The Study Of Ultrasonography In Different Months Infants With Developmental Dislocation Of The Hip Diagnosis

Part I The value of Ultrasonography and X-ray in Different Months Infants with Developmental Dislocation of the Hip Diagnosis Background and purpose:Developmental Dislocation of the Hip is a common joint deformity children(Developmental Dislocation of the Hip, DDH), diagnosis and treatment of DDH key is early diagnosis and early treatment. Ultrasound for the diagnosis of DDH, can display the X-ray showed hard cartilage and soft tissue structure, especially in children with femoral head ossification center has not yet appeared, ultrasound without radioactivity, and easy, low cost, and dynamically observed. This topic mainly further explore ultrasound diagnostic accuracy for infantile DDH, compared with ordinary X-ray plain film, to the infant with different months within 12 months of DDH diagnosis of positive detection rate if there is a difference, to explore ultrasound which months of age group is most suitable for infants andyoung children, observation of children with developmental dislocation of the hip and femoral head cartilage ossification center shape change. For the diagnosis of infants developmental dislocation of the hip screening effective index.Materials and methods:The children were examinatied who were at high risk of DDH: 1.Observe whether the striaevwere symmetry of the lower limbs, whether the limbs were shortening; 2.Allis sign-positive; 3.Hip abduction test positive;4.Missile into and the pop-up experiment test positive; 5.Lower limb activities and stepping were weak; 6.Hip were snapping. Who have one of the inclusion criteria these positive signs,and age within 12 months were collected. Collected cases(80 cases, 160 hips) were divided into four groups according to age(n = 20 cases, 40 hips), group A :0- 3 months;group B :4- 6 months; group C: 7-9 months; Group D; 10-12 months.Bilateral hip were examinated whith ultrasonography(Graf metheds) and anteroposterior pelvic X-ray. Comparison for the positive rate.Results:(1) Group A: the positive rate of ultrasonography was higher than the general X-ray examination, P < 0.05, the difference was statistically significant.(2) Group B results: the positive rate were no difference between ultrasound and X-ray examination, P> 0.05, the difference was not statistically significant.(3) The results in group C and D: the positive rateof general X-ray examination was higher than the ultrasonography, P <0.05, the difference was statistically significant.Conclusion:The ultrasound method is an effective metheds which could display hip structure in the newborn and infant period who has not yet ossification.In the diagnosis of DDH, copmpared with X-ray examination ultrasound can more early to find signs of dislocation of the hip. For children less than6 months, especially in children below 3 months, ultrasound can clearly reflects the advantages of imaging and the ability to reduce the hazards of ionizing radiation of infants and young children.Part Ⅱ Ultrasound and three-dimensional CT in the diagnosis of different months infant developmental dislocation of the hip that value analysisBackground and purpose:Abroad, ultrasound to developmental dysplasia of the hip to the newborn screening has been used widely, its resolution of soft tissue and cartilage and noninvasive, no radiation, can be repeated inspection characteristics have also been approved by the clinical doctors. In recent years, three-dimensional CT in the diagnosis of developmental dysplasia of the hip that important role has been confirmed by research at home and abroad, also for the study of the ultrasonic developmental dysplasia of the hip provides a good reference method. This study applies high frequency ultrasound to observe the C, D group of children, and carries on the contrast with three-dimensional CT, to explore the value of ultrasonography and computed tomography(CT) in diagnosis of infantile DDH larger.Materials and methods:1.The object of studyThe C, D group of children.2. The instrumentLOGIQ9 type ultrasonic diagnosis instrument and ALOKA10 G E companies in the United States, using linear array ultrasonic probe,ultrasonic frequency selection of 10 m H z, ordinary soft memory foam mattress mattress or groove type, metal connecting rod device. TOSHIBA Aquilion/Multi multislice machine company.3. Inspection methodsCT examination: in the parents’ help, children pose for supine, knees,maintain bilateral iliac spine and pubic symphysis before at the same level,to ensure that bilateral femoral condyle contact with inspection machine, to avoid pelvic tilt. The knee joint at a fixed limit activities to brake. When children side, tell her hip and knee relaxed, natural curve, parents help, get hip standard coronary section, and to measure A Angle, B Angle and observation of acetabulum bone edge, three-dimensional CT examination,three-dimensional CT image by three experienced radiologists independent analysis, comprehensive results, evaluation results are divided into normal hip, hip dysplasia, subluxation of the hip and the hip joint dislocation,completely after three diagnosis of DDH. To transmit data to 3 DCT workstation, through Vitrea2 software Version3.5 was carried out on the data obtained from the integration of 3 d reconstruction, reconstruction of three-dimensional image can be arbitrary rotation axis, and all-round multi-angle observation, and the standard measurement can be performed.Ultrasound examination: in the parents’ help, children pose as inspectors, lateral position state, nearly 35 ° hip flexion, nearly 15 ° internal rotation, get mild in spiral buckling, in order to get the hip coronary sectionof clear and accurate image, by moving the probe in a location with the long axis parallel to the torso, big rotor lateral, observation of newborns and infants hip coronal ultrasonic ultrasonographic. Instead, let the baby to lie in the opposite direction, the same process to get the contralateral hip coronal ultrasonic ultrasonographic(FIG. 3, 4). Respectively for the following: 1) the surrounding soft tissue ultrasonographic 2) femoral head audio-visual acetabulum fossa ultrasonographic figure 3). Will the results of ultrasonic diagnosis and three-dimensional CT reconstruction.4.Statistical methods researchThrough three-dimensional CT examination result divides into the subjects of the hip DDH group and normal group, using SPSS12.0 software for statistical analysis. The use of paired sample T test statistical analysis of measurement indexes, count index by chi-square test, p < 0.05 for the difference has a significant meaning.Results: 1. A set of 7-9 months; Group B for 10 to 12 months.(1) A set of results: three-dimensional CT examination of positive rate higher than that of high frequency ultrasound, P = 0.018 < 0.05, the difference was statistically significant.(2) group B results: three-dimensional CT examination of positive rate higher than that of high frequency ultrasound,P = 0.015 < 0.05, the difference was statistically significant.2. The morphological changes of acetabulum: this group of 40 cases of80 hip, Ⅰ type(acetabulum development basic normal, acetabulum slightlylighter, as shown in figure 13), 8 hips(10%). Ⅱ type(flange anterolateral dysplasia in the acetabulum, as shown in figure 14), 17 hips(21%); Type III(the outer dysplasia in the acetabulum, as shown in figure 15), 44 hips(55%); Ⅳ type(flange posterolateral dysplasia in the acetabulum, as shown in figure 16), hips(6%); V(acetabulum on rendering diffuse dysplasia, as shown in the attached figure 17), 6 hips(7%). Ⅱ ~ Ⅳ groove defect is the main performance of the ministry of acetabulum hypoplasia(as shown in the attached figure 18), type Ⅲ performance is most obvious, part can be observed from above false mortar form outside the acetabulum.3.Acetabulum fossa form Groups: whole dislocation, severe deformity,common in severe malformation infants and young children group(20%),all for the older group. Subluxation groups: with mild and moderate deformity, older group of severe deformity account for a quarter. Dysplasia groups: normal and common mild abnormalities, severe deformity. As shown in figure 9.4.The acetabulum, transverse and coronary pathological morphological characteristics Pubic bone and sciatic acetabulum index each group compared with normal no statistical difference(P > 0. 05).Before the acetabulum Angle on average about 15 ° ~ 20 °, no statistical differences between the various groups, there was no statistically significant difference compared with normal group(P > 0. 05). Acetabulum diameter compared with normal group is no statistical difference(P > 0. 05).Acetabulum center thickness of each group were larger than the normal group,(P < 0. 