0～6月龄婴儿发育性髋关节发育不良的临床筛查  

Clinical screening of developmental hip dysplasia in infants aged 0～6 months

作　　者：孙思媛 高雪婷 黄哲 SUN Siyuan;GAO Xueting;HUANG Zhe(Child Healthcare Department,Northwest Women and Children's Hospital,Xi'an 710061,Shaanxi,China)

机构地区：[1]西北妇女儿童医院儿童保健科

出　　处：《中国妇幼健康研究》2019年第11期1380-1384,共5页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨儿童保健门诊筛查婴儿发育性髋关节发育不良(DDH)的临床观察效果。方法选取西北妇女儿童医院2013年7月至2019年1月至儿童保健科健康体检的0~6月婴儿,经由儿童保健科主治医生体检进行DDH初步筛查,发现儿童存在可疑或者阳性体征者16 023人,行双侧髋关节B超检查。B超筛查结果异常者转诊至骨科,由骨科医生检查及X线片确诊,后对患儿进行定期复查,直到恢复正常。结果经由儿童保健科门诊初筛体征阳性患者中确诊DDH的发生率是4.7‰(152髋/32 046髋),其中有146例髋关节发育不良,3例髋关节半脱位,3例髋关节全脱位。随访治疗显示,Ⅱa型101例,其中3例失访,95例外展训练2~4周后正常,3例Pavlik挽具治疗12周内转为正常。Ⅱb型42例,1例失访,39例Pavlik挽具治疗转正常,2例经固定外展支具治疗转正常。Ⅱc至Ⅳ型共9例,4例患者Pavlik挽具治疗转正常,5例患者经固定外展支具治愈。初步筛查的外展受限、关节弹响阳性体征与确诊结果存在一致性(κ值为0.525、0.405,均P<0.01);高危因素臀位与确诊结果存在一致性(κ值为0.502,P<0.01)。结论产前健康宣教、儿童保健门诊手法检查及高危因素筛查相结合,配合超声检查联合的筛查流程,可早期发现DDH并早期治愈,符合本地新生儿DDH筛查工作的开展。Objective To investigate the clinical observation effect of screening infants for developmental hip dysplasia in child healthcare clinic.Methods A total of 16,023 infants of 0-6 months old with suspicious or positive signs of development hip dysplasia were examined by DDH in the physical examination during the period from July 2013 to January 2019 in the Children’s Healthcare Department of our hospital.Patients with abnormal B-ultrasound screening results were referred to the Department of Orthopedics for examination by orthopedic doctors and diagnosis by X-ray,and then the children were reexamined regularly until they got normal.Results The incidence of DDH was 4.7‰(152 hips/32 046 hips) among the patients with positive physical signs screened in the outpatient department.There were 146 cases of hip dysplasia,3 cases of hip subluxation,and 3 cases of total hip dislocation.Follow-up treatment showed that 101 patients with type Ⅱa,3 of whom were lost to follow-up,95 patients were normal after 2-4 weeks of exceptional training,and 3 patients were normal after 12 weeks of Pavlik harness treatment.42 cases of type Ⅱb,1 case lost to follow-up,39 cases of Pavlik harness turned to normal treatment,2 cases of fixed abductor support turned to normal treatment.A total of 9 patients from IIc to Ⅳ were treated with Pavlik harness,and 5 patients were cured with fixed abductor support.The initial screening results were consistent with the results of limited abduction and positive joint ringing(k= 0.525 and 0.405,respectively,P<0.01 for both).The breech position of high-risk factors was consistent with the diagnosed results(k=0.502,P<0.01).Conclusion Combination with prenatal health education,children’s healthcare out-patient manual inspection and high-risk factor screening along with ultrasonic inspection screening process can help to detect DDH that would be treated early,which is in line with the development of local newborn DDH screening.

关 键 词：儿童保健门诊 发育性髋关节发育不良 B超筛查 新生儿疾病筛查 

分 类 号：R726.8[医药卫生—儿科]