发育性髋关节发育不良的临床检查与超声检查结果比较。
Comparing results of clinical versus ultrasonographic examination in developmental dysplasia of hip.
作者信息
Arti Hamidreza, Mehdinasab Seyed Abdoulhossein, Arti Sara
机构信息
Associate Professor, Department of Orthopedic Surgery and Trauma Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Reasercher in Vice Chancellery for Research, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
J Res Med Sci. 2013 Dec;18(12):1051-5.
BACKGROUND
Developmental dysplasia of hip (DDH) is one of the congenital anomalies in newborns that if not diagnosed and treated on time can lead to a severe disability. Although clinical examination is a very useful way for screening, but in some patients, a confirmatory diagnostic method such as ultrasonography is needed. The aim of the present study is to compare the sensitivity and specificity of clinical examination and ultrasonography in early detecting of DDH.
MATERIALS AND METHODS
A total of 5800 of newborns were examined by orthopedic surgeon as a screening method. The newborns with risk factors or suspicious on clinical examination were introduced to repeat clinical and ultrasonographic examination of hip. The results were collected and recorded by a check list and then the sensitivity and specificity of clinical examination were calculated.
RESULTS
Of 5701 newborns (11402 hips) who were studied by two methods of clinical examination and ultrasonography (by Graf method), the overall incidence of DDH was 29 per 1000. Only 94 hips (13.5%) of 694 disordered ones according to clinical examination were involved on ultrasonographic evaluation. A total of 240 hips of 334 (72%) involved hips according to ultrasonography (Graf type IIb or more) were diagnosed normal on clinical examination, considering ultrasonography as a gold standard method of evaluating DDH, the sensitivity and specificity of clinical examination were calculated 28.1% and 94.5%, respectively.
CONCLUSION
According to the present study, ultrasonogeraphic examination has a high valuable in screening of DDH and the clinical examination done by an experienced orthopedic surgeon has an acceptable value in primary screening of DDH in developing countries for detecting of healthy neonates, but if the newborn has a risk factor or is suspicious on clinical examination, it will be necessary to get assistance from ultrasonography by an experienced sonographer.
背景
发育性髋关节发育不良（DDH）是新生儿先天性畸形之一，若不及时诊断和治疗可导致严重残疾。虽然临床检查是一种非常有用的筛查方法，但在某些患者中，需要超声检查等确诊诊断方法。本研究的目的是比较临床检查和超声检查在早期检测DDH中的敏感性和特异性。
材料与方法
共有5800名新生儿由骨科医生进行检查作为筛查方法。对有危险因素或临床检查可疑的新生儿进行髋关节重复临床和超声检查。结果通过检查表收集并记录，然后计算临床检查的敏感性和特异性。
结果
在通过临床检查和超声检查（Graf法）两种方法研究的5701名新生儿（11402个髋关节）中，DDH的总体发病率为每1000例29例。根据临床检查，694个异常髋关节中只有94个（13.5%）在超声评估中受累。根据超声检查（Graf IIb型或更高），334个受累髋关节中有240个（72%）在临床检查中被诊断为正常，将超声检查视为评估DDH的金标准方法，临床检查的敏感性和特异性分别计算为28.1%和94.5%。
结论
根据本研究，超声检查在DDH筛查中具有很高的价值，经验丰富的骨科医生进行的临床检查在发展中国家对健康新生儿进行DDH初步筛查中具有可接受的价值，但如果新生儿有危险因素或临床检查可疑，则需要经验丰富的超声科医生借助超声检查。
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