| Part I Studies of the prevalence and risk factor of ultrasonographic DDH in infantsPurpose: In pediatric orthopedics,different countries and regions used different strategies for ultrasound screening for DDH.Researches showed that the differences in strategies and timing for screening resulted in great difference of prevalence of DDH.Few studies focused on the risk factors of DDH and their correlation between DDH in China.And until now there was no study based on a standardized hip ultrasound screening program.The aim of this study is to find out the prevalence of DDH using a standardized ultrasound examination,and research the correlation between risk factors and the incidence of DDH.Methods: We retrospectively review the data of every newborn delivered in Shanghai Putuo Maternal and Infant Healthcare Center from 2012 to 2014.Each newborn underwent physical examination and ultrasound examination at the gestational age of 1 week,6 weeks and 12 weeks,and data were recorded.We used the results of the ultrasound at the age of12 weeks as the standard of diagnosis of DDH.Graf IIb,IIc,D,III,IV hips were considered DDH.The statistical methods included Chi-squared test and Logistic regression.All data were proceeded using SAS 9,2(SAS Institutes,Cary,North Carolina,USA).P<0.05 was considered significant.Results: 4698 newborns were included in this studies(9396 hips).There were 2603 male infants(55.4%),and 2095 female infant(44.6%).The overall incidence of DDH was7.45‰(Graf IIb and worse).For risk factors,female sex was a risk factor(OR=2.40;95%CI:1.85-4.82;P=0.012);positive family history was a risk factor(OR=11.01;95% CI:3.76-32.28;P<0.0001);breech position was a risk factor(OR=4.14;95% CI:2.08-8.23;P=0.0001);oligohydramnios was a risk factor(OR=6.14;95% CI:1.53-24.61;P=0.0104)?Other risk factors including way of delivery,first born,positive combined anomalies,gestational hypertension,gestational diabetes,limited hip abduction and asymmetrical skin folds didn't present any correlation between the incidence of DDH.Conclusion: Based on this study,the incidence of DDH was 7.45%.Female sex,positive family history,breech position and oligohydramnios were risk factors for DDH.Way of delivery,first born,positive combined anomalies,gestational hypertension,gestational diabetes,limited hip abduction and asymmetrical skin folds didn't present any correlation with DDH.This study was based on a single-centered universal ultrasound screening program,and provided references of risk factors for future studies.Part II The analysis of acetabular angle(A angle)in prediction of prognosis of physiologically immature hipsPurpose: An abundant amount of researches had reported that universal hip ultrasound screening could cause over diagnose,over treatment and a high follow-up rate.This was mainly due to the fact that hip ultrasound could find a great amount of physiologically immature hips that had the potential of spontaneous maturation.Graf types and sub-types,femoral head coverage could indicate these immature hips.In this study we found a novice way of indication the development of Graf IIa hips by the measurement of acetabular angle(A angle)in ultrasound picture,and we aimed to analyze the application for prognosis indication.Methods: We retrospectively review the data of every newborn delivered in Shanghai Putuo Maternal and Infant Healthcare Center from 2012 to 2014.Each newborn underwent physical examination and ultrasound examination at the gestational age of 1 week,6 weeks and 12 weeks,and data were recorded.We used the results of the ultrasound at the age of12 weeks as the standard of diagnosis of DDH.Graf IIb,IIc,D,III,IV hips were considered DDH.We chose the ultrasound pictures and the age of 6 weeks for measurement of A angle.We divided the subjects into 3 groups: those developed into DDH for the first group;those had spontaneous maturation for the second group;and a control group that had Type I hips at both 6 weeks and 12 weeks.A line connecting the outer rim of the acetabular cartilage and the lower limb of ilium was called the cartilage border line.The angle between the cartilage border line and a line perpendicular to the baseline was defined as the A angle.All A angles were separated measured by 2 different physicians.The A angle was used to determine the cartilaginous component of the acetabular.The statistical methods included Chi-squared test and Logistic regression.All data were proceeded using SAS 9,2(SAS Institutes,Cary,North Carolina,USA).P<0.05 was considered significant.Result: A total of 138 cases were diagnosed as IIa at the age of 6 weeks.At 12 weeks follow-up,in the first group 32 cases deteriorated into DDH,in which 5 cases had beenIIa(+)and 27 cases had been IIa(-).In the second group,106 cases had spontaneous maturation of the acetabular,in which 82 cases had been IIa(+)and 24 cases had been IIa(-).We depicted = the ROC curve for the A angle measurement,AUC was 0.915,with a maximum cutoff value at 12 degrees.Binary logistic regression showed that A angle had a correlation with the incidence of DDH(OR=22.70,95% CI:8.98-57.43,P<0.0001)?There was good reliability of the A angle measurements by performing intra-observer and inter-observer analysis.