婴儿发育性髋关节发育不良的研究进展

发育性髋关节发育不良(DDH)是婴幼儿骨骼系统最常见疾病之一。其病因尚不明确,认为是遗传因素与环境因素共同作用的结果,是一种多因素引起的多基因病。DDH临床表现因患儿年龄不同而异。目前髋关节超声检查是早期筛查DDH的首选影像学方法,应用最成熟的是Graf检查方法。本病预后关键在于早期诊断,及时合理治疗有助于大部分患儿髋关节恢复正常发育,而延误治疗可致终身残疾。     

Graf法超声筛查对发育性髋关节发育不良高危婴儿的诊断价值

目的:探究Graf法超声筛查对发育性髋关节发育不良(DDH)高危婴儿的诊断效果.方法:选取我院2019年1月—2020年12月接收的DDH高危婴儿85例设定为观察组,选取同一时间段健康体检婴儿85例作为对照组,均采用Graf法超声筛查,对比两组诊断结果.结果:①α角、β角水平:对照组α角、β角水平与观察组存在显著差异(...     

超声筛查发育性髋关节发育不良高危婴儿的临床价值

目的探讨应用超声Graf法筛查临床体征阳性合并其他高危因素婴儿发育性髋关节发育不良的临床价值。方法对488例临床体检提示有臀纹或大腿纹不对称、下肢长度差异、髋外展受限等阳性体征同时合并其他高危因素(女性、臀位妊娠、家族史或伴有其他骨骼肌肉畸形等)的婴儿进行髋关节超声Graf法检查,并与Graf髋关节病理分型进行对照分析。结果 976个受检髋关节中,Ⅰ型髋关节914个,占93.6%;Ⅱ型髋关节49个,占5.1%,其中ⅡA型25个,ⅡB型13个,ⅡC型11个;D型髋关节4个;Ⅲ型髋关节7个;Ⅳ型髋关节2个。合并臀位妊娠与合并家族史、合并家族史与合并其他骨骼肌肉畸形的婴儿不成熟髋关节及DDH髋关节阳性检出率比较差异均有统计学意义(均P0.05)。结论超声是筛查高危婴儿发育性髋关节发育不良的首选方法,并可比较不同高危婴儿之间发病率的差异性。     

超声用于发育性髋关节发育不良研究进展

发育性髋关节发育不良(DDH)是髋臼发育不良、髋关节半脱位及髋关节脱位等一系列病理变化的统称，早期诊断和治疗DDH具有重要临床意义。超声是影像学诊断DDH的首选方法，可全面观察髋关节结构，有助于临床评估DDH分型、制定治疗方案及评估预后。本文介绍超声用于DDH研究进展。     

发育性髋关节发育不良的婴儿早期筛查与干预

目的：分析早期筛查与干预对发育性髋关节发育不良的影响及结果,为早期筛查与干预提供科学依据,从而降低发育性髋关节发育不良（DD H ）的致残率。方法对在本院进行健康体检的0～6月儿童通过高危筛查、临床筛查,对筛查异常并经超声确诊的髋关节发育异常儿童根据超声分型结果及患儿年龄制定不同的干预措施和治疗方案,并积极进行早期个体化干预和定期随访。结果通过早期筛查及干预措施,诊断为GrafⅡa的181个髋关节,有176个经过髋关节外展操转为正常,有5个通过Pavlik吊带转为正常;诊断为GrafⅡb的13个髋关节通过Pavlik吊带转为正常。结论早期筛查及干预可以促使绝大多数发育异常的髋关节向正常的髋关节结构转化,具有重要的经济意义与社会意义,应在儿童保健中广泛开展。     

发育性髋关节发育不良儿童的社区护理指导

[目的]总结发育性髋关节发育不良(DDH)儿童的社区护理指导。[方法]对发育性髋关节发育不良儿童的早期筛查、心理护理、生活护理、功能锻炼及并发症预防性护理等内容进行护理指导。[结果]针对该病的预防和护理,提高了儿童家长的护病意识和护理水平,减少了并发症的发生。[结论]通过有效的社区护理指导可提高DDH儿童的生活质量和治疗效果。     

Graf法超声筛查对发育性髋关节发育不良高危婴儿的诊断价值

目的:探究对发育性髋关节发育不良高危婴儿实施G r a f法超声筛查的诊断价值.方法:从我院2018年4月—2020年8月择取80例发育性髋关节发育不良高危婴儿作为研究组,择取同期健康体检婴儿80例作为对照组,所选婴儿均实施Graf法超声筛查,对照分析两组α角、β角,并对照病理诊断结果,对Graf法超声筛查结果进行分析...     

