Diagnostic value of ultrasound and magnetic resonance imaging in children with developmental dysplasia of the hip
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摘要:
目的 以磁共振成像(MRI)对小儿发育性髋关节发育不良(DDH)诊断结果为参考,探讨超声对DDH的诊断价值。 方法 对117例DDH患儿的117个髋关节进行超声和MRI检查,对比超声和MRI对DDH患儿髋关节病变检出的一致性,并对病变程度进行分型,比较两者对病变程度诊断的一致性,最后比较超声和MRI对不同年龄诊断的一致性。 结果 超声和MRI两种方法对DDH患儿髋关节的骨性结构(髂骨、髋臼骨顶、股骨头)病变检出的一致性好(K=0.901-0.885,P<0.001),对髋臼软骨顶病变检出的一致性差(K=0.093,P=0.151),对髋臼盂唇病变检出的一致性差(K=0.188,P=0.108),对关节囊病变检出的一致性差(K=0.201,P=0.095)。超声和MRI对发育不良(GrafⅡa型、Ⅱb型与MRIⅠ型)的髋关节检出的一致性好(K=0.963,P<0.001),对完全脱位(GrafⅢ型、Ⅳ型与MRIⅢ型)的髋关节检出的一致性好(K=0.897,P<0.001),对不完全脱位(GrafⅡc型、D型与MRIⅡ型)的髋关节检出的一致性差(K=0.152,P=0.093)。超声和MRI对年龄≤6个月的DDH患儿检出的一致性好(K=0.819,P<0.001),对年龄>6个月的DDH患儿检出的一致性差(K=0.136,P=0.202)。 结论 超声对于早期DDH的检出具有重要意义,有利于随访观察以及指导临床治疗。 -
关键词:
- 超声检查 /
- 小儿 /
- 发育性髋关节发育不良 /
- 磁共振成像
Abstract: Objective To investigate the significance of ultrasound in the diagnosis of DDH. Methods The hip joints (117) in all DDH patients (117) were examined by ultrasound and MRI to compare the consistency of the results between the two methods. The classification was made according to the pathological degree. The consistence of the diagnosis results was compared in the two testing methods and patients in different ages. Results The diagonsis of ultrasound were consistent with that of MRI in the the results of bony structure (the ilium, the top of acetabulum and the femoral head ) of hip joints ( K=0.901-0.885, P<0.001). The diagonses of ultrasound and MRI have less consistence in the results of top of acetabulum cartilage lesions (K=0.093, P=0.151), in the glenoid labrum (K=0.188, P=0.108), and joint capsule (K=0.201, P=0.095) of hip joints in DDH patients. Additionally, the diagonsis of ultrasound were consistent with that of MRI in the results of hypogenetic hip joints (GrafⅡa type、Ⅱb typ and MRIⅠtype) (K=0.963, P<0.001), and in the complete hip joint dislocation (GrafⅢ type、Ⅳ type and MRIⅢ type) (K=0.897, P<0.001). The diagonses of ultrasound and MRI have less consistence in the results of incomplete hip joint dislocation (GrafⅡc type、D type and MRIⅡ type) (K=0.152, P=0.093). Finally, the diagonsis of ultrasound were consistent with that of MRI in the patients within 6 months (K=0.819, P<0.001). The diagonses of ultrasound and MRI have less consistence in the patients older than 6 months (K=0.136, P=0.202). Conclusion It is important to use DDH in early DDH for this method is benifit for follow-up observation and clinical treatment guidence.-
Key words:
- ultrasonography /
- pediatric /
- developmental dysplasia of the hip /
- MRI
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表 1 超声与MRI诊断DDH阳性结果检出的一致性
检查方法 骨性结构 软骨性结构及软组织 髂骨 髋臼骨顶 股骨头 髋臼软骨顶 髋臼盂唇 关节囊 超声 10 97 105 83 112 107 MRI 108 102 109 37 89 79 K 0.901 0.885 0.891 0.093 0.188 0.201 P <0.001 <0.001 <0.001 0.151 0.108 0.095 -
