重庆某区6月龄以下婴儿发育性髋关节异常的调查分析

发布时间：2018-03-18 12:32

  本文选题：髋关节　切入点：发育不良　出处：《第三军医大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景:发育性髋关节异常(developmental dysplasia of hip,DDH),是小儿常见的骨关节疾病之一,也是儿童保健医生经常面临的问题。以往认为髋关节异常即为髋关节脱位,并且是先天性发生的疾病,因此将其命名为先天性髋关节脱位(congenital dislocation of the hip,CDH)。但是随着对该病的进一步深入研究逐渐发现,它既包含股骨头和髋臼的发育异常,也包含他们在解剖关系中的改变,因此依照病变程度的不同,可以将其分为三种类型,分别为髋臼发育不良、髋关节半脱位和髋关节脱位。随着对该病的动态研究发现,有一部分患儿在出生的时候髋关节表现为不稳定,但是伴随着生长发育可以逐渐成为正常的、稳定的髋关节;还有一部分患儿在出生的时候髋关节可以是正常的,但是伴随着生长发育可能会逐渐地成为半脱位髋关节或者是脱位髋关节,说明该病可以发生在出生前,也可以发生在出生后。鉴于上述原因,1992年,北美小儿矫形外科学会正式用DDH替代了CDH。DDH是可以治疗的疾病,未经治疗可以导致成人期丧失重要关节功能,成为髋关节置换的重要原因。出生至6月龄为DDH治疗的黄金时间,通过Pavlik吊带对异常的髋关节进行固定,治疗周期1-3个月,痛苦小,治疗费用低。6月龄至2岁通过蛙式支架或石膏进行固定,治疗周期3-9个月。2岁以上多数需要通过手术进行治疗,治疗周期5-7个月,痛苦大,治疗费用高。因此早期检查和诊断是决定治疗方式的关键。DDH的检查方法包括临床检查、B超、X线、CT和MRI,临床检查有助于发现高危儿,其余检查方法则有助于诊断。检查方法的选择主要依据年龄而定。B超及MRI具有对软骨及软组织成像的优势多应用于6月龄以内的儿童,但是MRI具有检查费用较高、需要使用镇静剂等不足,而B超检查费用低、操作简便、安全,无需使用镇静剂,因此6月龄以内的儿童多采用B超进行诊断。6月龄以上儿童随着骨化中心的出现,X线和CT检查的优势得以体现。但是由于CT检查费用高和有较高的辐射暴露,此年龄段儿童多以X线作为诊断方法。目前世界各地对DDH发病率的报道差异较大,据报道其发病率为1.5‰-20‰。我国目前尚无全面的普查资料,对DDH发病率的报道多集中在东部地区,北京、天津、上海、香港、台湾等地区的报道显示ddh的发病率为0.07‰-3.37‰,而西部地区相对较少,成都市的报道为8.2‰。ddh的病因未明,各种危险因素与ddh发病的相关性存在较大争议,普遍认为是遗传因素与环境因素共同作用的结果。本研究对重庆市沙坪坝区妇幼保健院2014年1月1日至2014年12月31日的2066例6月龄以下婴儿ddh发病率筛查情况进行分析,将性别、出生季节、孕周、胎位、分娩方式、出生体重、母亲妊娠年龄、母亲孕期每日钙摄入量、母亲孕期每日维生素d摄入量与ddh发病率进行相关性分析,以了解ddh发病特点及其可能的危险因素,为今后婴儿ddh的防治提供参考,为优生优育提供科学的指导。研究目的:通过本中心的对沙坪坝区妇幼保健院2014年1月至12月的2066例6月龄以下婴儿ddh发病率筛查结果研究,了解ddh在我院筛查人群中的患病率,以及其发病特点,可能的危险因素,以减少引起ddh发病率增加的可能危险因素,为优生优育提供指导。研究对象和方法:1、抽取2014年1月1日至2014年12月31日出生的于重庆市沙坪坝区妇幼保健院的新生儿1017例,以及同期非该院出生但在该院儿童保健科体检的6月龄以下婴儿1049例,共计2066例。2、对所有研究对象运用东芝纳米10超声检测仪进行髋关节超声检查,筛查出髋关节发育异常病例数。根据ddh超声检查graf分型标准,详细记录超声检查异常髋关节的分型情况和异常髋关节的侧别分布情况。3、从该院儿童保健科的儿童健康管理系统中检索出所有对象的出生情况以及母亲情况等相关指标,并详细记录。4、通过统一的食物频率调查问卷、根据母亲提供的信息记录母亲孕期食物、钙补充制剂、维生素d补充制剂摄入情况,通过食物计算器软件获得母亲孕期平均每日钙摄入量和母亲孕期平均每日维生素d的摄入量。5、采用统一的标准对所得指标进行量化和整理,分析ddh发病的特点以及各指标与ddh发病的相关性,探讨ddh发病的危险因素。研究结果:1、2066例受检婴儿中,检出ddh180例(8.7%)。180例ddh中,髋关节为Ⅱa型者177例(98.3%),Ⅱc型者2例(1.1%),Ⅲ型者1例(0.6%)。2、2066例受检者中,男性1047例(50.7%),女性1019例(49.3%)。各年龄段的性别构成差异无统计学意义。超声检出男性DDH55例(5.3%),女性DDH125例(12.3%),差异有统计学意义。3、受检的2066个左髋中,异常的有137个(6.6%),2066个右髋中,异常的有102个(4.9%),左侧多于右侧,差异有统计学意义。4、在单因素分析中,儿童性别、侧别、胎位、母亲妊娠年龄、母亲孕期每日钙摄入量、母亲孕期每日维生素D摄入量与DDH发病有关,差异有统计学意义;儿童出生季节、出生孕周、分娩方式、出生体重与DDH发病无关,差异无统计学意义。5、在多因素分析中,筛选出的影响DDH发病的危险因素为儿童性别、胎位、母亲妊娠年龄、母亲孕期每日维生素D摄入量。结论:1、6月龄以下婴儿DDH发病有型别、侧别特征,以生理性发育不成熟最为常见,左侧多于右侧,与国内其他报道基本一致。2、婴儿性别、胎位、母亲妊娠年龄、母亲孕期每日维生素D摄入量与DDH的发病有相关性,女性、臀位产、母亲妊娠年龄超过35岁、母亲孕期每日维生素D摄入量5μg为DDH发病的危险因素。
[Abstract]:Background: developmental dysplasia of the hip (developmental dysplasia of hip, DDH), is one of the most common bone disease in children, but also children care physicians often face problems. The abnormal hip to hip dislocation, and congenital disease occurs, it will be named congenital hip joint (congenital dislocation of the hip dislocation, CDH). But with the further in-depth study of the disease gradually found that it contains both the femoral head and acetabular dysplasia, also contain in their anatomical relationships change, because this in accordance with the severity of disease, it can be divided into three types, respectively, acetabulum dysplasia of hip subluxation and dislocation of hip joint. With the dynamic study of the disease that is part of the children at the time of birth of hip joint performance is not stable, but with growth can become For normal, stable hip joint; and part of the children at the time of birth of hip joint can be normal, but with growth may gradually become hip subluxation or dislocation of hip joint, indicating that the disease can occur before birth, may also occur after birth. In view of the above reasons, 1992 North American Society of pediatric orthopaedic surgery, official use DDH instead of CDH.DDH is a disease that can be treated, untreated adults can cause loss of important joint function, become an important reason for hip replacement. Prime time from birth to 6 month old for the treatment of DDH, through the Pavlik sling on the abnormal hip joints were fixed for 1-3 months, the treatment cycle the pain is small, low cost of treatment.6 months to 2 years old by frog stent or