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目的了解宁波市鄞州区新生儿髋关节异常(developmental dysplasia of hip,DDH)发病情况,Ⅱa型DDH高危因素和临床表现,并随访其自然转归。方法使用Mylab50彩色多普勒超声诊断仪于2013年7月-2015年7月对宁波市鄞州第二医院出生新生儿在一周内行髋关节超声检查,对其中检查出为Ⅱa型于6~7周龄时免费来院检查,仍异常者予髋关节操和宽尿布法干预到12~14周龄再次复查。并分析Ⅱa型髋关节异常危险因素。结果在行髋关节超声检查2 225例新生儿中,按Graf法分型,发现Ⅱa型392例,Ⅱc型21例,Ⅲ型6例,Ⅳ型4例,初筛阳性率为19.01%(423例)。其中女326例,男97例,女孩发病率为29.74%,男孩的为8.59%,差异有统计学意义(χ2=161.61,P<0.05)。Ⅱa型DDH患儿中仅24例(6.12%)有明显高危因素,17例(4.34%)有临床阳性特征,最常见的高危因素是臀位产,最常见的临床特征是双侧臀纹不对称。Ⅱa型患儿于6~7周和12~14周复查时,大部分自然好转,且男孩比女孩好转率高。结论2013-2015年DDH在宁波市鄞州区新生儿中发病率很高,尤其女孩发病显著高于男孩。Ⅱa型高危因素及临床表现不显著,因此超声筛查尤为重要,对早期诊断和治疗起决定作用。随着生长发育,Ⅱa型大部分可自行好转,但是女孩需要治疗的发生率高于男孩。应当重视对新生女婴的髋关节超声筛查及随访。
Objective To investigate the incidence of neonatal developmental dysplasia of hip (DDH), risk factors and clinical features of type Ⅱ a DDH in Yinzhou District of Ningbo City. Methods Mylab50 color Doppler ultrasound diagnostic apparatus was used to perform ultrasound examination of hip joint within one week in Ningbo Yinzhou Second Hospital from July 2013 to July 2015, Free to hospital age check, still abnormal to hip surgery and wide diaper intervention to 12 to 14 weeks of age to review again. And analysis of type Ⅱ a hip abnormal risk factors. Results According to the Graf method, there were 392 cases of type IIa, 21 cases of type IIc, 6 cases of type III and 4 cases of type IV. The positive rate of primary screening was 19.01% (423 example). There were 326 women and 97 boys, the incidence of girls was 29.74%, and that of boys was 8.59%. The difference was statistically significant (χ2 = 161.61, P <0.05). Only 24 (6.12%) children with type IIa DDH had significant risk factors and 17 (4.34%) had clinically positive features. The most common risk factor was breech birth. The most common clinical feature was bilateral gluteal dorsal symmetry. Ⅱa-type children at 6 to 7 weeks and 12 to 14 weeks of review, most of the natural improvement, and the improvement rate of boys than girls high. Conclusion The incidence of DDH in Yinzhou District of Ningbo City during 2013-2015 is very high, especially in girls. Ⅱ a high risk factors and clinical manifestations are not significant, so ultrasound screening is particularly important for the early diagnosis and treatment play a decisive role. With the growth and development, most of Ⅱ a type can be improved on their own, but the incidence of girls need treatment is higher than boys. Should pay attention to the newborn baby girl hip ultrasound screening and follow-up.