天津市发育性髋关节异常的早期筛查

目的 了解天津市发育性髋关节异常(developmental dysplasia of the hip,DDH)的流行病学特征,探讨适合我国国情的早期筛查方法和模式.方法 由天津市16个区县妇幼机构和市妇女儿童保健中心分别对所有出生后6周婴儿采用B超实施双侧髋关节的初筛和复筛,可疑或异常者转诊至天津医院.由小儿骨科医师对转诊患儿进行临床检查(外展试验、Ortolani或Barlow试验),并对B超可疑患儿拍摄骨盆正位X线片,以进一步确诊.结果 2009年12月26日至2010年12月25日,共对94443例婴儿实施髋关节B超筛查,筛查率为85.28%.136例(165髋)B超检查可疑患儿和168例(200髋)B超检查异常患儿转诊至天津医院.可疑患儿中10例(11髋)Ortolani或Barlow试验阳性,73例(84髋)骨盆正位X线片显示髋臼发育不良,最终有251例(295髋)确诊为DDH.男孩40例,女孩211例;女孩、左侧以及秋冬季出生的婴儿多发.确诊DDH的295髋中238髋有临床检查阳性.天津地区DDH的发病率是2.66‰(251/94443).结论 天津市采取的对出生后6周婴儿的初筛-复筛-确诊模式,实现了对DDH的早发现、早诊断.耐心细致的临床检查和必要的X线检查,对确诊DDH有重要作用.

Abstract：

Objective To analyze the prevalence of developmental dysplasia of the hip (DDH) in Tianjin,and to establish early screening of DDH in China.Methods System of health care for maternity and children in Tianjin were used to perform early ultrasound-screening program for DDH during the first 6weeks of life.The infants with abnormal conditions or suspected ultrasound results were transferred to Tianjin hospital.All the infants were clinically examined by experienced pediatric orthopaedic physician.Anteroposterior pelvic X-rays were taken for suspected infants to make a definite diagnosis.Results Hip ultrasound examinations were performed for 94 443 infants between December 26,2009 and December 25,2010.The 136 cases (165 hips) were suspected as DDH and 168 cases (200 hips) were diagnosed as DDH by ultrasound.All of them were transferred to Tianjin hospital.Among suspected patients,the positive signal of Ortolani or Barlow was found in 10 cases (11 hips).The DDH signal on the radiograph was positive in 73 cases (84 hips).Two hundred and fifty-one infants (295 hips) were finally diagnosed as DDH.There were 40 boys and 211 girls.Also,left hips and infants bom in autumn or winter were more often involved.The prevalence of DDH in Tianjin area was 2.66% (251/94 443).Conclusion Accurate early detection and diagnosis of DDH could be expected with the Tianjin pattern of preliminary screening,secondary screening and definite diagnosis.Careful clinical examination and X-ray are important for diagnosis.

Early screening of developmental dysplasia of the hip in Tianjin

Objective To analyze the prevalence of developmental dysplasia of the hip (DDH) in Tianjin,and to establish early screening of DDH in China.Methods System of health care for maternity and children in Tianjin were used to perform early ultrasound-screening program for DDH during the first 6weeks of life.The infants with abnormal conditions or suspected ultrasound results were transferred to Tianjin hospital.All the infants were clinically examined by experienced pediatric orthopaedic physician.Anteroposterior pelvic X-rays were taken for suspected infants to make a definite diagnosis.Results Hip ultrasound examinations were performed for 94 443 infants between December 26,2009 and December 25,2010.The 136 cases (165 hips) were suspected as DDH and 168 cases (200 hips) were diagnosed as DDH by ultrasound.All of them were transferred to Tianjin hospital.Among suspected patients,the positive signal of Ortolani or Barlow was found in 10 cases (11 hips).The DDH signal on the radiograph was positive in 73 cases (84 hips).Two hundred and fifty-one infants (295 hips) were finally diagnosed as DDH.There were 40 boys and 211 girls.Also,left hips and infants bom in autumn or winter were more often involved.The prevalence of DDH in Tianjin area was 2.66% (251/94 443).Conclusion Accurate early detection and diagnosis of DDH could be expected with the Tianjin pattern of preliminary screening,secondary screening and definite diagnosis.Careful clinical examination and X-ray are important for diagnosis.