發(fā)布時(shí)間：2018-03-18 12:32

  本文選題：髖關(guān)節(jié)　切入點(diǎn)：發(fā)育不良　出處：《第三軍醫(yī)大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景:發(fā)育性髖關(guān)節(jié)異常(developmental dysplasia of hip,DDH),是小兒常見的骨關(guān)節(jié)疾病之一,也是兒童保健醫(yī)生經(jīng)常面臨的問題。以往認(rèn)為髖關(guān)節(jié)異常即為髖關(guān)節(jié)脫位,并且是先天性發(fā)生的疾病,因此將其命名為先天性髖關(guān)節(jié)脫位(congenital dislocation of the hip,CDH)。但是隨著對該病的進(jìn)一步深入研究逐漸發(fā)現(xiàn),它既包含股骨頭和髖臼的發(fā)育異常,也包含他們在解剖關(guān)系中的改變,因此依照病變程度的不同,可以將其分為三種類型,分別為髖臼發(fā)育不良、髖關(guān)節(jié)半脫位和髖關(guān)節(jié)脫位。隨著對該病的動態(tài)研究發(fā)現(xiàn),有一部分患兒在出生的時(shí)候髖關(guān)節(jié)表現(xiàn)為不穩(wěn)定,但是伴隨著生長發(fā)育可以逐漸成為正常的、穩(wěn)定的髖關(guān)節(jié);還有一部分患兒在出生的時(shí)候髖關(guān)節(jié)可以是正常的,但是伴隨著生長發(fā)育可能會逐漸地成為半脫位髖關(guān)節(jié)或者是脫位髖關(guān)節(jié),說明該病可以發(fā)生在出生前,也可以發(fā)生在出生后。鑒于上述原因,1992年,北美小兒矯形外科學(xué)會正式用DDH替代了CDH。DDH是可以治療的疾病,未經(jīng)治療可以導(dǎo)致成人期喪失重要關(guān)節(jié)功能,成為髖關(guān)節(jié)置換的重要原因。出生至6月齡為DDH治療的黃金時(shí)間,通過Pavlik吊帶對異常的髖關(guān)節(jié)進(jìn)行固定,治療周期1-3個月,痛苦小,治療費(fèi)用低。6月齡至2歲通過蛙式支架或石膏進(jìn)行固定,治療周期3-9個月。2歲以上多數(shù)需要通過手術(shù)進(jìn)行治療,治療周期5-7個月,痛苦大,治療費(fèi)用高。因此早期檢查和診斷是決定治療方式的關(guān)鍵。DDH的檢查方法包括臨床檢查、B超、X線、CT和MRI,臨床檢查有助于發(fā)現(xiàn)高危兒,其余檢查方法則有助于診斷。檢查方法的選擇主要依據(jù)年齡而定。B超及MRI具有對軟骨及軟組織成像的優(yōu)勢多應(yīng)用于6月齡以內(nèi)的兒童,但是MRI具有檢查費(fèi)用較高、需要使用鎮(zhèn)靜劑等不足,而B超檢查費(fèi)用低、操作簡便、安全,無需使用鎮(zhèn)靜劑,因此6月齡以內(nèi)的兒童多采用B超進(jìn)行診斷。6月齡以上兒童隨著骨化中心的出現(xiàn),X線和CT檢查的優(yōu)勢得以體現(xiàn)。但是由于CT檢查費(fèi)用高和有較高的輻射暴露,此年齡段兒童多以X線作為診斷方法。目前世界各地對DDH發(fā)病率的報(bào)道差異較大,據(jù)報(bào)道其發(fā)病率為1.5‰-20‰。我國目前尚無全面的普查資料,對DDH發(fā)病率的報(bào)道多集中在東部地區(qū),北京、天津、上海、香港、臺灣等地區(qū)的報(bào)道顯示ddh的發(fā)病率為0.07‰-3.37‰,而西部地區(qū)相對較少,成都市的報(bào)道為8.2‰。ddh的病因未明,各種危險(xiǎn)因素與ddh發(fā)病的相關(guān)性存在較大爭議,普遍認(rèn)為是遺傳因素與環(huán)境因素共同作用的結(jié)果。本研究對重慶市沙坪壩區(qū)婦幼保健院2014年1月1日至2014年12月31日的2066例6月齡以下嬰兒ddh發(fā)病率篩查情況進(jìn)行分析,將性別、出生季節(jié)、孕周、胎位、分娩方式、出生體重、母親妊娠年齡、母親孕期每日鈣攝入量、母親孕期每日維生素d攝入量與ddh發(fā)病率進(jìn)行相關(guān)性分析,以了解ddh發(fā)病特點(diǎn)及其可能的危險(xiǎn)因素,為今后嬰兒ddh的防治提供參考,為優(yōu)生優(yōu)育提供科學(xué)的指導(dǎo)。研究目的:通過本中心的對沙坪壩區(qū)婦幼保健院2014年1月至12月的2066例6月齡以下嬰兒ddh發(fā)病率篩查結(jié)果研究,了解ddh在我院篩查人群中的患病率,以及其發(fā)病特點(diǎn),可能的危險(xiǎn)因素,以減少引起ddh發(fā)病率增加的可能危險(xiǎn)因素,為優(yōu)生優(yōu)育提供指導(dǎo)。研究對象和方法:1、抽取2014年1月1日至2014年12月31日出生的于重慶市沙坪壩區(qū)婦幼保健院的新生兒1017例,以及同期非該院出生但在該院兒童保健科體檢的6月齡以下嬰兒1049例,共計(jì)2066例。2、對所有研究對象運(yùn)用東芝納米10超聲檢測儀進(jìn)行髖關(guān)節(jié)超聲檢查,篩查出髖關(guān)節(jié)發(fā)育異常病例數(shù)。根據(jù)ddh超聲檢查graf分型標(biāo)準(zhǔn),詳細(xì)記錄超聲檢查異常髖關(guān)節(jié)的分型情況和異常髖關(guān)節(jié)的側(cè)別分布情況。3、從該院兒童保健科的兒童健康管理系統(tǒng)中檢索出所有對象的出生情況以及母親情況等相關(guān)指標(biāo),并詳細(xì)記錄。4、通過統(tǒng)一的食物頻率調(diào)查問卷、根據(jù)母親提供的信息記錄母親孕期食物、鈣補(bǔ)充制劑、維生素d補(bǔ)充制劑攝入情況,通過食物計(jì)算器軟件獲得母親孕期平均每日鈣攝入量和母親孕期平均每日維生素d的攝入量。5、采用統(tǒng)一的標(biāo)準(zhǔn)對所得指標(biāo)進(jìn)行量化和整理,分析ddh發(fā)病的特點(diǎn)以及各指標(biāo)與ddh發(fā)病的相關(guān)性,探討ddh發(fā)病的危險(xiǎn)因素。研究結(jié)果:1、2066例受檢嬰兒中,檢出ddh180例(8.7%)。180例ddh中,髖關(guān)節(jié)為Ⅱa型者177例(98.3%),Ⅱc型者2例(1.1%),Ⅲ型者1例(0.6%)。2、2066例受檢者中,男性1047例(50.7%),女性1019例(49.3%)。各年齡段的性別構(gòu)成差異無統(tǒng)計(jì)學(xué)意義。超聲檢出男性DDH55例(5.3%),女性DDH125例(12.3%),差異有統(tǒng)計(jì)學(xué)意義。3、受檢的2066個左髖中,異常的有137個(6.6%),2066個右髖中,異常的有102個(4.9%),左側(cè)多于右側(cè),差異有統(tǒng)計(jì)學(xué)意義。4、在單因素分析中,兒童性別、側(cè)別、胎位、母親妊娠年齡、母親孕期每日鈣攝入量、母親孕期每日維生素D攝入量與DDH發(fā)病有關(guān),差異有統(tǒng)計(jì)學(xué)意義;兒童出生季節(jié)、出生孕周、分娩方式、出生體重與DDH發(fā)病無關(guān),差異無統(tǒng)計(jì)學(xué)意義。5、在多因素分析中,篩選出的影響DDH發(fā)病的危險(xiǎn)因素為兒童性別、胎位、母親妊娠年齡、母親孕期每日維生素D攝入量。結(jié)論:1、6月齡以下嬰兒DDH發(fā)病有型別、側(cè)別特征,以生理性發(fā)育不成熟最為常見,左側(cè)多于右側(cè),與國內(nèi)其他報(bào)道基本一致。2、嬰兒性別、胎位、母親妊娠年齡、母親孕期每日維生素D攝入量與DDH的發(fā)病有相關(guān)性,女性、臀位產(chǎn)、母親妊娠年齡超過35歲、母親孕期每日維生素D攝入量5μg為DDH發(fā)病的危險(xiǎn)因素。
