安徽省部分地区发育性髋关节异常的临床观察

摘要

目的 了解安徽省部分地区发育性髋关节异常(DDH)的流行病学特征,探讨并制定适合安徽省省情的早期筛查方法和标准化的诊断模式.方法 由安徽省部分地区包括合肥市、淮南市、阜阳市、亳州市、六安市、铜陵市和安庆市等13个区县妇幼保健机构利用国家已经建立完善的省市县乡级妇幼保健体系,各地市分别对辖区内所有出生后6～24周婴儿采用体格检查进行初筛,可疑或异常者体征者转诊至市妇幼保健中心及安徽省儿童医院,由小儿骨科医师对转诊患儿进行复筛,复筛内容包括体格检查(外展试验、 Allis征、Ortolani和Barlow试验)和影像学评估(B超检查,并对B超可疑者行骨盆正位X线),以进一步确诊.结果 2015年1月～2016年6月,共对73 274(共146 548髋)例婴儿实施初期筛查,共对10. 3％ (7 545例)的婴儿进行了复筛并行髋关节B超检查,其中136例(152髋)可疑患儿(Graf Ⅱa型)和142例(176髋)检查异常[Graf (Ⅱb～Ⅳ)型]患儿转诊至安徽省儿童医院骨科.最终有218例(256髋)确诊为DDH,男/女为1/3.74;DDH患儿与正常儿童相比在性别、头胎、臀位产、分娩方式、襁褓位方面差异有统计学意义(P<0.05),安徽省部分地区DDH发病率为2. 98％c(218/ 73 274).结论 安徽省部分地区利用国家已经建立的完善的省市县乡级妇幼保健体系,对出生后6～24周的婴儿按照初筛-复筛-确诊模式,可以初步实现对DDH的早发现、早诊断.通过早期筛查,特别是高危患儿,使得DDH患儿得到早期确诊和及时治疗,从而获得满意的效果.%Objective To investigate the epidemiological characteristics of developmental dysplasia of the hip(DDH) in some areas of Anhui Province, to explore and formulate the early universal screening program and standardized diagnostic models. Methods Maternal and child health care institutions in 13 districts and counties, coming from parts of Anhui Province including Hefei city, Huainan city, Fuyang city, Bozhou city, Lu'an city, Tongling city and Anqing city and others, had been made use of the perfect provincial, county and village level Maternal and Child Health care system established by the state to had a routine clinical hip examination for all newborns at age 6～24 weeks. The infants with abnormal clinical findings suggestive of developmental dysplasia of the hip were transferred to the public Maternal and Healthy Child center or Anhui Children's Hospital had both clinical and sonographical re-examinations and definitive diagnosis by one of the seasoned paediatricians. Clinical assessment of the hips included limited hip abduction, Allis sign and Barlow/Ortolani tests; while radiological evaluation included the ultrasonography examination, and anterposterior pelvic X-rays if necessary. Results Of 73 274 live births (146 548 hips) underwent early screening programs between January 2015 and May 2016, 7 545 cases(10.3％) were included for further ultrasonographic screening and reports based on clinical examinations. Of whom 136 cases of Graf II type (152 hips) and 142 cases of Graf (II b～IV) type (176 hips) were transferred to our hospital and 218 cases(2. 98％o, 256 hips) presented with DDH with the ratio of male/female 1/3. 74. DDH was more frequent in association with the female gender, first-born children, breech presentation at delivery, caesarean section and positive family history (P＜ 0. 05). Conclusion Anhui Province in some areas have been made use of the perfect provincial, county and village level Maternal and Child Health care system established by the state and achieved early detection and diagnosis of DDH at age 6～24 weeks after birth, according to the model of early clinical examination, clinical and sonographical re-examinations and definitive diagnosis, espenscially for high risk infants, so as to achieve satisfactory results.