The Correlation of Early Diagnostic Methods of Infants with Developmental Dysplasia of the Hip
|School||Tianjin Medical University|
|Keywords||Baby Developmental dislocation of the hip B- X-ray Diagnosis|
Objective: To elaborate B ultrasound, clinical examination and X-ray examination of the advantages and disadvantages of research between the three, to explore the baby early hip dysplasia diagnostic methods to identify appropriate hip dysplasia screening methods. : Relying on \Hospital pediatric orthopedics. The referral children for routine physical examination, and to shoot standard anteroposterior pelvic X-ray. Test results are divided into two groups, hip dislocation group and hip dysplasia group. We follow the internationally recognized the Ortolani sign positive cases shall be complete dislocation group, conduct a comprehensive analysis of the B-test results, so that the inspection ultrasonic diagnosis rate in the complete dislocation of the hip. While observing the children in this group standard anteroposterior pelvic X-ray acetabular shaped spinning, the proximal femur beak Perkins suddenly the line, measure the inside gap (d), above the gap (h), the lateral displacement ( c / b value), the top of the shift (h / b value) and acetabular index (AI), which summed up the characteristics of the the pelvic anteroposterior X-ray of the the early infancy hip dislocation proposed the pelvic anteroposterior X-ray diagnosis The early infancy hip dislocation standard for early screening, diagnosis is based on correlation analysis, while the B-test results and X-ray results. Graf Graf a typing type II defined for acetabular dysplasia cases of acetabular dysplasia group B ultrasound and X-ray results were compared to draw the correlation analysis, genotyping and Graf type Ⅱ c cases measurements inside the gap ( the value of d), above the gap (h), the lateral displacement (c / b value) is displaced upward (h / b value) and acetabular index (AI), proposed acetabular dysplasia of the diagnostic criteria for early timely therapy. Results: complete dislocation group of 66 patients (72 hips), including 7 males and 59 females, 34 cases of dislocation on the left, the right side of the dislocation in 26 cases, bilateral dislocation of the six cases, with an average age of 75.9 21.1d. The breech 66 patients, 16 cases (24.2%); amniotic fluid in 9 cases, ancient 14.5%; family history in 3 cases, accounting for 4.84%. Graf B super-typing results of 66 patients (72 hips) type Ⅱ a 9 hips, Ⅱ b type 3 hips, Ⅱ c 5 hips, D-27 hips, 21 hips of type III and type IV 7 hips. Graf typing type Ⅱ a, Ⅱ b type II c-type total of 17 hips, accounting for 24% of total hip femoral head ossification nuclear developing. Graf typing D-type, type III and type IV total of 54 hips, accounting for 76% of the total, which the group B ultrasound and clinical examination (76% the Ortolani sign :) compliance only. The group will Graf typing D-type, type III and type IV definition of B-positive, the proximal femur coracoid is located outside of the Perkins line defined for X-ray-positive, B ultrasound and the pelvic anteroposterior X-ray film examination results, The chi-square test Chi-square = 2.89, according to the significance level alpha = 0.05, B ultrasound and pelvic anteroposterior X-ray diagnosis dislocation is not statistically significant. All pelvic anteroposterior X-ray contralateral hip acetabular curved or straight, sharp outer edge of the acetabulum; ipsilateral acetabular performance of steep, was short oblique or long oblique, short oblique, hip The outer edge of the acetabulum cylindrical obtuse. 72 hips in 40 hips (55.6%) Shenton line interrupt, 32 hips Shenton line continuity; The proximal femur coracoid is located outside of the Perkins line 62 hips (86.1%), in the Perkins line inside 10 hip. Unilateral dislocation of the hip contralateral control group (after follow-up of delayed hip dysplasia or dislocation), hips d value of an average of 6.16mm, compared with the contralateral average increase 2.34mm; hips average value of h reduced compared with the contralateral 8.89mm 1.47mm; suffering from hip c / b is 0.97, compared with the contralateral increase of about 0.09; suffering from hip h / b is 0.24, a decrease of approximately 0.05 compared with the contralateral; suffering from hip AI value an average of 33.14. Compared with the contralateral average increase of 4.33. . 5 sets of data uninvolved were statistically significant. Acetabular dysplasia group to the group of 233 patients, a total of 251 hip, including 37 males, female 196 cases, the left hip dysplasia 110 cases, the right side of the 68 cases of dysplasia, bilateral dysplasia 55 cases, the average age 60.3 20.1d. 233 patients in the breech 38 cases, accounting for 16.3%; amniotic fluid at least 16 cases, accounting for 6.9%; family history of four cases, accounting for 1.7%. Which the Graf classification type Ⅱ a 145 hip Ⅱ b-45 hip Ⅱ c-61 hip. Ortolani sign was positive in 17 hips, hip Barlow and positive signs, 28 hip clinical examination negative, hip x-ray findings negative. B-ultrasound and clinical and X-ray examination in acetabular dysplasia diagnosis coincidence rate was 79.2%. Which II c-61 hip were measured inside the gap and acetabular index was not statistically significant. Conclusion: B super easy as easy screening tools, non-radioactive damage, suitable for screening large sample populations, especially for 6 weeks after birth the baby B-ultrasound to reduce the false-positive cases, adequate economical and effective, worthy of promotion. B ultrasound in the diagnosis of hip dislocation in line with the 76% rate meter, so stressed for the unstable hip, B ultrasound should not be used alone as a diagnostic method, need to be combined with clinical examination or pelvic anteroposterior X-ray. B-ultrasound, high sensitivity, The adverse developmental aspects of clinical and X-ray standard in the diagnosis of hip acetabular compliance rate was 79.2%, should be wary of over-diagnose the problem. Pelvis under the X-ray film Perkins line is a very sensitive diagnostic indicators in the absence of B-screening areas as a means of diagnosis of DDH.