[Abstract]:Background: developmental dysplasia of the hip (developmental dysplasia of hip, DDH), is one of the most common bone disease in children, but also children care physicians often face problems. The abnormal hip to hip dislocation, and congenital disease occurs, it will be named congenital hip joint (congenital dislocation of the hip dislocation, CDH). But with the further in-depth study of the disease gradually found that it contains both the femoral head and acetabular dysplasia, also contain in their anatomical relationships change, because this in accordance with the severity of disease, it can be divided into three types, respectively, acetabulum dysplasia of hip subluxation and dislocation of hip joint. With the dynamic study of the disease that is part of the children at the time of birth of hip joint performance is not stable, but with growth can become For normal, stable hip joint; and part of the children at the time of birth of hip joint can be normal, but with growth may gradually become hip subluxation or dislocation of hip joint, indicating that the disease can occur before birth, may also occur after birth. In view of the above reasons, 1992 North American Society of pediatric orthopaedic surgery, official use DDH instead of CDH.DDH is a disease that can be treated, untreated adults can cause loss of important joint function, become an important reason for hip replacement. Prime time from birth to 6 month old for the treatment of DDH, through the Pavlik sling on the abnormal hip joints were fixed for 1-3 months, the treatment cycle the pain is small, low cost of treatment.6 months to 2 years old by frog stent or gypsum fixation, treatment period for 3-9 months.2 years most need to be treated by surgery, treatment cycle 5-7 July, big pain and high cost of treatment. Therefore early detection and diagnosis is the key determinant of.DDH examination method in the treatment of the clinical examination, ultrasound, X-ray, CT and MRI, the clinical examination is helpful to find the high-risk infants, the rest of the examination method is helpful for diagnosis. Mainly based on age and examination methods. Ultrasound and MRI of cartilage and soft tissue imaging advantages applied to less than 6 month old of the children, but MRI has the inspection cost is higher, need less sedation, and ultrasound examination of low cost, simple operation, safety, without the use of sedatives, so less than 6 month old of the children were diagnosed by ultrasound in children.6 months old with the emergence of ossification center, X-ray and CT advantage. But due to the high cost of CT radiation and a higher exposure, this age