髋周皮纹不对称在发育性髋关节发育不良筛查中的意义  

Significance of the asymmetry of skin folds around the hip in screening for developmental dysplasia of the hip

作　　者：井艳 沈阳 李大进 孙庆增 JING Yan;SHEN Yang;LI Dajin;SUN Qingzeng(Department of Child Health Care,Xuzhou Children’s Hospital Affiliated to Xuzhou Medical University,Xuzhou 221000,Jiangsu,China;Department of Pediatric Orthopedics,Xuzhou Children’s Hospital Affiliated to Xuzhou Medical University,Xuzhou 221000,Jiangsu,China)

机构地区：[1]徐州医科大学附属徐州儿童医院儿童保健科,江苏徐州221000 [2]徐州医科大学附属徐州儿童医院儿童骨科,江苏徐州221000

出　　处：《中国现代医生》2024年第22期80-83,共4页China Modern Doctor

摘　　要：目的探讨髋关节周围皮纹不对称与发育性髋关节发育不良(developmental dysplasia of the hip,DDH)的关系。方法回顾性分析2017年1月至2022年12月在徐州医科大学附属徐州儿童医院进行DDH筛查的308名婴儿。根据筛查原因将其分为观察组(单纯皮纹不对称,n=116例)、临床异常组(具有髋关节弹响、髋关节外展受限、双下肢不等长等临床表现,n=92)和对照组(单纯行髋关节筛查,n=100)。分析临床评估结果及Graf法髋关节超声检查结果,比较各组病理性DDH的检出率,计算髋关节周围皮纹不对称诊断病理性DDH的阳性预测值、阴性预测值、敏感度、特异性。结果观察组检出病理性DDH 5例(4.31%);临床异常组检出病理性DDH 28例(30.43%);对照组检出病理性DDH 4例(4.00%)。观察组和对照组婴儿的病理性DDH检出率比较差异无统计学意义(χ^(2)=0.909,P=0.592);临床异常组婴儿的病理性DDH检出率显著高于对照组(χ^(2)=24.109,P<0.001)。单纯髋关节周围皮纹不对称对病理性DDH的阳性预测值为4.31%,阴性预测值为96.00%,敏感度为55.56%,特异性为46.38%。出现异常临床表现对病理性DDH的阳性预测值为30.43%,阴性预测值为96.00%,敏感度为87.50%,特异性为60.00%。结论单纯髋关节周围皮纹不对称诊断病理性DDH的价值较低,应更加重视是否存在其他临床体征,以指导婴儿的影像学筛查。Objective To investigate the relationship between asymmetry of skin folds around the hip and developmental dysplasia of the hip(DDH).Methods A retrospective analysis was performed on 308 infants who underwent DDH screening at Xuzhou Children’s Hospital Affiliated to Xuzhou Medical University from January 2017 to December 2022.According to screening reasons,they were divided into observation group(simple asymmetry of skin folds around the hip,n=116),clinical abnormality group(clinical manifestations such as hip snap,limited hip abduction,unequal length of lower limbs,n=92)and control group(simple hip screening,n=100).Clinical evaluation results and Graf hip ultrasonography results were analyzed,and the detection rate of pathological DDH in each group was compared.The positive predictive value,negative predictive value,sensitivity and specificity of pathological DDH were calculated.Results Five cases(4.31%)were detected as pathological DDH in observation group.Twenty-eight cases(30.43%)were detected as pathological DDH in clinical abnormality group.Four cases(4.00%)were detected with pathological DDH in control group.There was no significant difference in detection rate of pathological DDH between observation group and control group(χ^(2)=0.909,P=0.592).The detection rate of pathological DDH in clinical abnormal group was significantly higher than that in control group(χ^(2)=24.109,P<0.001).The positive predictive value,negative predictive value,sensitivity and specificity of asymmetry of skin folds around the hip for pathological DDH were 4.31%,96.00%,55.56%and 46.38%,respectively.The positive predictive value,negative predictive value,sensitivity and specificity of abnormal clinical manifestations for pathological DDH were 30.43%,96.00%,87.50%and 60.00%,respectively.Conclusion The value of asymmetry of skin folds around the hip in diagnosing pathological DDH is lower,especially whether there are other clinical signs to guide imaging screening of infants.

关 键 词：发育性髋关节发育不良 诊断 皮纹不对称 髋关节超声 新生儿髋关节筛查 

分 类 号：R726.8[医药卫生—儿科]