超声筛查婴幼儿发育性髋关节发育不良的临床价值

探讨超声Graf法筛查婴幼儿发育性髋关节发育不良(DDH)的临床价值。选取2012年3月~2017年1月我院收治75例DDH婴幼儿(DDH组)、90例非DDH婴幼儿(非DDH组)作为研究对象,所有研究对象均接受髋关节超声Graf法检查。两组婴幼儿性别(χ~2=0.1610,P=0.7064)、年龄(u=0.7040,P=0.4825)、体质指数(u=1.3316,P=0.1849)比较差异无统计学意义(P>0.05)。超声Graf法诊断DDH的灵敏度、特异度、阳性预测值、阴性预测值、诊断准确度分别为89.3%、100.0%、100.0%、91.8%、95.2%。超声Graf法筛查DDH的临床价值确切,其灵敏度、特异度均较高,该方法值得临床推广应用。     

人工智能技术用于超声筛查婴儿发育性髋关节发育不良

目的 构建人工智能(AI)自动识别髋关节超声标准冠状切面及测量相关参数模型,观察其辅助超声筛查婴儿发育性髋关节发育不良(DDH)的价值。方法 [JP2]回顾性分析2 164名婴儿共4 328侧髋关节超声视频,由5名超声科主治医师采用SonoKit标注软件以统一标准于每段视频中选取1幅标准、2幅非标准髋关节冠状切面声像图,并于标准冠状切面图中标注关键解剖结构。经2名超声科主任医师审核,共获得11 100幅声像图(3 665幅标准、7 435幅非标准),以其中8 100幅为训练集(2 665幅标准、5 435幅非标准)、3 000幅为验证集(1 000幅标准、2 000幅非标准)。基于训练集数据构建AI模型,自动识别髋关节超声标准冠状切面,并于其中自动测量α角、β角和股骨头覆盖率(FHC);以验证集验证AI模型识别标准切面的效能。另选取110名健康婴儿的220幅髋关节标准冠状切面声像图,分别由超声科医师手动测量、以AI模型自动测量其α角、β角和FHC,分析测量结果的一致性及相关性。结果 对于验证集髋关节超声标准冠状切面,AI模型与超声科主任医师识别结果的一致性较好(Cohen''s Kappa=0.925);AI模型自动测量与医师手动测量α角、β角及FHC的一致性均较好,组内相关系数分别为0.814、0.730和0.953,均具有强相关性(r=0.826、0.731、0.967)。结论 AI模型能有效自动识别髋关节超声标准冠状切面并自动测量相关参数,可辅助超声筛查婴儿DDH。     

股骨头骨性髋臼覆盖率在筛查婴儿发育性髋关节发育不良中的应用

目的 探讨股骨头骨性髋臼覆盖率（FHC）在婴儿发育性髋关节发育不良（DDH）筛查中的应用价值。方法 收集接受髋关节超声筛查的2 111名（4 222侧髋关节）婴儿,测量其中立位和屈曲位FHC,分析其与Graf分型的关系,并绘制ROC曲线评价其对DDH的诊断效能;计算中立位与屈曲位的FHC的差值（FHC-D）,评价其评估髋关节稳定性的效能。结果 4 222侧髋关节中,稳定髋关节4 056侧,不稳定髋关节166侧;DDH 1 593侧,正常髋关节2 629侧。中立位和屈曲位FHC均与α角呈正相关（r=0.680、0.737,P均<0.001）。中立位FHC（59.39%±6.70%）大于屈曲位FHC（54.96%±9.30%）,差异有统计学意义（t=19.122,P<0.001）;两者诊断DDH的ROC曲线的AUC分别为0.884和0.879（P均<0.001）。不同Graf分型间中立位FHC和屈曲位FHC的总体差异均有统计学意义（P均<0.001）,随着分型的加重,FHC逐渐降低,两两比较FHC差异均有统计学意义（P均<0.05）。FHC-D评估髋关节稳定性的AUC为0.972（P<0.001）,临界值为8.50%,敏感度为89.0%,特异度为93.0%,准确率为93.9%。结论 中立位和屈曲位FHC均可作为筛查DDH的参考指标之一;FHC-D可用于定量评估髋关节的稳定性。     