children as a diagnostic method in X-ray. At present the world of DDH Reported differences in incidence of larger, reported incidence rate was 1.5 per thousand -20 per thousand. At present there is no comprehensive census data on the incidence of DDH reported more concentrated in the eastern region, Beijing, Tianjin, Shanghai, Hongkong, Taiwan and other regions of the reported incidence rate of DDH was 0.07 per thousand and -3.37%. The western region is relatively small, Chengdu City reported 8.2 per thousand.Ddh for the cause is unknown, there is great controversy between various risk factors and the pathogenesis of DDH, generally considered the interaction of genetic factors and environmental factors. The results of the research on the Chongqing city Shapingba District Maternal and child health hospital from January 1, 2014 to December 31, 2014, 2066 cases of 6 month old infants under DDH incidence the rate of screening analysis, gender, season of birth, gestational age, fetal position, mode of delivery, birth weight, gestational age, maternal calcium intake during pregnancy, the mother of vitamin D daily The correlation analysis and the incidence of DDH, DDH in order to understand the characteristics of the disease and its risk factors, to provide reference for the prevention and control of the future baby DDH, to provide scientific guidance for eugenics. Objective: through maternal and child health hospital in Shapingba district from January 2014 to December 2066 cases of 6 month old infants under the incidence of DDH screening results of the center understand the DDH screening in our hospital, the prevalence rate, as well as its clinical features, risk factors, in order to reduce the incidence of DDH caused by increased risk factors, to provide guidance for eugenics. Subjects and methods: 1, from January 1, 2014 to December 31, 2014 was born in Chongqing city Shapingba District Maternal and Child Health Hospital of the newborn in 1017 cases, and at the same time the hospital was born but in the examination of child health care, the hospital of the 6 month old infants under 1049 cases, a total of 2066 cases of.2, the study of the application of Xiang Dong Hip ultrasonography of Chicago nano 10 ultrasonic testing instrument, screening out hip dysplasia cases. According to DDH ultrasound Graf type standard, detailed record of ultrasound classification of abnormal hip and abnormal hip side distribution.3, retrieve the relevant index of all objects and the birth mother from the children's Health Department of child health management system, and detailed records of.4, by food frequency questionnaire, according to information provided by the mother record of maternal food, calcium supplements, vitamin D supplementation through food intake, average daily gain calculator software of maternal calcium intake during pregnancy and average daily vitamin.5 intake of D, using a uniform standard and quantitative analysis of the indicators, analysis of the characteristics of the pathogenesis of DDH and the index and the incidence of DDH. 鍏蟲，

本文編號：1629595