[1] Kotlarsky P, Haber R, Bialik V, et al. Developmental dysplasia of the hip: What has changed in the last 20 years?[J]. World J Orthop, 2015, 6(11): 886-901. doi: 10.5312/wjo.v6.i11.886 [2] Williams D, Protopapa E, Stohr K, et al. The most relevant diagnostic criteria for developmental dysplasia of the hip: a study of British specialists[J]. BMC Musculoskelet Disord, 2016, 17(6): 38-43. [3] Sarkissian EJ, Sankar WN, Zhu XW, et al. Radiographic follow-up of DDH in infants: are x-rays necessary after a normalized ultrasound?[J]. J Pediatr Orthop, 2015, 35(6): 551-5. doi: 10.1097/BPO.0000000000000326 [4] Querol F, Rodriguez-Merchan EC. The role of ultrasonography in the diagnosis of the musculo-skeletal problems of haemophilia[J]. Haemophilia, 2012, 18(3): e215-26. doi: 10.1111/hae.2012.18.issue-3 [5] Ashby E, Roposch A. Diagnostic yield of sonography in infants with sus-pected hip dysplasia: diagnostic thinking efficiency and therapeutic efficiency[J]. AJR Am J Roentgenol, 2015, 204(1): 177-81. doi: 10.2214/AJR.14.12477 [6] Hareendranathan AR, Mabee M, Punithakumar K, et al. Toward automated classification of acetabular shape in ultrasound for diagnosis of DDH: Contour alpha angle and the rounding index[J]. Comput Methods Programs Biomed, 2016, 129(8): 89-98. [7] Karnik AS, Karnik A, Joshi A. Ultrasound examination of pediatric muscu-loskeletal diseases and neonatal spine[J]. Indian J Pediatr, 2016, 83(6): 565-77. doi: 10.1007/s12098-015-1957-2 [8] Kyung BS, Lee SH, Jeong WK, et al. Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening[J]. Clin Orthop Surg, 2016, 8(2): 203-9. doi: 10.4055/cios.2016.8.2.203 [9] Graf R, Scott. Hip sonography: diagnosis and management of infant hip dysplasia[M]. 2nd ed, Springer, 2006. [10] Dunn PM. The anatomy and pathy of congenital dislocation of the hip[J]. Clin Orthop, 1976, 11(9): 23-7. [11] Lee J, Spinazzola RM, Kohn N, et al. Sonographic screening for developmental dysplasia of the hip in preterm breech infants: do current guidelines address the specific needs of premature infants?[J]. J Perinatol, 2016, 36(7): 552-6. doi: 10.1038/jp.2016.7 [12] 陈文娟, 段星星, 李 皓, 等. 高频超声对疑似发育性髋关节异常患儿髋关节发育的评估价值[J]. 临床小儿外科杂志, 2011, 10(5): 345-7. http://www.cnki.com.cn/Article/CJFDTOTAL-BTYX201704027.htm [13] Mace J, Paton RW. Neonatal clinical screening of the hip in the diagnosis of developmental dysplasia of the hip: a 15-year prospective longitudinal observational study[J]. Bone Joint J, 2015, 97-B(2): 265-9. doi: 10.1302/0301-620X.97B2.34858 [14] Laborie LB, Markestad TJ, Davidsen H, et al. Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991-2006[J]. Pediatr Radiol, 2014, 44(4): 410-24. doi: 10.1007/s00247-013-2838-3 [15] Kumar RK, Shah P, Ramya AN, et al. Diagnosing developmental dysplasia of hip in newborns using clinical screen and ultrasound of Hips-An Indian experience[J]. J Trop Pediatr, 2016, 62(3): 241-5. doi: 10.1093/tropej/fmv107 [16] Wicart P, Bocquet A, Gelbert N, et al. Congenital dislocation of the hip: Optimal screening strategies in 2014[J]. Orthop Traumatol Surg Res, 2014, 100(6): S339-47. doi: 10.1016/j.otsr.2014.08.001 [17] Burnei G. Eradicating developmental dislocation of the hip: a National program in Romania using the Graf method of ultrasound examination[J]. Med Ultrason, 2014, 16(4): 391-2.