新生儿期发育性髋关节发育不良筛查方法分析

目的 通过比较发育性髋关节发育不良(DDH)不同筛查方法的结果、分析DDH危险因素,探讨在新生儿期筛查DDH的最适合方法,为DDH早诊断早治疗提供依据。方法 对2014年11月-2015年11月139例住院新生儿进行临床体检和髋关节超声检查以及随访,调查分析影响髋关节发育的因素。结果 1)根据Graf法超声诊断DDH 83例,检出率59.7%,Ⅱc型检出率为4.3%,1例最终诊断髋关节脱位,检出率0.7%;2)左侧髋关节发育不良的检出率为右侧的1.863倍,臀位发生DDH风险为其他胎位的4.063倍;3)以超声检查结果为准,体格检查敏感性为42.1%,特异性为66.1%;4)不同性别、胎龄、分娩方式、羊水量、胎次、体格检查结果的新生儿DDH检出率的差异无统计学意义(P>0.05)。结论 体检诊断DDH敏感性及特异性低,超声在早期检查DDH中起着重要作用;左侧髋关节、臀位为DDH危险因素;大部分Graf Ⅱa型以及部分Ⅱc型髋关节可在3~6月龄自行发育正常,但需要密切随访。

Investigation of screening methods of developmental dysplasia of the hip in newborn infants

Objective To analyze the most appropriate method for the diagnosis of developmental dysplasia of the hip (DDH),thereby making it possible to treat DDH earlier and achieve good prognoses by assessing the role of clinical examinations,ultrasonic (US) examination and associated risk factors in infants with DDH. Method Totally 139 infants hospitalized in the NICU of the first affiliated hospital of Shantou University Medical College from November 2014 to November 2015 were involved.Clinical data and Results of physical examinations and US examinations of the hips were collected,and followed up according to the results.Several risk factors which may affect hip development were analyzed. Results 1)Among 139 infants,83 (59.7%) had abnormal US examinations,in which 6 were Graf type Ⅱc and one (0.7%) was eventually diagnosed as hip dislocation.2)The study showed higher prevalence of DDH in left side hip than the right ride (OR=1.863,P<0.05) and in breech presentation (OR=4.063,P<0.05).3)Compared with US results,clinical examination had a sensitivity of 42.1% and specificity of 66.1%.4) Gender,gestational age,delivery mode,amniotic fluid volume and PE Results did not have significant difference in DDH prevalence. Conclusions To detect DDH,US examination is necessary and important since the sensitivity and specificity of clinical examinations are quite low.The left side hip and breech presentation are significantly associated with DDH.Most Graf type Ⅱa hips and some Graf type Ⅱc hips resolve spontaneously at the age of 3~6 months,but close follow-up is recommended.