 2, and 3 months of age. The control group (n = 2066) was screened by routine physical examination as part of the programme for child health surveillance at the child health care centres (CHC screening). For evaluation of the screening, the children in both the intervention and control group received an ultrasound examination after 6 months of age to detect any abnormality that might have been missed by the screening. RESULTS: The sensitivity of the ultrasound screening was 88.5%, and the referral rate 7.6%. As a result of the ultrasound screening, 4.6% of the children were treated. The sensitivity of the CHC screening was 76.4%, with a referral rate of 19.2%. The treatment rate was 2.7%. Of the treated children in the ultrasound screening group, 67% were referred before the age of 13 weeks, whereas in the CHC screening group only 29% were referred before this age. CONCLUSIONS: This study shows that ultrasound screening detects more children with DDH than CHC screening and that more of them are detected at an earlier age. To accomplish this, even fewer children have to be referred. However, even general ultrasound screening seems not to eradicate late cases of DDH. The higher treatment rate in the population screened by ultrasound may be a result of overtreatment.     

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.     

Description of the ‘pronation manoeuvre’ for the diagnosis of developmental hip dysplasia

IntroductionWithout a prompt diagnosis, developmental dysplasia of the hip (DDH) in infants can lead to severe sequelae. Current screening strategies emphasize the use of Ortolani and Barlow physical examination manoeuvres, yet they exhibit low sensitivity. The purpose of this study is to evaluate the performance of a new physical examination tool (the pronation manoeuvre) as a screening tool for DDH.MethodsTo evaluate the new manoeuvre, a cross-sectional and analytic study was performed with a nonprobabilistic sampling method. Patients with either a positive Ortolani or Barlow manoeuver were evaluated with the new manoeuvre and hip ultrasound. Controls were infants with negative Ortolani, Barlow and pronation manoeuvres and also had ultrasound performed.ResultsDDH was confirmed in 83 of 130 cases (64%) and 2 of 130 controls (2%). The new pronation manoeuvre had a sensitivity of 76% and a specificity of 94% as compared to the Ortolani and Barlow manoeuvres (sensitivity 31 to 32%, specificity 93 to 100%) (P<0.05).ConclusionThis new physical examination manoeuvre could serve as another clinical tool for the initial screening of DDH in newborns. Its promising results against traditional screening procedures might potentially impact diagnosis and prognosis for patients with DDH.     

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...     

腹部B超在新生儿坏死性小肠结肠炎诊断中的价值

目的探讨腹部B超在新生儿坏死性小肠结肠炎（NEC）诊断中的价值。方法选择2011年4月至2013年4月我院新生儿科收治的临床可疑NEC早产儿,患儿在诊断可疑NEC后常规行腹部正侧位X线片及腹部B超检查,并在12 h后复查X线片和腹部B超,以出现肠壁增厚、肠壁积气、门静脉积气之中的任何一项判定为阳性结果,均未出现判为阴性结果。采用诊断性检验方法,以灵敏度、特异度、准确度及ROC曲线评估腹部B超诊断NEC的价值。结果共纳入93例可疑NEC早产儿,男49例,女44例;胎龄（31.4±2.1）周;体重（1825±236）g。第1次检查腹部B超阳性61例,X线平片阳性52例,腹部B超的灵敏度和特异度分别为90.5%和54.9%,准确度66.6%,ROC曲线下面积（AUC）=0.727（95%CI 0.622～0.831）。12 h后复查腹部B超阳性69例,X线平片阳性53例,腹部B超的灵敏度和特异度分别为88.7%和45.0%,准确度74.2%,AUC=0.668（95%CI 0.554～0.783）。结论腹部B超结合临床表现可能优于Bell法在NEC的诊断,具有重要的临床应用价值。     

Riesgo de displasia del desarrollo de la cadera en pacientes sometidos a versión cefálica externa

Introduction

Developmental dysplasia of the hip (DDH) refers to the spectrum of abnormalities of maturation and development of the hip. Breech presentation is associated with DDH. This risk factor can be modified by external cephalic version (ECV). The aim of this study is to evaluate the incidence of DDH in patients who successfully underwent ECV, as well as to evaluate need for these children (breech for a period during gestation) to be included in the DDH screening protocol.

The diagnosis and management of congenital dislocation of the hip

Congenital dislocation of the hip (CDH) or developmental dysplasia of the hip (DDH) is a common condition that encompasses a spectrum of pathology affecting the neonatal hip. Clinical signs of instability may be difficult to detect at birth using the Barlow Ortolani test. A clear imperative is to make an early diagnosis since delay after 3 months is synonymous with the necessity for surgery and also leads to a compromised prognosis. There is considerable controversy about clinical screening for DDH or ultrasound screening, either comprehensive or selective. Risk factors – such as breech presentation, oligohydramnios and talipes – are well known and there is some evidence that selective screening for these babies with ultrasound may assist diagnosis. The incidence of neonatal hip instability is around 15–20 per 1000 live births but that of established dislocation 1–2 per 1000 live births in unscreened cohorts. The usual early treatment is with the Pavlik harness but after 3 months, surgery – either an open or closed reduction – is necessary and in some surgically untreated children, secondary procedures such as pelvic osteotomy are necessary.     

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.