Developmental dysplasia of the hip

Developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. The identification of risk factors, including breech presentation and family history, should heighten a physician's suspicion of developmental dysplasia of the hip. Diagnosis is made by physical examination. Palpable hip instability, unequal leg lengths, and asymmetric thigh skinfolds may be present in newborns with a hip dislocation, whereas gait abnormalities and limited hip abduction are more common in older children. The role of ultrasonography is controversial, but it generally is used to confirm diagnosis and assess hip development once treatment is initiated. Bracing is first-line treatment in children younger than six months. Surgery is an option for children in whom nonoperative treatment has failed and in children diagnosed after six months of age. It is important to diagnose developmental dysplasia of the hip early to improve treatment results and to decrease the risk of complications.     

Developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip (CDH), is a term used to describe a variety of abnormalities of the hip in development. The treatment options are diverse depending on etiology, degree of dislocation, and age of the child when diagnosis is made. This article provides the reader with a knowledge base to assist with early diagnosis, treatment, and nursing care of the client with dislocations and subluxations of the hip. Presented are the definitions, diagnostic techniques, treatments, and nursing diagnoses and interventions for the client with DDH and for the child's family.     

Developmental dysplasia of the hip: nursing implications and anticipatory guidance for parents

Developmental dysplasia of the hip (DDH) is a comprehensive term used to describe an abnormal relationship between the femoral head and the acetabulum. Developmental dysplasia of the hip includes a very wide spectrum of abnormality from a frank dislocation (very unstable) to a stable hip with a slightly shallow acetabulum. As many of these findings may not be present at birth, the term developmental more accurately reflects the biologic features than does the term congenital. Despite the recent increased awareness of DDH and the importance of thorough screening programs, hip dysplasia continues to be a frequently missed diagnosis in pediatrics. Earlier detection and diagnosis of DDH is associated with a much more successful and less invasive outcome.     

Sonography of hip dysplasia

Early diagnosis of developmental dysplasia of the hip (DDH) is important to institute appropriate treatment and reduce the incidence of long-term complications. Risk factors for DDH include genetic, developmental, mechanical, and physiologic factors. Physical examination using Ortolani and Barlow maneuvers is standard for early detection. Plain film radiography is limited for the diagnosis of DDH even when applying several classic landmarks, lines, and measurements, due to the lack of visualization of the cartilaginous components of the infant's hip. Ultrasound arose as a tool for evaluation of the cartilaginous structures of the hip in the early 1980s. Graf's method of examination by ultrasound stresses morphology, whereas dynamic examination uses physical maneuvers to elicit laxity of the hip. The Pavlik harness is the mainstay of treatment of DDH in the young infant, and ultrasound examination in the harness is useful to monitor progress. Closed or open surgical reduction is reserved for unresponsive or advanced cases. Universal ultrasound screening of newborns is not deemed cost effective by most North American authors, although in Europe non-selective screening has been more widely used.     

Sonographically monitored hip dysplasia

A report is presented of the possibilities that sonography offers in the investigation of the hip joint in newborn babies and infants. On the basis of experience gained over the past 6 years in the investigation of over 5000 infant hips, it is possible to produce an exact classification of disorders of hip maturation. Sonography renders possible the early recognition of hip maturation disorders, selection of optimal form of treatment and control of the adopted therapy. Sonography is, therefore, not limited to a mere depiction of the hip joint, but renders possible direct control of the therapeutic procedure. However, an introduction to the examination and measurement technique is indispensable.     

