标题：DDH患儿不同体位超声PFD测量及其应用价值

      作者：李乔乔，李梦娜    长安医院超声医学科，陕西 西安 710016

      卷次： 2023年34卷23期

      【摘要】 目的 探讨髋关节发育不良(DDH)患儿不同体位超声耻骨-股骨距(PFD)测量及其应用价值。方法 前瞻性选取 2019年 5月至 2022年 5月长安医院收治的 102例DDH患儿作为观察组，同时选取80例健康体检者作为对照组。所有受检者均经超声检查，测量并比较两组受检者的PFD值、骨缘覆盖率、基线与骨顶线的夹角α，比较两组受检者不同性别的左、右髋部PFD差值(ΔPFD)；同时比较观察组单侧、双侧DDH患儿的ΔPFD情况；采用受试者工作特征曲线(ROC)评估α 角、骨缘覆盖率、PFD各指标对DDH患儿的诊断价值。结果 观察组患儿中双侧患病38例，单侧病患64例，共145患髋；女性121髋，男性24髋；左侧88髋，右侧57髋；根据超声检查可知Graf Ⅱa型42髋，Graf Ⅱb型17髋，Graf C型18髋，Graf D型20髋，Graf Ⅲ型25髋，Graf Ⅳ髋23髋。观察组患儿的PFD 为(6.33±1.54) mm，明显大于对照组的(3.28±0.27) mm，差异有统计学意义(P<0.05)。观察组患儿的α 角(51.25±6.87)°、骨缘覆盖率(36.32±10.36)%，明显小(低)于对照组的(69.45±10.18)°、(65.45±9.15)%，差异均具有统计学意义(P<0.05)。观察组患儿的ΔPFD为(3.43±0.78) mm，明显高于对照组的(0.58±0.17) mm，差异有统计学意义(P<0.05)；观察组中男性和女性患儿ΔPFD分别为(3.43±0.54) mm、(3.58±0.97) mm，明显高于对照组[男性(0.53±0.14) mm、女性(0.58±0.17) mm]，差异均有统计学意义(P<0.05)，而观察组中男性与女性患儿的ΔPFD比较差异无统计学意义(P>0.05)。观察组单侧患儿的ΔPFD为(3.46±0.45) mm、双侧患儿为(3.28±1.07) mm，明显高于对照组的(0.58±0.17) mm，差异均有统计学意义(P<0.05)，而观察组中单侧与双侧DDH患儿的ΔPFD比较差异无统计学意义(P>0.05)。经ROC分析结果显示，α角、骨缘覆盖率、PFD诊断DDH患儿的特异性分别为 91.3%、88.2%、99.3%，敏感性分别为78.2%、69.6%、90.6% (P<0.05)。结论 不同体位超声PFD测量有助于DDH患儿的筛查诊断，且髋PFD差值与患儿性别相互独立，可为DDH疾病诊疗提供客观指导。
      【关键词】 髋关节发育不良；体位；超声检查；耻骨-股骨距；骨缘覆盖率；骨顶线
      【中图分类号】 R726.8 【文献标识码】 A 【文章编号】 1003—6350（2023）23—3458—05

Measurement of pubo-femoral distance by ultrasound in different body positions in patients with developmentaldysplasia of hip and its application value.
LI Qiao-qiao, LI Meng-na. Department of Ultrasound Medicine, Chang'anHospital, Xi’an 710016, Shaanxi, CHINA
【Abstract】 Objective To investigate the value of measurement of pubo-femoral distance (PFD) by ultrasoundin different body positions in patients with developmental dysplasia of hip (DDH). Methods A total of 102 patientswith DDH admitted to Chang'an Hospital from May 2019 to May 2022 were prospectively selected as the observationgroup, and 80 healthy subjects were selected as the control group. All subjects were examined by ultrasonography, andthe PFD value, bone margin coverage, angle between baseline and the top line of the bone α were measured and com-pared between the two groups. The difference of left and right hip PFD (ΔPFD) was compared between the two groups.The ΔPFD of children with unilateral and bilateral DDH were observed and compared. Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of α angle, bone margin coverage, and PFD in DDH patients.Results In the observation group, there were 38 cases of bilateral diseases and 64 cases of unilateral diseases, involv-ing a total of 145 hips (121 hips for females and 24 hips for males; 88 hips on the left and 57 hips on the right. Accord-ing to ultrasound examination, there are 42 hips of Graf Ⅱa, 17 hips of Graf Ⅱb, 18 hips of Graf C, 20 hips of Graf D,25 hips of Graf Ⅲ, and 23 hips in Graf Ⅳ. The PFD of the observation group was (6.33±1.54) mm, significantly higherthan (3.28±0.27) mm of the control group (P<0.05). The α angle and bone margin coverage rate of children in the obser-vation group were (51.25±6.87)° and (36.32±10.36)%, significantly smaller (lower) than (69.45±10.18)° and (65.45±9.15)% in the control group (P<0.05). ΔPFD of the children in the observation group was (3.43±0.78) mm, significantlyhigher than (0.58±0.17) mm in the control group (P<0.05). ΔPFD of the males and females in the observation groupwere (3.43±0.54) mm and (3.58±0.97) mm, respectively, which were significantly higher than (0.53±0.14) mm and(0.58±0.17) mm in the control group (P<0.05); there was no statistically significant difference in ΔPFD between malesand females in the observation group (P>0.05). ΔPFD was (3.46±0.45) mm for children with unilateral DDH in the ob-servation group and (3.28±1.07) mm for those with bilateral DDH, both significantly higher than (0.58±0.17) mm in thecontrol group (P<0.05); There was no statistically significant difference in Δ PFD between children with unilateralDDH and those with bilateral DDH (P>0.05). ROC curve analysis showed that the specificity of α-angle, bone margincoverage, and PFD in the diagnosis of DDH was 91.3%, 88.2%, and 99.3%, respectively, and the sensitivity was 78.2%,69.6%, and 90.6%, with statistically significant differences (P<0.05). Conclusion Ultrasound measurement of PFD indifferent body positions contributes to the screening and diagnosis DDH patients, and the difference in hip PFD is inde-pendent of the gender of the child, which can provide objective guidance for the diagnosis and treatment of DDH.
      【Key words】 Developmental dysplasia of hip; Body position; Ultrasonography; Pubo-femoral distance; Bonemargin coverage; Bone parietal line