gypsum fixation, treatment period for 3-9 months.2 years most need to be treated by surgery, treatment cycle 5-7 July, big pain and high cost of treatment. Therefore early detection and diagnosis is the key determinant of.DDH examination method in the treatment of the clinical examination, ultrasound, X-ray, CT and MRI, the clinical examination is helpful to find the high-risk infants, the rest of the examination method is helpful for diagnosis. Mainly based on age and examination methods. Ultrasound and MRI of cartilage and soft tissue imaging advantages applied to less than 6 month old of the children, but MRI has the inspection cost is higher, need less sedation, and ultrasound examination of low cost, simple operation, safety, without the use of sedatives, so less than 6 month old of the children were diagnosed by ultrasound in children.6 months old with the emergence of ossification center, X-ray and CT advantage. But due to the high cost of CT radiation and a higher exposure, this age children as a diagnostic method in X-ray. At present the world of DDH Reported differences in incidence of larger, reported incidence rate was 1.5 per thousand -20 per thousand. At present there is no comprehensive census data on the incidence of DDH reported more concentrated in the eastern region, Beijing, Tianjin, Shanghai, Hongkong, Taiwan and other regions of the reported incidence rate of DDH was 0.07 per thousand and -3.37%. The western region is relatively small, Chengdu City reported 8.2 per thousand.Ddh for the cause is unknown, there is great controversy between various risk factors and the pathogenesis of DDH, generally considered the interaction of genetic factors and environmental factors. The results of the research on the Chongqing city Shapingba District Maternal and child health hospital from January 1, 2014 to December 31, 2014, 2066 cases of 6 month old infants under DDH incidence the rate of screening analysis, gender, season of birth, gestational age, fetal position, mode of delivery, birth weight, gestational age, maternal calcium intake during pregnancy, the mother of vitamin D daily The correlation analysis and the incidence of DDH, DDH in order to understand the characteristics of the disease and its risk factors, to provide reference for the prevention and control of the future baby DDH, to provide scientific guidance for eugenics. Objective: through maternal and child health hospital in Shapingba district from January 2014 to December 2066 cases of 6 month old infants under the incidence of DDH screening results of the center understand the DDH screening in our hospital, the prevalence rate, as well as its clinical features, risk factors, in order to reduce the incidence of DDH caused by increased risk factors, to provide guidance for eugenics. Subjects and methods: 1, from January 1, 2014 to December 31, 2014 was born in Chongqing city Shapingba District Maternal and Child Health Hospital of the newborn in 1017 cases, and at the same time the hospital was born but in the examination of child health care, the hospital of the 6 month old infants under 1049 cases, a total of 2066 cases of.2, the study of the application of Xiang Dong Hip ultrasonography of Chicago nano 10 ultrasonic testing instrument, screening out hip dysplasia cases. According to DDH ultrasound Graf type standard, detailed record of ultrasound classification of abnormal hip and abnormal hip side distribution.3, retrieve the relevant index of all objects and the birth mother from the children's Health Department of child health management system, and detailed records of.4, by food frequency questionnaire, according to information provided by the mother record of maternal food, calcium supplements, vitamin D supplementation through food intake, average daily gain calculator software of maternal calcium intake during pregnancy and average daily vitamin.5 intake of D, using a uniform standard and quantitative analysis of the indicators, analysis of the characteristics of the pathogenesis of DDH and the index and the incidence of DDH. 鍏虫，

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