新生儿髋关节筛查资料分析

目的 探讨超声及临床髋关节检查在新生儿发育性髋关节发育不良（DDH）早期筛查中的意义.方法 采用前瞻性的方法,分两阶段对我院2011年8月1日至2013年3月29日出生的新生儿分别进行髋关节临床检查和超声检查,并对筛查结果进行分析.第一阶段为2011年8月1日至2013年1月29日,筛查出生3 ～ 10天的新生儿,了解我院新生儿DDH的患病率、DDH发生的高危因素,以及髋关节超声筛查和临床物理检查两者之间的吻合度等.第二阶段为2013年1月30日至2013年3月29日,对初诊与复诊的一致性及灵敏度和特异度进行调查.结果 第一阶段共筛查5193例新生儿,临床髋关节检查阳性616例（11.86％）,超声检查阳性556例（10.71％）.男、女超声阳性率分别为6.41％和15.78％.臀位及羊水量少的新生儿超声检查阳性率分别为10.55％和13.00％.男、女左、右髋超声分度比较和男、女左髋、右髋、双髋超声检查比较显示,女婴、臀位、羊水量少、右髋发生DDH的风险高,差异有统计学意义（P＜0.05）.第二阶段共筛选出符合超声初查和复查双条件的新生儿108例,初诊与复诊结果差异无统计学意义（P＞0.05）.ROC曲线下面积为0.675（95％ CI：0.183～1.000）.阳性预测值5.88％,阴性预测值98.90％.灵敏度及特异度的95％可信区间分别为50.00％ （95％ CI：1.26％ ～ 98.70％）,84.90％（95％ CI：76.60％ ～91.10％）.结论 超声进行新生儿髋关节DDH检查排除性诊断的意义大.运用髋关节临床及超声检查筛查新生儿DDH简便、安全,可早期发现可疑及异常病例,有利于门诊随访和早期干预.

Analysis of hip joint screening of 5193 neonates

Objective To investigate the value of ultrasound screening and clinical physical examination for developmental dysplasia of the hip （DDH） in neonates.Methods Two-stage prospective study was carried out from August 1st 2011 to March 29th 2013 in Shanghai Maternal and Child Health Hospital of Minhang District.During the first stage （August 1st 2011 to January 29th 2013）,3-to-10-day old neonates received ultrasound screening and clinical physical examination to investigate the incidence of DDH,the risk factors of DDH and the consistency of the two method in detecting DDH.During the second stage （January 30th 2013 to March 29th 2013）,the consistency,sensitivity and specificity of the initial and the subsequent examination were investigated.Results Total of 5193 neonates were screened during the first stage.616 （11.86%） were diagnosed with DDH according to the clinical examination.556 neonates （10.71%） were diagnosed with DDH according to the ultrasound screening.6.41% of male and 15.78% of female,10.55% breech-presented neonates and 13.00% neonates with oligohydramnios were diagnosed with DDH according to the ultrasound screening.Female,breech position,oligohydramnios and right hip were risk factors for DDH.During the second stage,108 neonates who took repeated examinations were included.The result showed that there was no significant difference between the initial and the subsequent examination （P 〉 0.05）.The area under the ROC curve was 0.675 （95% CI：0.183-1.00）.The positive predictive value was 5.88% and the negative predictive value was 98.9%.The 95% confidence interval of sensitivity and specificity were 50% （95%CI：1.26%-98.7%） and 84.9% （95% CI：76.6%-91.1%） respectively.Conclusions Neonates who were female,breech-presented and with oligohydramnios had higher risk of getting DDH on the right hip.Ultrasound screening was important to rule out the diagnose of DDH.Early diagnosis of suspicious cases was important for proper treatment and follow-up.