Genetic study on developmental dysplasia of the hip

Eur J Clin Invest 2012; 42 (10): 1121-1125 ABSTRACT: Background Developmental dysplasia of the hip (DDH) is a developmental disorder of the hip joint that results in an abnormal socket of the femoral head, ranging from instability, subluxation and complete dislocation of the hip joint. DDH has a considerable genetic component. Design We reviewed the recent progress on genetic study of DDH. Results By linkage and case-control association studies, DDH loci have been identified with several susceptibility genes that involve in bone and joint biology; however, no unequivocal genes with global significance have been detected. The current problem of the association study in DDH is discussed. Conclusions By advanced technologies and international collaboration, we need to find more susceptibility genes and bridge the gap between genetic evidence and molecular mechanisms.     

Orthotic treatment of developmental hip dysplasia

Summary. Abduction orthoses are used in the treatment of hip dysplasia in newborns and infants. These devices force ca. 1000-1100 flexion of the hips and 30-600 abduction. In this position, the femoral head assumed a concentric position in relation to the acetabulum, which is a basic precondition for normal hip development. This article presents the orthoses most commonly used id Poland to treat development hip dysplasia. Flexion-abduction orthoses are an excellent replacement for the plaster casts formerly used in these cases. The selection of orthosis depends on the attendant physician's experience and the type of defect. The treatment of developmental hip dysplasia is charged with the risk of nutritional defects of the femoral head, and thus requires caution. Orthotic treatment is suitable only for children to age 6 months, since at a later age it can disturb hip development. Lack of parent cooperation can cause complications or lack of treatment effect.     

大转子截骨非骨水泥全髋置换治疗成人髋关节发育不良

背景：人工全髋哭竹置换是公认的治疗成人髋关节发育不良晚期髋关节病变的仃效手段,但存在较多的困难及风险。目的：评估行大转了截骨的非骨水泥全髋置换治疗Crowe Ⅳ型成人髋关节发育不良的短期疗效。方法：18例（22髋）成人CroweIV掣发育性髋关节脱位患者采用后外侧入路非骨水泥固定,行火转于截骨调整臀t心肌张力,在髋臼的解削位胃安放臼杯。结果与结论：患者随访均超过10个月,最K随访38个月。患者关节置换前甲均患肢短缩4．5cm（3．4-6．0cm）,置换后患肢较置换前平均延长4．0cm（3．2—4．8cm）。置换后最终随访时Harris评分平均87分（79分-91分）,显蒋高于置换前（P〈0．01）。置换中3例3髋股骨近端发生骨折,但股骨假体稳定,予俐丝固定或未作特殊处理,均于茂换后2个月复查X射线片提小骨折已愈合。1例胃换后出现坐骨神经麻痹症状,3个月后症状消失。术出现置换后髋关节脱值、假体松动、感染及有临床表现的深静脉血栓形成等并发症。表明行大转了截骨的作水泥假本能订效治疗CroweIV型成人发育性髋关节脱位,能重建复杂髋关节发育不良的生物学及生物力学,不增加并发症风险。     

全髋关节置换治疗髋关节发育不良并骨性关节炎的疗效评价

背景:利用全髋关节置换治疗成人髋关节发育不良合并骨性关节炎可以有效缓解髋关节疼痛,改善髋关节功能障碍,提高患者的生活质量.目的:综合评价全髋关节置换治疗成人髋关节发育不良并发骨性关节炎的疗效.方法:电子检索中国期刊全文(CNKI)数据库发表于2001-01/2010-06有关全髋关节置换术治疗髋关节发育不良合并骨性关节炎的临床研究文献,排除重复研究和综述,筛选出符合纳入标准的文献,对其进行疗效的评价和归纳.结果与结论:通过阅读标题和摘要,初步检索出50篇文献,进一步检索全文,根据纳入标准,共有16篇文献进入结果分析,通过对各文献报道的Harris髋关节评分,近期优化率和患者主观满意度的评价进行归纳和分析,作者认为,全髋关节置换术是治疗髋关节发育不良并骨性关节炎的有效方法,但手术难度较大,加深髋臼、内移,重建髋关节旋转中心是全髋关节置换成功的最重要部分,在真臼上安放假体,加深髋臼和保持骨性覆盖,可以有助于全髋关节置换取得良好效果.     

Shelf reconstruction for hip dysplasia.

Shelf reconstruction of the hip has been successful in 12 patients, with an average of 14 years' follow-up. Revision has been done in two to again give relief of pain and continued stability. Average age at the time of oepration was 20 years.