Ultrasonic Diagnosis Room, Shandong Medical Imaging Research Institute, 324 Jing Wu Rd, Huai Yin District, 250021 Jinan, Shandong, China.
J Ultrasound Med. 2012 Jun;31(6):827-31. doi: 10.7863/jum.2012.31.6.827.
To determine the value of sonography for evaluating unilateral hip dislocation in a spica cast after closed reduction for developmental dysplasia of the hip.
Seventy-three cases of unilateral hip dislocation were detected by sonography after closed reduction and monitored through the perineal opening of the cast during follow-up. The transinguinal approach was used first to determine the position of the femoral head. Then a sonogram of the bilateral hips was obtained by transverse scanning on the lower margin of the pubic symphysis. To determine the status of the affected femoral head, a bilateral comparison of the femoral head positions was made by measuring the horizontal distance from the medial rim of each femoral head to a center line through the pubic symphysis.
In all 73 cases, the femoral head position after reduction could be identified by sonography. With the transinguinal approach, the reduction was successful in 69 cases and unsuccessful in 4. On the sonograms of the bilateral hips, the dislocated femoral heads were repositioned in the acetabular fossa in the successful cases and redislocated posterolaterally in the unsuccessful cases. Among the successful cases, the position differences were less than 2 mm in 61, 3 to 4 mm in 7, and 5 mm in 1. In the unsuccessful cases, the positions of the bilateral hips were asymmetric; the differences were indecipherable after an unsuccessful first reduction but were 3 to 5 mm after a successful second reduction. During follow-up, the differences were never greater than 2 mm in the cases with initial differences of less than 2 mm and gradually decreased to less than 2 mm in those with initial differences of greater than 2 mm.
Sonography can be considered as the first imaging tool for evaluating the effect of closed reduction for developmental dysplasia of the hip.
探讨超声在评价发育性髋关节发育不良（DDH）患儿行闭合复位后支具固定期间单侧髋关节半脱位中的价值。
73 例单侧髋关节脱位患儿行闭合复位后，通过支具会阴开窗进行随访，并采用经皮经腹股沟途径首先确定股骨头位置，然后在耻骨联合下缘行横向扫描，获得双侧髋关节声像图。通过测量两侧股骨头内缘到耻骨联合中线的水平距离，双侧比较股骨头位置，以确定患侧股骨头的情况。
73 例患儿的股骨头复位后位置均能通过超声显示。经皮经腹股沟途径，69 例复位成功，4 例复位失败。在双侧髋关节声像图中，成功复位的病例中脱位的股骨头重新位于髋臼窝内，而失败复位的病例中股骨头向后外侧再脱位。在成功复位的病例中，61 例股骨头位置差异小于 2mm，7 例为 34mm，1 例为 5mm。在复位失败的病例中，双侧髋关节位置不对称，初次复位失败时差异无法辨认，而二次复位成功时差异为 35mm。在随访过程中，初始差异小于 2mm 的病例差异从未超过 2mm，且逐渐减小至小于 2mm，而初始差异大于 2mm 的病例差异逐渐减小至小于 2mm。
超声可作为评价发育性髋关节发育不良患儿闭合复位效果的首选影像学方法。
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