| Research background:Developmental Dysplasia of Hip, DDH, one of the common diseases of the hip in children, is one problem frequently faced by child health care doctors. Being mistakenly regarded as dislocation of the hip which occurred congenitally, dysplasia of the hip was named congenital dislocation of the hip, CDH. But further research has discovered that it includes a series of abnormalities of hip joint in the development and/or the anatomic relationship of femoral head and acetabulum. Thus, according to the extent of the pathological changes, DDH can be grouped into the following three categories: acetabular dysplasia,hip subluxation and dislocation of hip joint. Dynamic studies also find that the instability of hip joint in some children at the birth may become stable and normal with the growth and development of the children while some other children may develop subluxation or dislocation of hip joint during the growth even though their hip joint were normal at birth. These discoveries prove that DDH may occur either before or after the birth. In light of the discovery, North American Pediatric Orthopaedic Society renamed CDH as DDH in 1992.DDH is curable, but without treatment, it may lead to the loss of important joint function in adulthood, which is the main cause of hip replacement. The prime time of DDH treatment is from children’s birth to the age of 6 months. The abnormal hip joint will be fixed by Pavlik sling with little pain and less cost. The treatment cycle is 1-3 months. As to the children whose age between 6 months to 2 years, frog-type position bracket or gypsum will be used in fixation. The treatment cycle is 3-9 months. When the children reach over 2 years old, most cases need to be treated by surgery with much suffering and high cost. The treatment cycle is 5-7 months. Therefore, early detection and diagnosis of DDH is critical in treatment. DDH’s inspection methods include clinical examination, B ultrasound, X-ray, CT and MRI. Clinical examination is helpful to find high risk infants while the rest of the inspection methods are helpful for diagnosis. The selection of inspection method depends mostly on age. Enjoying the advantages of cartilage and soft tissue imaging, B ultrasound and MRI are mainly applied to children under the age of 6 months. In contrast with the high cost of MRI which also needs to use a sedative, B ultrasound is low in cost, safe and simple in operation and it needs no sedative. Therefore, B ultrasound is applied in diagnosis among children under the age of 6 months. As to the children over 6 months, with the occurring of ossification center, X-ray and CT examination will exert more advantages. Due to the drawbacks of high cost and higher exposure to radiation in CT examination, X-ray is adopted in diagnosis.Up to now, reports on DDH around the world vary a lot, arranging from 1.5‰ to 20‰. At present, there is no comprehensive survey data in China. Reports on the incidence of DDH concentrated mainly in the eastern region. Reports from such regions as Beijing, Tianjing, Shanghai, Hongkong and Taiwan show that the incidence of DDH 0.07‰-3.37‰. There are fewer reports from the west part of China and the report on Chengdu is 8.2‰. The pathogeny of DDH is still unclear. Great disputes revolve on the correlation between the risk factors and the incidence of DDH and it is generally accepted that DDH is the result of the joint function of genetic factors and environmental factors. This research will analyze 2066 cases of DDH screening among infants under 6 months in Maternal and Child Health Hospital of Shapingba District, Chongqing. The analysis will focus on the correlation between the incidence of DDH and mother’s condition, mother’s pregnancy and the birth of children, so as to understand the characteristics of DDH and to provide guidance to promote better development.Research objectiveThe analysis will focus on the incidence of 2066 cases of DDH screening among infants under 6 months in Maternal and Child Health Hospital of Shapingba District, Chongqing, so as to understand the characteristics of DDH and the risk factors,and to provide guidance to promote better development.Research object and method1. 2066 cases are selected for study, among which 1017 cases are those newborns born in Maternal and Child Health Hospital in Shapingba District, Chongqing, from January 1, 2014 to December 31, 2014 and 1049 cases are those infants under the age 6 months who were not born in the hospital but conducted health care examination here at the same period.2. Ultrasonic examination of hip joint is performed on all subjects. Abnormal ultrasound examination of hip joint will be screened. And according to the Graf standard of hip joint ultrasound examination, the subtypes and lateral distribution of abnormal hip joint will be recorded in detail.3. Birth conditions and mother’s status and other related indicators will be retrieved and recorded from the health management system in Child Health Care Department.4. A unified dietary questionnaire will be developed in order to get the information about the intake of calcium and vitamin D during pregnancy in the mother’s pregnancy. Through the inquiry method, the intake of calcium and vitamin D supplements during mother’s pregnancy will be examined. With the two sources of information combined, the mother’s daily calcium, vitamin D intake will be decided.5. With a unified standard, all indexes will be quantized and sorted so as to analyze the characteristics of DDH and the correlation between the indexes and the incidence of DDH and then explore the risk factors of DDH.Research results1. Among the 2066 cases of children being screened, 180 cases of DDH(8.7%) were detected. Among the 180 cases, 177 cases are of type IIa(98.3%), 2 cases type Ⅱc(1.1%) and 1 case type Ⅲ(0.6%).2. Among the 2066 cases of study, 1047 are males(50.7%) and 1019 females(49.3%). There was no significant difference in gender composition of all ages. By ultrasound, 55 cases of DDH are male(5.3%) and 125 cases are female(12.3%). The difference is statistically significant.3. Among the 2066 left hips being examined, abnormal cases are 137(6.6%). Among the 2066 right hips being examined, abnormal cases are 102(4.9%). So DDH occurs more often in left side than right side and the difference is statistically significant.4. In single factor analysis, DDH onset is related with such factors as children’s gender, side, fetal position, mother pregnancy age, maternal daily calcium intake and maternal daily vitamin D intake. And the difference is statistically significant. On the contrary, it is not related with such factors as seasons of birth, gestational age, delivery mode and birth weight.5. In multiple factor analysis, the risk factors of DDH screened are children’s gender, gestational age, fetal and maternal intake of vitamin D dailyConclusion:1. The incidence of DDH is related with categories and sides. Generally speaking, it occurs more often as acetabular dysplasia, in left side than right side. The discovery is in line with other reports in China.2. The incidence of DDH is related with children’s gender, gestational age, fetal and maternal intake of vitamin D daily, which are risk factors. |
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