Soboleski D A, Babyn P
Department of Radiology, Kingston General Hospital, Ontario, Canada.
AJR Am J Roentgenol. 1993 Oct;161(4):839-42. doi: 10.2214/ajr.161.4.8372771.
Dynamic and static sonography has become the imaging technique of choice in the diagnosis and follow-up of developmental dysplasia of the hip. The purpose of this study was to determine the value of using the thickness of acetabular cartilage as measured on sonograms as a discriminating factor in the diagnosis of developmental dysplasia.
We evaluated 220 consecutive hips in 110 infants referred for sonography because of possible developmental dysplasia (referred group). We also evaluated 66 hips in 33 infants who had normal findings on physical examination and no clinical or sonographic evidence of the abnormality (control group). The thickness of the acetabular cartilage, the alpha angle, and the presence of subluxation or dislocation on sonograms were recorded. Follow-up clinical and sonographic examinations were performed between 6 weeks and 6 months after the initial examinations in 19 patients in whom the thickness of the acetabular cartilage was increased (> 3.5 mm) and in 20 patients in whom the thickness was in the normal range (< 3.5 mm). All 39 patients who had follow-up examinations were from the referred group, and all these hips were normal according to conventional sonographic criteria on the initial examination.
Of the 220 hips in the referred group, 170 were initially classified as normal according to traditional sonographic standards, and 50 were classified as dysplastic (alpha angle < 55 degrees with or without subluxation or dislocation). The mean thickness of the acetabular cartilage in the control group was 2.6 mm (1 SD = 0.37) as compared with 4.6 mm (1 SD = 0.71) for the dysplastic hips in the referred group. The mean thickness in the hips classified as normal in the referred group was 3.0 mm. Nineteen hips in the referred group in which the thickness of the acetabular cartilage was greater than in the control group (i.e., > 3.4 mm) were imaged again during follow-up examinations. Sixteen of these 19 hips had become clinically unstable or dysplastic according to conventional sonographic criteria.
The results suggest that sonographic evidence of increased thickness of the acetabular cartilage is an early sign of developmental dysplasia of the hip and that close follow-up of infants with this abnormality is indicated.
动态和静态超声检查已成为诊断和随访发育性髋关节发育不良的首选成像技术。本研究的目的是确定超声测量的髋臼软骨厚度作为发育性髋关节发育不良诊断中的鉴别因素的价值。
我们评估了110例因可能存在发育性髋关节发育不良而转诊进行超声检查的婴儿的220个髋关节（转诊组）。我们还评估了33例体格检查结果正常且无临床或超声异常证据的婴儿的66个髋关节（对照组）。记录超声检查时髋臼软骨的厚度、α角以及半脱位或脱位的情况。对19例髋臼软骨厚度增加（>3.5mm）和20例厚度在正常范围内（<3.5mm）的患者在初次检查后6周和6个月之间进行了随访临床和超声检查。所有39例接受随访检查的患者均来自转诊组，且根据初次检查时的传统超声标准，所有这些髋关节均正常。
在转诊组的220个髋关节中，根据传统超声标准，最初有170个被分类为正常，50个被分类为发育不良（α角<55度，伴有或不伴有半脱位或脱位）。对照组髋臼软骨的平均厚度为2.6mm（标准差1=0.37），而转诊组发育不良髋关节的平均厚度为4.6mm（标准差1=0.71）。转诊组中被分类为正常的髋关节的平均厚度为3.0mm。转诊组中有19个髋关节的髋臼软骨厚度大于对照组（即>3.4mm），在随访检查期间再次进行了成像。根据传统超声标准，这19个髋关节中有16个已出现临床不稳定或发育不良。
结果表明，髋臼软骨厚度增加的超声证据是发育性髋关节发育不良的早期迹象，对于有这种异常的婴儿应密切随访。
