van Bussel E M, van Marle L, Bonsel J M, de Vrij D, Weinans H, Sakkers R
Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
Department of Orthopedic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Ultrasound J. 2025 May 30;17(1):26. doi: 10.1186/s13089-025-00419-3.
Current methods to classify developmental dysplasia of the hip (DDH) on ultrasound (US) images, such as the Graf method, provide limited prognostic information. This study aimed to improve the prediction of the clinical course and outcome at age five of decentered hips, diagnosed on the first US made in the first months after birth, by identifying acetabular shape variants on these US images using a statistical shape model (SSM).
US images of the hip were retrieved from a single-center retrospective cohort of patients with DDH Graf type D/III/IV. A SSM was created from the US images made at initial diagnosis.. The association between the identified acetabular shape variants and an unfavorable outcome (residual DDH at age five and open reduction and/or a pelvic osteotomy before age five) was established with multivariable regression models.
92 decentered dysplastic hips with full history could be retrieved from the database and were included. At age five, 12 patients (13%) had undergone open reduction, 13 (14%) had a pelvic osteotomy, and 32 (35%) patients showed residual DDH. Four shape variants represented 95% of the variance in acetabular shape. Mode 4 was associated with an unfavorable outcome (odds ratio (OR): 1.80 (95% CI 1.12-2.90). Mode 1 was associated with less risk on open reductions or pelvic osteotomies (OR: 0.56 (95% CI 0.33-0.96).
A potential new method of analyzing US images for DDH using SSM established four distinct acetabular shapes on neonatal US images with unstable DDH, of which two were associated with outcomes at five years of age. This tool could serve as a basis for a better prediction of outcome and a more personalized and effective guide for treatment.
目前在超声（US）图像上对发育性髋关节发育不良（DDH）进行分类的方法，如Graf法，提供的预后信息有限。本研究旨在通过使用统计形状模型（SSM）识别出生后最初几个月首次超声检查诊断为髋关节脱位的髋臼形状变异，改善对其五岁时临床病程和结局的预测。
从一个单中心回顾性队列中检索DDH Graf D/III/IV型患者的髋关节超声图像。根据初始诊断时的超声图像创建一个SSM。通过多变量回归模型确定所识别的髋臼形状变异与不良结局（五岁时残留DDH以及五岁前切开复位和/或骨盆截骨术）之间的关联。
从数据库中检索到92例有完整病史的髋关节脱位发育不良病例并纳入研究。五岁时，12例患者（13%）接受了切开复位，13例（14%）进行了骨盆截骨术，32例（35%）患者显示有残留DDH。四种形状变异占髋臼形状变异的95%。模式4与不良结局相关（优势比（OR）：1.80（95%可信区间1.12 - 2.90））。模式1与切开复位或骨盆截骨术的风险较低相关（OR：0.56（95%可信区间0.33 - 0.96））。
一种使用SSM分析DDH超声图像的潜在新方法在新生儿不稳定DDH的超声图像上确定了四种不同的髋臼形状，其中两种与五岁时的结局相关。该工具可作为更好地预测结局以及更个性化和有效治疗指南的基础。
