天津市婴儿发育性髋关节发育不良的筛查结果及危险因素分析  

Screening results and analysis of risk factors of developmental dysplasia of hip in infants in Tianjin

作　　者：潘蕾[1] 张中礼[2] 张涛[1] 付喆[2] 何鑫[2] 满盈盈 冷俊宏[1] 杨建平[2] Pan Lei;Zhang Zhongli;Zhang Tao;Fu Zhe;He Xin;Man Yingying;Leng Junhong;Yang Jianping(Department of Child Healthcare Instruction,Tianjin Women and Children's Health Center,Tianjin 300070,China;Department of Pediatric Orthopaedics,Tianjin Hospital,Tianjin 300211,China;Department of Children Health,Tianjin Jinnan District Maternal and Child Health and Family Planning Service Center,Tianjin 300350,China)

机构地区：[1]天津市妇女儿童保健中心儿保指导科,天津300070 [2]天津市天津医院小儿骨科,天津300211 [3]天津市津南区妇幼保健计划生育服务中心儿保科,天津300350

出　　处：《中华骨科杂志》2022年第9期570-578,共9页Chinese Journal of Orthopaedics

基　　金：天津市卫生行业重点攻关项目(16KG141)。

摘　　要：目的探讨天津市婴儿发育性髋关节发育不良(developmental dysplasia of the hip,DDH)的B超筛查Graf分型结果及危险因素。方法回顾性分析2013年1月至2020年12月利用妇幼卫生保健三级管理和天津市妇幼卫生信息操作系统对生后6~8周的婴儿进行早期髋关节B超筛查的资料。筛查采用"初筛-复筛-确诊治疗"的"2+1"模式。统计筛查阳性率和不同年份、不同Graf分型患儿转诊治疗时的年龄,比较不同性别、胎次、胎位、生产方式、胎龄、出生体重、家族史患儿阳性率的差异,并采用二分类变量logistic回归分析筛选DDH的危险因素。结果筛查婴儿807889名,检出B超Graf分型Ⅱa型及以上阳性2039例(2841髋),检出阳性率为2.52‰(2039/807889)。异常髋中Ⅱa(+)型685髋、Ⅱa(-)型959髋、Ⅱb型367髋、Ⅱc型262髋、D型227髋、Ⅲ型265髋、Ⅳ型76髋;占比最多的依次为Ⅱa(-)型(33.76%,959/2841)、Ⅱa(+)型(24.11%,685/2841)、D型及以上型(19.99%,568/2841)。左侧髋异常率为2.02‰(1632/807889),大于右侧的1.50‰(1209/807889),侧别差异有统计学意义(χ^(2)=63.09,P<0.001)。女婴髋异常率为3.27‰(2541/777272),大于男婴的0.36‰(300/838506),性别差异有统计学意义(χ^(2)=1947.87,P<0.001)。男婴DDH阳性率0.50‰(209/419253)、女婴4.71‰(1830/388636),男女婴检出比为1∶8.76,不同性别DDH阳性率的差异有统计学意义(χ^(2)=1420.10,P<0.001)。不同胎位(头位/臀位)、生产方式(顺产/剖宫产)、出生体重(正常/低体重)、家族史(有DDH/无DDH)患儿DDH阳性率的差异均有统计学意义(P<0.05),不同胎次(第一胎/第二胎及以上)、胎龄(足月/早产)患儿DDH阳性率的差异均无统计学意义(P>0.05)。Logistic回归分析结果显示,女婴(OR=10.50,P<0.001)和胎位为臀位(OR=3.40,P<0.001)是DDH发生的独立危险因素,早产(OR=0.91,P<0.001)为DDH的保护因素。各年份不同B超Graf分型患儿转诊治疗年龄的差异均有统计学意义(P<0.05)。结�Objective To investigate the Graf classification results and risk factors of infants for developmental dysplasia of the hip(DDH)by B-ultrasound screening in Tianjin.Methods A retrospective analysis was conducted from January 2013 to December 2020 using the three-tier maternal and child health care management and the Tianjin maternal and child health information system for the early B-ultrasound screening data of 6-8 weeks old infants.The"2+1"screening model of"primary screening-re-screening-diagnostic treatment"was applied.The positive screening rate and age of infants at the time of referral for treatment in different years and different Graf classifications were analyzed,and the differences in positive infants with different sex,parity,fetal position,mode of production,gestational age,birth weight,and family history were compared.Binary logistic regression was used to analyze risk factors for DDH.Results A total of 807889 babies were screened,and 2039 children(2841 hips)were detected with B-ultrasound Graf classification count IIa and above,with the positive rate was 2.52‰(2039/807889).Among the abnormal hips,685 were type IIa(+)hips,959 were type IIa(-)hips,367 were type IIb hips,262 were type IIc hips,227 were type D hips,265 were type III hips,and 76 were type IV hips.Type IIa(-)was the most common,accounting for 33.76%(959/2841),type IIa(+)accounted for 24.11%(685/2841),type D and above was 19.99%(568/2841).The abnormality rate of the left hip was 2.02‰(1632/807889),which was greater than 1.50‰(1209/807889)of the right side,and the difference is statistically significant(χ2=63.09,P<0.001).The rate of hip abnormalities in female infants was 3.27‰(2541/777272),greater than 0.36‰(300/838506)in male infants,which the difference between the sexes had statistically significant(χ^(2)=1947.871,P<0.001).The positive rate of DDH in male infants was 0.50‰(209/419253),and that in female infants was 4.71‰(1830/388636).The detection ratio of male to female infants was 1∶8.76,and the difference in the po

关 键 词：髋脱位 先天性 新生儿筛查 超声检查 危险因素 

分 类 号：R726.8[医药卫生—儿科]