早期筛查对发育性髋关节发育不良的预防意义及其影响因素分析
|
摘要
目的分析早期筛查对发育性髋关节发育不良的预防意义及其影响因素。方法以北京积水潭医院2009年1月至2013年12月间收治住院的1 376名发育性髋关节脱位(developmental dysplasia of the hip,DDH) DDH患儿为研究对象,对患儿父母进行不记名问卷调查。根据初次就诊年龄、不同就诊途径对所有受试者进行分组,问卷调查内容包括患儿初次就诊年龄、患儿父母文化程度、家庭中是否有从医人员、患儿年平均医疗费用、患儿骨科疾病患病史、首次就诊的主管医生级别等。结果2009年1月至2013年12月间,2岁以下DDH患儿占当年全部初次就诊患儿总数的比例呈现逐年升高的趋势(P <0. 05),而6岁以上DDH患儿占当年全部初次就诊患儿总数的比例呈现逐年降低的趋势(P <0. 05)。由当地医生发现并推荐就诊的患儿比例呈不断上升的趋势。Logistic回归分析结果显示,入选的变量包括患儿父亲文化程度、患儿母亲文化程度以及首次就诊的主管医生级别。结论新生儿进行髋关节早期筛查的意识已经得到一定程度的提高,疾病诊疗相关知识逐渐丰富,患儿父母亲文化程度及首次就诊的主管医生级别是DDH患儿接受早期筛查年龄的主要影响因素。
Objective To explore the preventive significance and influencing factors of developmental dysplasia of the hip( DDH) for early screening. Methods A total of 1376 DDH children hospitalized from January 2009 to December 2013 were recruited and divided according to the age of initial visit and different treatment routes. Their parents were surveyed by an anonymous questionnaire of age of initial visit,family's wealth status,parental education level,medical insurance,average annual medical expenses,history of orthopedic disease and level of attending physician during an initial visit. Results The proportion of DDH children aged under 2 years showed a year-on-year increase among the total number of children visiting initially( P <0. 05) while the proportion of DDH children aged over 6 years accounted for a decreasing proportion( P <0. 05). The proportion of children diagnosed and referred by local physicians was on the rise. Logistic regression analysis showed that the relevant variables included paternal/maternal educational level and seniority of physician during an initial visit. Conclusion There is a heightened awareness of early screening for hip dislocation in newborns. And the knowledge of disease diagnosis and treatment is gradually expanding. Parental education level and seniority of physician during an initial visit are two major influencing factors of early screening age of DDH children.
Objective To explore the preventive significance and influencing factors of developmental dysplasia of the hip( DDH) for early screening. Methods A total of 1376 DDH children hospitalized from January 2009 to December 2013 were recruited and divided according to the age of initial visit and different treatment routes. Their parents were surveyed by an anonymous questionnaire of age of initial visit,family's wealth status,parental education level,medical insurance,average annual medical expenses,history of orthopedic disease and level of attending physician during an initial visit. Results The proportion of DDH children aged under 2 years showed a year-on-year increase among the total number of children visiting initially( P <0. 05) while the proportion of DDH children aged over 6 years accounted for a decreasing proportion( P <0. 05). The proportion of children diagnosed and referred by local physicians was on the rise. Logistic regression analysis showed that the relevant variables included paternal/maternal educational level and seniority of physician during an initial visit. Conclusion There is a heightened awareness of early screening for hip dislocation in newborns. And the knowledge of disease diagnosis and treatment is gradually expanding. Parental education level and seniority of physician during an initial visit are two major influencing factors of early screening age of DDH children.
引文
1吕学敏,郭源,边臻,等.婴儿发育性髋关节发育不良自然发育过程研究[J].中华小儿外科杂志,2014,35(11):848-852.DOI:10.3760/cma.j.issn.0253-3006.2014.11.012.Lv XM,Guo Y,Bian Z,et al.Natural progress of infantile developmental dysplasia of hip[J].Chin J Pediatr Surg,2014,35(11):848-852.DOI:10.3760/cma.j.issn.0253-3006.2014.11.012.
2潘少川.实用小儿骨科学[M].北京:人民卫生出版社,2005.5.Pan SC.Practice of Pediatric Orthopedics[M].Beijing People's Medical Publishing House,2005.5.
3边臻,郭源,田伟.闭合复位治疗婴幼儿发育性髋脱位的疗效观察[J].中华外科杂志,2009,47(13):1017-1019.DOI:10.3760/cma.j.issn.0529-5815.2009.13.017.Bian Z,Guo Y,Tian W.Treatment of developmental dysplasia of the hip in children:results of dosed reduction and immobilization in hip spica cast[J].Chin J Surg,2009,47(13):1017-1019.DOI:10.3760/cma.j.issn.0529-5815.2009.13.017.
4 George H,Nikolaos T,Engessster IO.Total hip replacement in young adults with hip dysplasia[J].Acta Orthop,2011,82(5):149-154.
