股骨头骨性髋臼覆盖率在筛查婴儿发育性髋关节发育不良中的应用  

Application of femoral head coverage in screening of developmental dysplasia of hip in infants

作　　者：樊伟[1] 高虹[1] 刘乔建[1] 易欣[1] 郭峻梅 张咏梅 李雪娇[1] FAN Wei;GAO Hong;LIU Qiaojian;YI Xin;GUO Junmei;ZHANG Yongmei;LI Xuejiao(Department of Ultrasound,Kunming Children's Hospital,Kunming 650228,China)

机构地区：[1]昆明市儿童医院超声科,云南昆明650228

出　　处：《中国医学影像技术》2018年第11期1694-1698,共5页Chinese Journal of Medical Imaging Technology

基　　金：昆明市医药卫生科技计划项目(2018-09-02-004);昆明市科技计划重点项目(2017-1-S-15222);昆明市卫生科技人才培养项目[2017-SW(带)-20]

摘　　要：目的探讨股骨头骨性髋臼覆盖率(FHC)在婴儿发育性髋关节发育不良(DDH)筛查中的应用价值。方法收集接受髋关节超声筛查的2 111名(4 222侧髋关节)婴儿,测量其中立位和屈曲位FHC,分析其与Graf分型的关系,并绘制ROC曲线评价其对DDH的诊断效能;计算中立位与屈曲位的FHC的差值(FHC-D),评价其评估髋关节稳定性的效能。结果 4 222侧髋关节中,稳定髋关节4 056侧,不稳定髋关节166侧;DDH 1 593侧,正常髋关节2 629侧。中立位和屈曲位FHC均与α角呈正相关(r=0.680、0.737,P均<0.001)。中立位FHC(59.39%±6.70%)大于屈曲位FHC(54.96%±9.30%),差异有统计学意义(t=19.122,P<0.001);两者诊断DDH的ROC曲线的AUC分别为0.884和0.879(P均<0.001)。不同Graf分型间中立位FHC和屈曲位FHC的总体差异均有统计学意义(P均<0.001),随着分型的加重,FHC逐渐降低,两两比较FHC差异均有统计学意义(P均<0.05)。FHC-D评估髋关节稳定性的AUC为0.972(P<0.001),临界值为8.50%,敏感度为89.0%,特异度为93.0%,准确率为93.9%。结论中立位和屈曲位FHC均可作为筛查DDH的参考指标之一;FHC-D可用于定量评估髋关节的稳定性。Objective To investigate the application value of femoral head coverage(FHC)in screening of developmental dysplasia of the hip(DDH)in infants.Methods Totally 2 111 infants(4 222 sides of hips)screened with ultrasound were enrolled.Neutral and flexional FHC were measured,and the relationship to Graf types was evaluated,while ROC curve was drawn to evaluate the diagnostic efficacy of DDH.The difference of neutral FHC and flexion FHC(FHC-D)was calculated,and its diagnostic efficacy to hip stability was assessed.Results Among all 4 222 sides of hip joints,4 056 were stable and 166 were unstable,1 593 were DDH and 2 629 were normal.Both neutral FHC and flexional FHC had positive correlation withαangle(r=0.680,0.737,both P<0.001).The neutral FHC(59.39%±6.70%)was greater than flexional FHC(54.96%±9.30%),and the difference was statistically significant(t=19.122,P<0.001).AUC of ROC curve was 0.884 for neutral FHC and 0.879 for flexional FHC in diagnosis of DDH(both P<0.001).The overall difference between neutral FHC and flexional FHC among different Graf types was statistically significant(both P<0.001).With the aggravation of Graf types,FHC gradually decreased,and the statistical differences were found in multiple comparisons(all P<0.05).AUC was 0.972 for FHC-D in the assessment of the stability of hips(P<0.001).Taking 8.50%as the threshold,the accuracy was 93.9%,the sensitivity and specificity was 89.0%and 93.0%,respectively.Conclusion Both neutral and flexional FHC can be used as reference indexes for screening DDH.FHC-D can be used to assess the stability of the hip quantitatively.

关 键 词：发育性髋关节发育不良 超声检查 股骨头 

分 类 号：R726.8[医药卫生—儿科] R445.1[医药卫生—临床医学]