Analysis in ultrasound screening results of developmental dysplasia of the hip in 1 534 infants aged 4 to 6 weeks
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摘要:目的 分析1 534例4~6周婴儿发育性髋关节发育不良(DDH)的超声筛查结果。方法 采用高频线阵探头和Graf法，对2020年8月—2021年2月儿童保健门诊就诊的1 058例4~6周足月儿(出生孕周≥37周)进行首次髋关节超声筛查; 另收集同期在高危儿随访门诊就诊的早产儿476例，予纠正胎龄4~6周首次行髋关节超声筛查。比较2组婴儿髋关节超声检查结果，并分析影响髋关节发育的相关因素。结果 足月儿1 058例，检测双侧髋关节共2 116次，检出髋关节异常97例，检出率为9.17% (97/1 058), 其中检出Ⅱa型116次, Ⅱc型1次。早产儿476例，检测双侧髋关节共952次，检出髋关节异常16例，检出率为3.36%(16/476), 其中检出Ⅱa型8次, Ⅱb型9次。进一步分析发现，足月儿DDH的检出率高于早产儿，女性患儿DDH检出率高于男性患儿，左侧DDH检出率高于右侧，差异均有统计学意义(P < 0.05)。分析DDH的影响因素发现，巨大儿DDH检出率高于低体质量儿、正常体质量儿，初产妇DDH检出率高于经产妇，差异均有统计学意义(P < 0.05)。结论 出生后早期进行髋关节B超检查是筛查DDH的有效手段，女童、左侧、初产、足月巨大儿是髋关节发育不良的高危因素，在临床工作中应重视4~6周婴儿DDH的初次筛查。
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关键词:
- 发育性髋关节发育不良 /
- 高频超声 /
- 早期筛查 /
- 早产儿 /
- 巨大儿
Abstract:Objective To analyze the ultrasound screening results of developmental dysplasia of the hip (DDH) in 1 534 infants aged 4 to 6 weeks.Methods High-frequency linear array probe and Graf method were used to perform the first-time ultrasonic screening of hip joint for 1 058 infants aged 4 to 6 weeks (gestational age≥37 weeks) from August 2020 to February 2021 in the child health clinic; in addition, 476 premature infants in the follow-up clinic of high-risk infants in the same period were collected, and they were conducted with first-time ultrasonic screening of hip joint after correcting gestational age with 4 to 6 weeks. The results of ultrasound examination of hip joint were compared between two groups, and the related factors affecting the development of hip joint were analyzed.Results In 1 058 full-term infants, bilateral hip joints were detected for 2 116 times, 97 cases were detected with hip joint abnormalities, including 116 times of type Ⅱa and 1 time of type Ⅱc, and the detection rate was 9.17% (97/1 058). In 476 premature infants, bilateral hip joints were detected for 952 times, 16 cases were detected with hip joint abnormalities, including 8 times of type Ⅱa and 9 times of type Ⅱb, and the detection rate was 3.36% (16/476). Further analysis showed that the detection rates of DDH in the full-term infants, the female children and the left side were significantly higher than those in the preterm infants, the male children and the right side (P < 0.05). Analysis in the influencing factors of DDH showed that the detection rate of DDH in macrosomia was significantly higher than that in the infants with low body weight and normal body weight, and the detection rate of DDH in primiparas was significantly higher than that in multiparas (P < 0.05).Conclusion B-ultrasound examination of hip joint is an effective method for screening DDH in the early stage after childbirth, and girls, left side, primipara and full-term macrosomia are the high-risk factors of hip dysplasia, so we should pay attention to the initial screening of DDH in the infants aged 4 to 6 weeks in clinical work. -
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表 1 髋关节Graf超声分类标准
Graf分类 骨顶/骨顶线夹角α 骨顶缘 软骨顶/软骨顶夹角 年龄 Type Ⅰ 形态良好，头臼对位, α≥60° 锐利或园钝 Ⅰa, β≤55°; Ⅰb, β>55° 任何年龄 Type Ⅱa/Ⅱb 形态稍差，未脱位, α=50~ < 60° 园钝或弧形 β=55~77° Ⅱa < 3个月, Ⅱb>3个月 Type Ⅱc 形态稍差，未脱位, α=43~ < 50° 扁平或阶梯 β < 77° 任何年龄 Type Ⅲ 形态稍差，脱位, α < 43° 扁平或阶梯 股骨头向上加压，近端软骨膜向上靠近髂骨壁 任何年龄 Type Ⅳ 形态稍差，脱位, α < 43° 扁平或阶梯 股骨头向下加压，近端软骨膜嵌压在股骨头与髂骨壁之间 任何年龄 
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表 2 1 534例婴儿髋关节异常检出情况
项目 髋关节检测次数/次 髋关节异常检出次数/次 异常检出率/% 类型 早产儿 952 17 1.79 足月儿 2 116 117 5.53* 性别 男性 1 560 28 1.80 女性 1 508 106 7.03# 侧别 右侧 1 534 42 2.74 左侧 1 534 92 6.00△ 与早产儿比较, *P < 0.05; 与男性比较, #P < 0.05;
与右侧比较, △P < 0.05。
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表 3 DDH的影响因素分析
影响因素 髋关节检测次数/次 髋关节异常检出次数/次 异常检出率/% 出生体质量 低体质量儿 860 14 1.63* 正常体质量儿 2 050 111 5.41* 巨大儿 158 9 5.70 分娩经历 初产妇 2 276 111 4.88* 经产妇 792 23 2.90 高龄产妇 是 2 574 118 4.58 否 494 15 3.04 妊娠胎数 单胎 2 666 122 4.58 双胎 402 12 2.99 孕周 < 28周(超早早产儿) 114 2 1.75 28~ < 32周(极早早产儿) 182 1 0.55 32~ < 34周(中期早产儿) 118 5 4.24 34~37周(晚期早产儿) 538 9 1.67 分娩方式 阴道分娩 1 634 69 4.22 剖宫产 1 434 65 4.53 受孕方式 自然受孕 2 586 116 4.49 辅助生殖 482 18 3.73 与巨大儿比较, *P < 0.05; 与经产妇比较, #P < 0.05。
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