本文選題：發(fā)育性髖關(guān)節(jié)發(fā)育不良 + GrafⅡ型��； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:比較3種干預(yù)方式(蛙式抱、Pavlik挽具,寬尿布濕以及屈髖外展被動(dòng)操)對(duì)GrafⅡ(Ⅱa、Ⅱb、Ⅱc、Ⅱd)型發(fā)育性髖關(guān)節(jié)發(fā)育不良(DDH)患兒的療效,從而探討GrafⅡ型DDH的治療方案。探討超聲隨訪與X線隨訪的關(guān)系。方法:本研究為多中心、回顧性臨床研究。從2011年1月至2015年12月,納入我國(guó)7個(gè)城市7家兒童醫(yī)院,既往無(wú)治療史、且不合并神經(jīng)肌肉疾患的GrafⅡ型DDH患兒的資料,共409例。對(duì)其臨床表現(xiàn)、干預(yù)方式、診治經(jīng)過(guò)、影像結(jié)果等進(jìn)行回顧性分析。采用單因素方差分析兩兩比較,評(píng)估3種不同干預(yù)方式對(duì)GrafⅡa型DDH患兒的轉(zhuǎn)歸;采用單因素方差分析,評(píng)估Pavlik挽具及非Pavlik挽具(蛙式抱、寬尿布濕以及屈髖外展被動(dòng)操)對(duì)GrafⅡb型DDH患兒的轉(zhuǎn)歸。采用配對(duì)四格表Fisher確切概率法,比較超聲檢查發(fā)現(xiàn)異常的陽(yáng)性率和X線檢查的差異。結(jié)果:409例中,男124例,女285例;GrafⅡa型292例,Ⅱb型102例,Ⅱc型14例,Ⅱd型1例。GrafⅡa型DDH患兒分別采用3種干預(yù)方式干預(yù)后,正常轉(zhuǎn)歸時(shí)間分別為:Pavlik挽具,平均38 d;寬尿布濕以及屈髖外展被動(dòng)操,平均46 d;蛙式抱,平均56 d,差異有統(tǒng)計(jì)學(xué)意義(F=9.422,P=0.0001)。GrafⅡb型DDH患兒采用Pavlik挽具與非Pavlik挽具干預(yù)正常轉(zhuǎn)歸時(shí)間分別為32 d和45 d,差異有統(tǒng)計(jì)學(xué)意義(F=5.566,P=0.001)。超聲檢查和X線隨訪檢查發(fā)現(xiàn)異常結(jié)果的陽(yáng)性率分別為9.05%(18/199)和0.50%(1/199),差異無(wú)統(tǒng)計(jì)學(xué)意義(c2=10.106,P=0.09)。結(jié)論:GrafⅡ型DDH均能用Pavlik挽具治愈。(1)對(duì)GrafⅡa型、Ⅱb型DDH患兒,Pavlik挽具干預(yù)與寬尿布濕以及屈髖外展被動(dòng)操干預(yù)、蛙式抱干預(yù)比較,治愈所需時(shí)間最短。(2)所有409例臨床隨訪均未發(fā)現(xiàn)髖關(guān)節(jié)異常。(3)超聲是隨訪評(píng)價(jià)GrafⅡ型DDH患兒有效的工具。
[Abstract]:Objective: To compare the effect of 3 kinds of intervention methods (breaststroke, Pavlik harness, wetness of wide diaper and flexion of hip abduction) to Graf II (II A, II B, II C, d) developmental dysplasia of the hip (DDH), and discuss the therapeutic scheme of Graf type II DDH. The relationship between the follow-up and the follow-up of the ultra sound follow-up. Methods: This study was a multicenter and retrospective study. From January 2011 to December 2015, 7 children's hospitals in 7 cities of China were included in 409 cases of Graf II DDH children without history of treatment and no neuromuscular disorders. The clinical manifestations, intervention methods, diagnosis and treatment, and image results were retrospectively analyzed. The comparison of single factor analysis of variance 22 was used. The outcome of 3 different intervention methods for children with Graf II a DDH was evaluated. By single factor analysis of variance, the prognosis of children with Graf II B DDH was evaluated by Pavlik harness and non Pavlik harness (breaststroke, wide diaper wetness and flexion of hip abduction). A paired four lattice Fisher exact probability method was used to compare the positive rate and X-ray findings of abnormal ultrasound. Results: among the 409 cases, there were 124 males and 285 females, 292 cases of Graf II A, 102 cases of type II B, 14 cases of type II C, 1 children of type.Graf II a DDH in type II d, respectively: Pavlik harness, average 38 D, wide diaper wetness and flexion hip abduction passive exercise, average 46 D, frog type, average 56 D, the difference, the difference, the difference, the mean of 56 D, the difference, the difference, the difference, the difference, the mean of 56 D, the difference, the difference, the difference, the difference, the difference, the difference, the difference, the difference, the difference, the difference, the mean, the difference, the mean 56 D, difference, the difference The statistical significance (F=9.422, P=0.0001).Graf II B DDH children with Pavlik harness and non Pavlik harness intervention were 32 D and 45 D, respectively. The difference was statistically significant (F=5.566, P=0.001). The positive rates of abnormal results were 9.05% (18/199) and 0.50% (1/199), respectively, with no statistical difference. Significance (c2=10.106, P=0.09). Conclusion: Graf II type DDH can be cured with Pavlik harness. (1) Graf II A, type II B DDH children, Pavlik harness intervention and wide diaper wetness and flexion hip abduction passive intervention, breaststroke intervention comparison, the shortest cure time. (2) all 409 cases of clinical follow-up did not find hip abnormality. (3) ultrasound is followed up and evaluation An effective tool for children with type Graf type II DDH.

【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.8

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