05). Shame of acetabulum triangle cartilage, sciatic for acetabulum behind the halfway point, so the acetabulum midpoint area are located in the acetabulum sciatic part, no statistical difference between dislocation group and normal group(P > 0. 05).5.The acetabulum index(AI) of measurement resultsAll exceptions acetabulum in top acetabulum form is divided into five type: type Ⅰ, slightly shallow acetabulum and acetabulum top basic normal development; Ⅱ type, the superior border of acetabulum anterolateral dysplasia; Ⅲ type, on the outer acetabulum hypoplasia; TopⅣ type, acetabulum posterolateral dysplasia; Ⅴ type, diffuse in the acetabulum hypoplasia. The normal acetabulum reconstruction of three-dimensional CT with the above five type, each type as a set.Conclusion: 1. Each DDH patients the pathological changes of the complex three-dimensional structure with different hip, so by 3 DCT in preoperative fully recognize and understand the structure change of hip joint, the extent of the lesion, the scheme selection and operation has a pivotal role. 2. Are the main differences with other 2 d imaging techniques and 3 d CT on different positions of the acetabulum, femoral head and deformities is clearly reflect, through the ALAL, PLAL, LAI, TR, such as indicators of detection, CE Angle, the index of acetabulum, and can be in before and after, side a measure, such as a different plane. 3. Bycomparison, in small months son, ultrasound has its unique superiority, it avoids the three-dimensional CT radiation effect, and low cost, easily accepted by the public, easy to operate, the children don’t cause psychological burden, reduce the parents’ concern, can check again and again. In addition, ultrasound can be a powerful complement X-ray or CT can provide some information, around the hip joint cartilage and soft tissue structure, part of the soft tissue within the acetabulum has good display effect, the cartilage of femoral head and the relative spatial relationship of the acetabulum and femoral head cartilage jar observation of changes in the structure of labial form and more intuitive. 4. 3 d CT compared with high-frequency ultrasound, for big months son, can accurately distinguish infant hip dysplasia, and degree of acetabulum hypoplasia or dislocation has the accurate assessment, can be used as a routine screening method of DDH.Part III Thevalue of MRI in Infants with Developmental Dislocation of the Hip follow-upBackground and purpose:In big months hip developmental bad follow-up, MRI shows its irreplaceable importance, the growth of the acetabulum, hip and surrounding soft tissue structures within the pathological changes and evolution of accurate judgment and evaluation, MRI to timely understand the big months of DDH with hip within and surrounding the development and change of organization structure, development of play an important role, and can provide important information for the diagnosis and follow-up of DDH, for follow-up to provide important reference for the information.Although the X-ray and CT in DDH of follow-up also occupies the important position, but both good for pelvic osseous structure response, but can’t do it within the acetabulum, hip and surrounding soft tissue structures of good observation. Correctly display effect and magnetic resonance imaging(MRI) because of its factors hindering the research on the dislocation after intra-articular, and make more conducive to the follow-up of DDH. Magnetic resonance imaging(MRI) technology has no damage in DDH, convenient, for the soft tissue imaging. In children with no damage to the big months, hydration chloral enema,(dose calculated at every age of1 ~ 2 ml) in 15 minutes before the inspection, after waiting for children wassleeping, namely to MRI, full of children with no damage, no joint imaging of anesthesia and for children with no damage, and, more importantly, MRI has no radiation, reduced the worries of parents, are suitable to older children. Easy to check the whole process of MRI is less than half an hour,radiography is more sophisticated, without children, don’t need to children anesthesia, relieve the suffering of the children. MRI is the superiority of other tests on soft tissues can be for its clear, as distinct is can’t do other inspection. MRI is the imaging characteristics of through the establishment of a 3 d image, the strength of the signal in sagittal and frontal plane and cross-sectional observation of the bone cortex of the skeletal system,trabecular bone(bone marrow), articular