5 Aborie 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):410-424.DOI:10.1007/s00247-013-2838-3.
6孙琳.加强新生儿DDH筛查工作的质量控制[J].山东医药,2011,51(24):3.DOI:10.3969/j.issn.1002-266X.2011.24.003.Sun L.Strengthening quality control of neonatal DDH screening[J].Shandong Medical Journal,2011,51(24):3.DOI:10.3969/j.issn.1002-266X.2011.24.003.
7陈博昌.发育性髋关节异常的早期诊断和早期治疗[J].中华小儿外科杂志,2005,26(11):603-605.DOI:10.3760/cma.j.issn.0253-3006.2005.11.015.Chen BC.Early diagnosis and early treatment of developmental hip dysplasia[J].Chin J Pediatr Surg,2005,26(11):603-605.DOI:10.3760/cma.j.issn.0253-3006.2005.11.015.
8杨建平,底垚宗.天津市DDH早期筛查的组织实施与初步结果[J].山东医药,2011,5(24):4-5.DOI:10.3969/j.issn.1002-266X.2011.24.004.Yang JP,DI YZ.Organization and implementation of early DDH screening in Tianjin and preliminary results[J].Shandong Medical Journal,2011,5(24):4-5.DOI:10.3969/j.issn.1002-266X.2011.24.004.
9 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):265-269.
10李连永,张立军.发育性髋关节发育不良早期诊断-我们能做什么?[J].中华实用儿科临床杂志,2015,30(23):1765-1768.DOI:10.3760/cma.j.issn.2095-428X.2015.23.002.Li LY,Zhang LJ.Early diagnosis for developmental dysplasia of the hip:what can we do in China?[J].Chin J Appl Clin Pediatr,2015,30(23):1765-1768.DOI:10.3760/cma.j.issn.2095-428X.2015.23.002.
11高永嘉,胡卓杰,孙玉琴.儿保医生在发育性髋关节发育不良普查及早期诊断中的作用[J].中国初级卫生保健,2008,22(12):31-32.DOI:10.3969/j.issn.1001-568X.2008.12.014.Gao YJ,Hu ZJ,Sun YQ.Role of child healthcare physician in general survey and early diagnosis of developmental dysplasia of the hip[J].Chinese Primary Health Care,2008,22(12):31-32.DOI:10.3969/j.issn.1001-568X.2008.12.014.
12邓红岩,蔡婧晔,邹秋艳,等.张家港市7830名婴儿DDH筛查结果分析[J].中国妇幼健康研究,2013,(6):807-809.DOI:10.3969/j.issn.1673-5293.2013.06.006.Deng HY,Cai JY,Zou QY,et al.Analysis of DDH screening results of 7830 infants in Zhangjiagang City[J].Chinese Journal of Woman and Child Health Research,2013,(6):807-809.DOI:10.3969/j.issn.1673-5293.2013.06.006.
13 Kurdi B.PO-0692 The Value Of Risk Factors In Screening For Developmental Dysplasia Of The Hip(ddh).Can Selective Screening Replace Universal Screening?[J].Archives of Disease in Childhood,2014,99(Suppl 2):A480-A480.DOI:10.1136/archdischild-2014-307384.1331.
14 Giuseppe R,Aldo B,Sergio S,et al.Ultrasound screening for developmental dysplasia of the hip[J].Pediatr Radiol,2003,33(5):475-481.DOI 10.1007/s00247-003-0940-7.
15 Mathew DS,Deborah M,Eastwood.Screening and treatment in developmental dysplasia of the hip-where do we go from here?[J].International Orthopaedics(SICOT),2011,35(9):1359-1367.DOI 10.1007/s00264-011-1257-z.
16 Michael R,Gerolf S,Franz GrillRein,et al.Screening for developmental hip dysplasia(DDH)-clinically or sonographically?Comments to the current discussion and proposals[J].Pediatr Radiol,2013,43(5):637-640.DOI 10.1007/s00247-012-2578-9.
17 Meghan I,Vanessa S,Philip S,et al.Mubarak.Is ultrasound screening for DDH in babies born breech sufficient?[J].JChild Orthop,2010,4(1):3-8.DOI:10.1007/s11832-009-0217-2.
18 Alexander K,Nina S,Mariella MP,et al.Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns:analysis and evaluation of risk factors[J].International Orthopaedics(SICOT),2016,40(2):123-127.DOI:10.1007/s00264-015-2799-2.
2潘少川.实用小儿骨科学[M].北京:人民卫生出版社,2005.5.Pan SC.Practice of Pediatric Orthopedics[M].Beijing People's Medical Publishing House,2005.5.
