Graf法超声在1500例婴儿高危发育性髋关节发育不良诊断中的应用价值

目的探讨分析Graf法超声在1500例婴儿高危发育性髋关节发育不良(DDH)诊断中的应用价值。方法回顾性分析2014年3月至2015年9月期间在深圳市宝安区妇幼保健院出生的1500例DDH多种高危因素新生儿为研究对象,行Graf法超声检查。比较不同高危因素患儿的DDH发病率,及合并2种、3种、4种高危因素患儿的DDH发病率;比较异常与正常髋关节α角、β角的差异;同时将临床查体及X线检查作为“金标准”,评估Graf法超声对DDH的诊断效能。结果1500例婴儿中,DDH检出率为21.00%;女性、臀位分娩、有家族史、伴有其他骨骼肌肉畸形的DDH检出率分别为23.04%、25.32%、24.07%、24.51%,均高于男性、非臀位分娩、无家族史、不伴有其他骨骼肌肉畸形者(9.38%、4.76%、12.41%、17.81%),差异有统计学意义(P<0.05)。合并2种、3种、4种高危因素DDH检出率分别为18.28%、23.06%、33.82%;合并不同数量高危因素患者DDH检出率差异有统计学意义(P<0.05),合并高危因素越多,DDH检出率越高。被检的3000个髋关节中,髋关节异常率14.00%,异常髋关节中,Ⅱc型9.80%,Ⅱd型2.33%,Ⅲ型1.37%,Ⅳ型0.50%。测量Ⅱc型、Ⅱd型、Ⅲ型髋关节α、β角发现,相比正常髋关节,异常髋关节α角显著变小,β角显著变大(P<0.05)。Graf法超声诊断DDH准确度为99.80%,敏感度为98.59%,特异度为100.0%。结论对具有高危因素婴儿采用Graf法超声筛查DDH,能够早期诊断,特别是合并多种高危因素的婴儿;且Graf法超声对于婴儿发育性髋关节发育不良具有良好的诊断效能。

Application value of Graf ultrasound in 1500 infants with high risk factors for developmental dysplasia of the hip

Objective To explore and analyze the application value of Graf ultrasound in 1500 infants with high risk factors for developmental dysplasia of the hip(DDH).Methods A total of 1500 neonates with multiple high-risk factors for DDH who were born in Shenzhen Baoan maternal and Child Health Hospital from March 2014 to September 2015 were randomly selected as the research objects.Graf ultrasound was performed to compare the DDH of infants with different high-risk factors.Incidence,and the incidence of DDH in infants with 2,3,and 4 high-risk factors;the difference between abnormal and normal hip jointαandβangles were compared;at the same time,clinical and X-ray examinations were used as the"gold standard"for evaluation.The diagnostic efficiency of Graf ultrasound for DDH.Results Among 1500 infants,the detection rate of DDH was 21.00%.The detection rates of DDH in female,breech delivery,with the detection rates of DDH with family history and other musculoskeletal deformities were 23.04%,25.32%,24.07%,24.51%,respectively,which were higher than those of men,non-breech delivery,no family history,and no other musculoskeletal deformities(9.38%,4.76%,12.41%,17.81%),the differences were statistically significant(P<0.05).The detection rates of DDH combined with two,three,and four high-risk factors were 18.28%,23.06%,33.82%,respectively;the detection rates of DDH in patients with different numbers of high-risk factors were significantly different(P<0.05),and the more high-risk factors were combined more,the higher the detection rate of DDH.Among the 3000 hip joints examined,the abnormality rate of hip joints was 14.00%;Among abnormal hip joints,typeⅡc was 9.80%,typeⅡd was 2.33%,typeⅢwas 1.37%,and typeⅣwas 0.50%.Theαandβangles of typeⅡc,typeⅡd andⅢhip joints were measured,found that compared with normal hip joints,theαangle of the abnormal hip joint was significantly smaller and theβangle was significantly larger(P<0.05).The accuracy of Graf ultrasound diagnosis was 99.80%,the sensitivity was 98.59%,and the specificity was 100.0%.Conclusion The application of Graf ultrasound in screening infants with high risk factors for DDH can be diagnosed early,especially for infants with multiple high-risk factors;and Graf ultrasound has a good diagnosis of infant DDH efficacy.