Contro Elena, Larcher Laura, Lenzi Jacopo, Benfenati Arianna, Massinissa Magini Giulia, Galeati Giulia, Terrone Maria, Galletti Silvia, Arcuri Santo, Seidenari Anna, Farina Antonio
Department of Medicine and Surgery, Division of Obstetrics and Prenatal Medicine, IRCCS Sant'Orsola-Malpighi, University of Bologna, 40138 Bologna, Italy.
Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
Diagnostics (Basel). 2021 May 12;11(5):868. doi: 10.3390/diagnostics11050868.
developmental dysplasia of the hip has an incidence of 3-5 out of 1000 children. Currently, only postnatal screening is available.
to test the feasibility of a method based on Graf technique application at antenatal ultrasound in assessing the normal development of the hip in unselected term fetuses.
a prospective cohort study in a single university tertiary hospital from January 2017 to January 2020. Single uncomplicated term pregnancies (37-40 weeks) attending our center for routine ultrasound were consecutively recruited for the purpose of the study. A 3D volume acquisition was launched on the coxofemoral joint of the fetus by a single expert operator, and offline analysis was then performed in the multiplanar mode by two operators (blinded to each other analysis) in order to measure the alpha and beta angles according to our modified Graf technique. Intra- and inter-observer variations were calculated. Reference charts for normal values of both angles were produced. Postnatal ultrasound was then performed to measure the Graf angles in newborns, confirming a normal development of the hip.
in the study period, 433 uncomplicated term pregnancies underwent 3D ultrasound for the assessment of the fetal hip. One case was subsequently excluded because of confirmed postnatal diagnosis of developmental dysplasia of the hip. The measurement of our modified Graf angles was feasible at prenatal ultrasound with a good reproducibility. The inter-rater and intra-rater reliability of both angles was substantial. Reference charts for normal values of both angles were produced.
the evaluation of the coxofemoral joint in fetuses at term of gestation has never been attempted before. The Graf technique application, currently employed at postnatal ultrasound, may also be adapted to prenatal ultrasound with a substantial reproducibility. However, there was no evidence of a linear relationship between prenatal and postnatal alpha angles and beta angles. Further research is needed to establish if developmental dysplasia of the hip could be diagnosed antenatally.
髋关节发育不良在每1000名儿童中的发病率为3至5例。目前，仅有产后筛查可用。
测试一种基于在产前超声中应用格拉夫技术的方法在评估未选择的足月胎儿髋关节正常发育方面的可行性。
2017年1月至2020年1月在一家大学三级医院进行的前瞻性队列研究。为该研究连续招募在我们中心进行常规超声检查的单胎无并发症足月妊娠（37至40周）。由一名专家操作员对胎儿的髋股关节进行三维容积采集，然后由两名操作员（相互盲法分析）以多平面模式进行离线分析，以便根据我们改良的格拉夫技术测量α角和β角。计算观察者内和观察者间的差异。制作了两个角度正常值的参考图表。随后对新生儿进行产后超声检查以测量格拉夫角，证实髋关节发育正常。
在研究期间，433例无并发症的足月妊娠接受了三维超声检查以评估胎儿髋关节。随后有1例因产后确诊为髋关节发育不良而被排除。我们改良的格拉夫角测量在产前超声中是可行的，具有良好的可重复性。两个角度的评分者间和评分者内信度都很高。制作了两个角度正常值的参考图表。
以前从未尝试过在妊娠足月时对胎儿的髋股关节进行评估。目前在产后超声中使用的格拉夫技术也可适用于产前超声，且具有很高的可重复性。然而，没有证据表明产前和产后的α角和β角之间存在线性关系。需要进一步研究以确定是否可以在产前诊断髋关节发育不良。
