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目的探讨超声及临床髋关节检查在新生儿发育性髋关节发育不良(DDH)早期筛查中的意义。方法采用前瞻性的方法,分两阶段对我院2011年8月1日至2013年3月29日出生的新生儿分别进行髋关节临床检查和超声检查,并对筛查结果进行分析。第一阶段为2011年8月1日至2013年1月29日,筛查出生3~10天的新生儿,了解我院新生儿DDH的患病率、DDH发生的高危因素,以及髋关节超声筛查和临床物理检查两者之间的吻合度等。第二阶段为2013年1月30日至2013年3月29日,对初诊与复诊的一致性及灵敏度和特异度进行调查。结果第一阶段共筛查5193例新生儿,临床髋关节检查阳性616例(11.86%),超声检查阳性556例(10.71%)。男、女超声阳性率分别为6.41%和15.78%。臀位及羊水量少的新生儿超声检查阳性率分别为10.55%和13.00%。男、女左、右髋超声分度比较和男、女左髋、右髋、双髋超声检查比较显示,女婴、臀位、羊水量少、右髋发生DDH的风险高,差异有统计学意义(P<0.05)。第二阶段共筛选出符合超声初查和复查双条件的新生儿108例,初诊与复诊结果差异无统计学意义(P>0.05)。ROC曲线下面积为0.675(95%CI:0.183~1.000)。阳性预测值5.88%,阴性预测值98.90%。灵敏度及特异度的95%可信区间分别为50.00%(95%CI:1.26%~98.70%),84.90%(95%CI:76.60%~91.10%)。结论超声进行新生儿髋关节DDH检查排除性诊断的意义大。运用髋关节临床及超声检查筛查新生儿DDH简便、安全,可早期发现可疑及异常病例,有利于门诊随访和早期干预。
Objective To investigate the significance of ultrasonography and clinical hip examination in the early screening of neonatal impaired development of hip dysplasia (DDH). Methods A prospective method was used to perform clinical and ultrasound examinations of hip joint in newborns from August 1, 2011 to March 29, 2013 in our hospital in two phases. The screening results were analyzed. The first phase is from August 1, 2011 to January 29, 2013, screening of newborns 3 to 10 days old, to understand the prevalence of DDH in our hospital newborns, DDH risk factors, as well as hip ultrasound Screening and clinical physical examination of the fit between the two. The second phase, from January 30, 2013 to March 29, 2013, investigated the consistency and sensitivity and specificity of the first and second visit. Results A total of 5193 newborns were screened in the first phase. There were 616 (11.86%) positive clinical hip examinations and 556 (10.71%) positive ultrasound examinations. Male and female ultrasound positive rates were 6.41% and 15.78%. The bilirubin and amniotic fluid less positive rate of neonatal ultrasound were 10.55% and 13.00%. Male and female left and right hip ultrasound indexing and male, female left hip, right hip, double hip ultrasound examination showed that the baby, breech, amniotic fluid less, right hip DDH occurrence of high risk, the difference was statistically significant (P <0.05). In the second phase, 108 newborns were screened to meet the initial conditions and double examinations. There was no significant difference between the first visit and the second visit (P> 0.05). The area under the ROC curve was 0.675 (95% CI: 0.183-1.000). Positive predictive value of 5.88%, negative predictive value of 98.90%. The 95% confidence intervals for sensitivity and specificity were 50.00% (95% CI: 1.26% -98.70%) and 84.90% (95% CI: 76.60% -91.10%), respectively. Conclusion The diagnosis of neonatal DDH DDH exclusion of great significance. Screening neonatal DDH by clinical and ultrasonographic examination of hip joint is simple, safe and can detect suspicious and abnormal cases early, which is good for outpatient follow-up and early intervention.