cartilage, joint capsule, tendons,ligaments, muscles, joints, liquid, etc. MIR in DDH screening and follow-up, through its special signal of soft tissue structures of different,understanding before by X-ray, ultrasound, CT diagnosis of DDH children’s progress and the treatment is effective, more important is that can be observed in the hip joint and surrounding soft tissue structures of the pathological changes of the process, to determine its recovery degree and the progress, provide after treatment with constantly updated data and ideas more clearly, to provide better guidance for the diagnosis and treatment of DDH with follow-up.Materials and methods:1.The object of studyFor before using ultrasound, X-ray and CT in the diagnosis of patients with hip developmental bad, select cooperation degree good children with40 cases using MRI follow-up, starting in 2010, follow-up every 1 year follow-up, has been followed up for 6 years. All the children will do MRI,the images and measurement, observation to coincide with the standard.Among them, 16 cases of male(a total of 32) of the hip, female 24 cases(a total of 48 hip), age 12 to 36 months, average months for 22 months. Case inclusion criteria: the follow-up has been diagnosed DDH with the crowd,inspected as follows: 1. Observe whether the dermatoglyph of lower limbs is symmetrical, physical presence of shortening; 2. Positive Allis disease; 3.Hip outreach experiment positive; 4. Play into positive and pop-up experiment; 5. Lower limb activity less, weak stamped on; 6. The hip joint sound and play.2.Inspection methodUse of Germany’s Siemens 0.35 T MRI scanner(0.35 T all models:Magnetom C!). Before the start of scanning to give children 10% chloral hydrate 0.5 ml/kg enema to make the children calm, took the sleeping child supine, straighten the buttocks, together and make it slightly inward turning her feet. Scan range from edge to edge of the femoral neck on the acetabulum, incentive number 1 to 2 times, 3 mm, with a thick layer of layer spacing of 0.1 mm. Scan parameters: the body coil, using SE sequence: coronal and axial T1 WI TR 355-450 ms, TE 15 and 22 ms,matrix is 512 x 256, FOV is 256 x 300 mm; Fast spin echo(TSE) sequence,coronal T2 WI TR 3800-4000 ms, TE 95-110 ms, matrix is 512 x 192, FOV is 192 x 250 mm; Coronary STIR TR 4500-5280 ms, 60-82 ms TE, matrix is 256 x 256, FOV is 256 x 300 mm.Results:1. Follow-up observation indexes: joint function assessment of 30points; Pain degree evaluation of 40 points; Walking gait assessment of 15points; Anatomy of functional assessment of 15 points. The follow-up evaluation before three completed by children orthopaedics doctor, after a doctor completed by MRI. Comprehensive rating in 90-90 points as optimal; Comprehensive score in 80-89 rated as good; Comprehensive rating in 70-70 is divided into acceptable; Comprehensive score below 70 points for the poor.2. The average follow-up time of 3.8 years, this study selected can full weight-bearing walking 40 cases underwent follow-up, the results of MRI and clinical doctor comprehensive physical examination results, in accordance with the above standard scores, MRI showed that 20 cases of children with good bony and cartilaginous acetabulum cover, according to effective treatment, the other 20 cases of children with bony and cartilaginous acetabulum cover, and part of a display joint effusion, adipose tissue hyperplasia and hypertrophy of joint lip, even joint deformities.Cases of the line to the next step of pelvic osteotomy treatment,postoperative MRI follow-up for half a year again.3. 28 cases of dislocation of the hip children by MRI follow-up 1 year after closed reduction, main observation indexes to forecast the avascular femoral head necrosis may be the epiphyseal perfusion, if lower than normal, the might of the avascular necrosis of the femoral head, found in the follow-up of 18 cases of postoperative hip joint in perfusion lower for 6cases of hip, 3 cases of the hip joint is severely reduced perfusion, 2 cases of the hip is moderate, 1 case of hip is mild, different epiphyseal perfusion,femoral head avascular necrosis of the femoral head may be different,through the femoral perfusion of epiphyseal can predict the possibility of the avascular necrosis of the femoral head, and the situation has been we then ultrasonic and X-ray, confirmed that all imaging the different situations of the avascular necrosis of the femoral head.