3边臻,郭源,田伟.闭合复位治疗婴幼儿发育性髋脱位的疗效观察[J].中华外科杂志,2009,47(13):1017-1019.DOI:10.3760/cma.j.issn.0529-5815.2009.13.017.Bian Z,Guo Y,Tian W.Treatment of developmental dysplasia of the hip in children:results of dosed reduction and immobilization in hip spica cast[J].Chin J Surg,2009,47(13):1017-1019.DOI:10.3760/cma.j.issn.0529-5815.2009.13.017.
4 George H,Nikolaos T,Engessster IO.Total hip replacement in young adults with hip dysplasia[J].Acta Orthop,2011,82(5):149-154.
5 Aborie 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):410-424.DOI:10.1007/s00247-013-2838-3.
6孙琳.加强新生儿DDH筛查工作的质量控制[J].山东医药,2011,51(24):3.DOI:10.3969/j.issn.1002-266X.2011.24.003.Sun L.Strengthening quality control of neonatal DDH screening[J].Shandong Medical Journal,2011,51(24):3.DOI:10.3969/j.issn.1002-266X.2011.24.003.
7陈博昌.发育性髋关节异常的早期诊断和早期治疗[J].中华小儿外科杂志,2005,26(11):603-605.DOI:10.3760/cma.j.issn.0253-3006.2005.11.015.Chen BC.Early diagnosis and early treatment of developmental hip dysplasia[J].Chin J Pediatr Surg,2005,26(11):603-605.DOI:10.3760/cma.j.issn.0253-3006.2005.11.015.
8杨建平,底垚宗.天津市DDH早期筛查的组织实施与初步结果[J].山东医药,2011,5(24):4-5.DOI:10.3969/j.issn.1002-266X.2011.24.004.Yang JP,DI YZ.Organization and implementation of early DDH screening in Tianjin and preliminary results[J].Shandong Medical Journal,2011,5(24):4-5.DOI:10.3969/j.issn.1002-266X.2011.24.004.
9 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):265-269.
10李连永,张立军.发育性髋关节发育不良早期诊断-我们能做什么?[J].中华实用儿科临床杂志,2015,30(23):1765-1768.DOI:10.3760/cma.j.issn.2095-428X.2015.23.002.Li LY,Zhang LJ.Early diagnosis for developmental dysplasia of the hip:what can we do in China?[J].Chin J Appl Clin Pediatr,2015,30(23):1765-1768.DOI:10.3760/cma.j.issn.2095-428X.2015.23.002.
11高永嘉,胡卓杰,孙玉琴.儿保医生在发育性髋关节发育不良普查及早期诊断中的作用[J].中国初级卫生保健,2008,22(12):31-32.DOI:10.3969/j.issn.1001-568X.2008.12.014.Gao YJ,Hu ZJ,Sun YQ.Role of child healthcare physician in general survey and early diagnosis of developmental dysplasia of the hip[J].Chinese Primary Health Care,2008,22(12):31-32.DOI:10.3969/j.issn.1001-568X.2008.12.014.
12邓红岩,蔡婧晔,邹秋艳,等.张家港市7830名婴儿DDH筛查结果分析[J].中国妇幼健康研究,2013,(6):807-809.DOI:10.3969/j.issn.1673-5293.2013.06.006.Deng HY,Cai JY,Zou QY,et al.Analysis of DDH screening results of 7830 infants in Zhangjiagang City[J].Chinese Journal of Woman and Child Health Research,2013,(6):807-809.DOI:10.3969/j.issn.1673-5293.2013.06.006.
13 Kurdi B.PO-0692 The Value Of Risk Factors In Screening For Developmental Dysplasia Of The Hip(ddh).Can Selective Screening Replace Universal Screening?[J].Archives of Disease in Childhood,2014,99(Suppl 2):A480-A480.DOI:10.1136/archdischild-2014-307384.1331.
14 Giuseppe R,Aldo B,Sergio S,et al.Ultrasound screening for developmental dysplasia of the hip[J].Pediatr Radiol,2003,33(5):475-481.DOI 10.1007/s00247-003-0940-7.
15 Mathew DS,Deborah M,Eastwood.Screening and treatment in developmental dysplasia of the hip-where do we go from here?[J].International Orthopaedics(SICOT),2011,35(9):1359-1367.DOI 10.1007/s00264-011-1257-z.
16 Michael R,Gerolf S,Franz GrillRein,et al.Screening for developmental hip dysplasia(DDH)-clinically or sonographically?Comments to the current discussion and proposals[J].Pediatr Radiol,2013,43(5):637-640.DOI 10.1007/s00247-012-2578-9.
17 Meghan I,Vanessa S,Philip S,et al.Mubarak.Is ultrasound screening for DDH in babies born breech sufficient?[J].JChild Orthop,2010,4(1):3-8.DOI:10.1007/s11832-009-0217-2.
18 Alexander K,Nina S,Mariella MP,et al.Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns:analysis and evaluation of risk factors[J].International Orthopaedics(SICOT),2016,40(2):123-127.DOI:10.1007/s00264-015-2799-2.