摘要
目的探讨6个月以下婴幼儿腿纹不对称对发育性髋关节发育不良(DDH)诊断的临床意义。方法回顾性分析2012年1月至2019年4月在中国医科大学附属盛京医院小儿骨科门诊及儿科门诊行DDH超声筛查患儿的病历资料,以6个月以下患儿为研究对象。共纳入患儿3266例,其中男1185例,女2081例;平均年龄2.8个月(1 d^6个月)。根据患儿就诊原因分为6类,分别为常规筛查379例(11.6%)、关节弹响59例(1.8%)、双下肢不等长或不等粗188例(5.8%)、髋关节活动受限或活动范围不对称58例(1.8%)、腿纹不对称2107例(64.5%)及因其他骨关节畸形筛查475例(14.5%)。诊断结果以Graf方法为标准,Ⅰ型、Ⅱa型髋定义为正常,Ⅱb型及以上分型定义为DDH。比较各类病史DDH的诊断率。结果3266例(6532髋)患儿中,共194例(230髋)诊断为DDH,总诊断率为5.94%。其中男31例,女163例;左侧DDH 109例,右侧49例,双侧36例。其中因常规筛查的诊断率为8.71%(33/379例),因关节弹响的诊断率为6.78%(4/59例),因双下肢不等长或不等粗的诊断率为14.36%(27/188例),因髋关节活动受限或活动范围不对称的诊断率为10.34%(6/58例),因腿纹不对称的诊断率为4.79%(101/2107例),因其他骨关节畸形而筛查的诊断率为4.84%(23/475例)。在上述所有病史中腿纹不对称的诊断阳性率最低(χ^2=37.14,P<0.05)。结论尽管腿纹不对称是最常见的DDH筛查体征,但其作为≤6个月婴幼儿DDH的早期筛查项目临床意义有局限,不应将腿纹不对称作为独立的DDH筛查指征。
Objective To investigate the clinical significance of asymmetric skin folds in the diagnosis of developmental dysplasia of the hip(DDH)in infant.Methods The clinical data of 3266 infants aged up to 6 months who were evaluated because of suspicious findings for DDH,hospitalized at Department of Pediatric Orthopaedics,Shengjing Hospital of China Medical University between January 2012 and April 2019 were reviewed retrospectively,including 1185 boys and 2081 girls,with a mean age of 2.8 months(ranging from 1 d to 6 months).The referred reasons included regular screening for DDH without suspicious findings[379 cases(11.6%)],clunk of the hip[59 cases(1.8%)],limb-length discrepancy[188 cases(5.8%)],limitation of hip motion or asymmetrical range of motion[58 cases(1.8%)],asymmetric skin folds[2107 cases(64.5%)],and combined conditions of musculoskeletal disorder[475 cases(14.5%)].The Graf′s ultrasound method was used to define the hip conditions.A typeⅠorⅡa hip was graded as normal,and a typeⅡb or more serious was graded as DDH.The percentages of DDH for various reasons were compared.Results Among 3266 patients(6532 hips),a total of 194 infants(230 hips)were diagnosed as DDH,and the total diagnostic rate was 5.94%,including 31 males and 163 females;there were 109 cases involving in the left,49 cases in the right,and 36 cases in the bilateral.The DDH diagnosed rate for regular screening was 8.71%(33/379 cases),6.78%(4/59 cases)for clunk of the hip,10.34%(6/58 cases)for limitation of hip motion,14.36%(27/188 cases)for limb-length discrepancy,4.79%(101/2107 cases)for asymmetric skin folds,4.84%(23/475 cases)for combined conditions of musculoskeletal disorder,and the DDH diagnosed rate for asymmetric skin folds was the lowest(χ^2=37.14,P<0.05).Conclusions Although asymmetric skin folds is the most common reason for DDH screening in infant up to 6 months,its clinical significance is limited,asymmetric skin folds should not be considered as an independent indication for DDH screening.
作者
刘冰
胡晓云
李连永
高树熹
Liu Bing;Hu Xiaoyun;Li Lianyong;Gao Shuxi(Department of Pediatric Orthopaedics,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Ultrasound,Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2019年第24期1882-1885,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
国家自然科学基金(81772296,81371918)。
关键词
发育性髋关节发育不良
腿纹不对称
诊断
超声筛查
Developmental dysplasia of the hip
Asymmetric skin fold
Diagnosis
Ultrasound screening