(Intra-observer reliability ICC : 0.72-0,91,P<0.001;Inter-observer reliability ICC:0.71-0.88,P<0.001)Conclusion: There were few studies focused on the outcome of IIa hips.Based on this study,most hips that could have spontaneous maturation at the age of 12 weeks had an A angle<12 degrees at the age of 6 weeks.If a cutoff value of 12 degrees was applied as a diagnosis criterion,the sensitivity was 91.8% with a specificity of 78.1%.We recommended that every newborn with an A angels higher than 12 degrees should be followed up.This study showed that A angle could be a novice criterion for the prediction of prognosis of physiologically immature hips.Part III The analysis of the width of cartilaginous roof and bony roof in prediction of prognosis of physiologically immature hips.Purpose: Hip instability and morphological abnormity were main presentation of DDH in newborns.Morphological abnormity would have a greater impact with growth.The morphology determined the prognosis and function of the hip,especially in those with mild dysplasia.The obstruction of ossification and maturation of cartilaginous component at the edge of acetabular may lead to hip dysplasia.The aim of this study was to investigate the morphology of hip by the measurements of the width of cartilaginous roof and bony roof on the pictures of hip ultrasound,and to predict the prognosis of immature hips.Methods: We retrospectively review the data of every newborn delivered in Shanghai Putuo Maternal and Infant Healthcare Center from 2012 to 2014.Each newborn underwent physical examination and ultrasound examination at the gestational age of 1 week,6 weeks and 12 weeks,and data were recorded.We used the results of the ultrasound at the age of12 weeks as the standard of diagnosis of DDH.Graf IIb,IIc,D,III,IV hips were considered DDH.We chose the ultrasound pictures and the age of 6 weeks for measurement of the width of cartilaginous roof and bony roof.We divided the subjects into3 groups: those developed into DDH for the first group;those had spontaneous maturation for the second group;and a control group that had Type I hips at both 6 weeks and 12 weeks.The perpendicular distance from the edge of cartilaginous component of the acetabulum to the baseline(a)and the perpendicular distance from the lower limb of ilium to the baseline(b)were measured.Their ratio a/b*100 were used as an index.All measurements were separately done by 2 different physicians.The statistical methods included Chi-squared test and Logistic regression.All data were proceeded using SAS 9,2(SAS Institutes,Cary,North Carolina,USA).P<0.05 was considered significant.Result: A total of 138 cases were diagnosed as IIa at the age of 6 weeks.At 12 weeks follow-up,in the first group 32 cases deteriorated into DDH,in which 5 cases had been IIa(+)and 27 cases had been IIa(-).In the second group,106 cases had spontaneous maturation of the acetabular,in which 82 cases had been IIa(+)and 24 cases had been IIa(-).We depicted = the ROC curve for the a/b*100 ratio measurement,AUC was 0.861,with a maximum cutoff value at 50.Binary logistic regression showed that a/b*100 ratio had a correlation with the incidence of DDH(OR=9.41,95% CI:4.06-21.78,P<0.0001)?There was good reliability of the a/b*100 ratio measurements by performing intra-observer and inter-observer analysis.(Intra-observer reliability ICC : 0.65-0,88,P<0.001;Inter-observer reliability ICC:0.63-0.87,P<0.001)Conclusion: The cartilaginous components on the outer edge of acetabulum at the age of 6 week have a correlation with the maturation of the hip.It can be determine by the measurement of the ratio of the width of cartilaginous roof and bony roof.Based on this study,if the a/b*100 ratio was larger than 50 in the IIa hips,a majority of them could have spontaneous maturity.If the a/b*100>50 was set as a diagnosis criterion,the sensitivity is94.7% with a specificity of 71.9%,and had a signification correlation with the incidence of DDH.The a/b*100 ratio could also be used as a criterion of prognosis of the physiologically immature hips. |
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