超声波髋关节检查的诊断标准.ppt

1、超声波髋关节检查的诊断标准,陈博昌 上海交大医学院附属上海儿童医学中心,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,Type I 正常髋关节 Type II髋关节头臼同心对位，发育尚未成熟，骨化延迟 Type III髋关节半脱位或低位脱位 Type IV髋关节高位

2、脱位,Graf Hip Classification,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,Graf Hip Classification,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,76d, F =64 =43 Type I,Shanghai Childrens Medical Center Med

3、ical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,33d, F =55 =51 Type IIa,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,72d, F =43 =61 Type IIc,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,14d,

4、 M =37 =88 Type III,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,52d, F =无法测量 =123 Type IV,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,Graf 分类标准，是其它所有分类标准的基础 Graf 分类标准较为繁琐，在实际使用上不易掌握 Graf 分类与X线摄片的诊断标

5、准并没有同步,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,X线诊断标准 正常髋脱位 髋臼发育不良（股骨头同心对位，髋臼指数大于25） 髋关节半脱位（股骨头骨化中心位于Perkin方格外下象限） 髋关节脱位（股骨头骨化中心位于Perkin方格外上象限）,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,超声波诊断分

6、类(Graf) Type I 正常髋关节（60o 77o ） Type III 髋关节半脱位（ 77o ） Type IV 髋关节脱位（ 无法测量 77o ）,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,脱位,半脱位,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,正常到脱位,Shanghai Children

7、s Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,51,71,55,72,角度测量相似，畸形程度不同,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,有必要增加其它的观察指标 MR，Morin Index 代表骨性髋臼对股骨头的覆盖程度，用%表示,Shanghai Childrens Medical Center Medical School of

8、Shanghai Jioatong University,超声波髋关节检查的诊断标准,51,71,55,72,股骨头覆盖率MR,d,D,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,d,D,股骨头覆盖率MR,MR= 100% (d/D),Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,SCMC诊断标准,Shang

9、hai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,SCMC标准 经过6年反复修正 方便、易学、易记 后三项定义为DDH,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University

10、,超声波髋关节检查的诊断标准,Graf Hip Classification,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,各指标间的权重关系 权重第一位，骨性髋臼顶角度 权重第二位，髋臼对股骨头覆盖率MR 权重第三位，软骨性髋臼顶角度,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,31d,M 55, 65,

11、MR 57.4% 髋关节不稳定,31d, M 51, 67, MR62% 髋关节发育不良,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,33d, F,L =38, =110 MR 40% 髋关节脱位,33d, F, R =57, =56 MR 55.6% 髋关节不成熟,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标

12、准,其它观察指标 骨顶角形态锐角钝角阶梯状 盂唇位置正常内翻 骨化中心无可见半月状 园韧带,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,正常髋关节 骨性髋臼顶呈锐角 当髋关节发育欠佳时，骨顶角可以出现钝化或是阶梯状表现,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,骨顶角呈钝性（弧形）改变,Shanghai

13、Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,骨顶角呈阶梯状改变,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,骨顶角呈阶梯状改变,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,盂唇内翻

14、,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,骨顶钝化 盂唇未内翻,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,角顶阶梯状 盂唇未内翻,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关

15、节检查的诊断标准,角顶阶梯状，盂唇内翻,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,188d,102d,133d,95d,23m,34d,半月状,半月状,无,可见,可见,可见,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,股骨头骨化中心的出现和大小也是判定髋关节发育是否成熟的标志之一 DDH病例，股骨头骨化中

16、心的出现往往较晚,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,园韧带在动态观察中的增大、增粗现象往往是髋臼内阻挡的标志,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong Un

17、iversity,超声波髋关节检查的诊断标准,园韧带在动态观察中的增大、增粗现象往往是髋臼内阻挡的标志,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,标准图像的获得 骨顶角、盂唇是否位置、形态正常 角是否大于60度？ MR是否大于55%？ 是否小于55度？,如何来评判一个超声波髋关节检查结果,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,

18、超声波髋关节检查的诊断标准,标准图像 髂骨呈直线 骨顶有孔隙 盂唇看得见 臼底,几点技巧,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,髂骨在DDH时可以不呈水平状,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,髂骨倾斜,Shanghai Childrens Medical Center Medical Sch

19、ool of Shanghai Jioatong University,超声波髋关节检查的诊断标准,盂唇显像不清可以用股骨头切线代替,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,小结,超声波髋关节筛查是早期诊断DDH主要手段 从筛查中判别非正常髋关节远比对髋关节的超声波影像学表现进行分类重要 对可疑病例，可以通过反复复查获得最终诊断 多做干预、少做治疗 将非正常病例转诊给专科医生是最佳的途径,Shanghai Childrens Medical Ce

20、nter Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,通过儿童保健专业开展新生儿和小婴儿发育性髋关节异常DDH筛查工作的初步目的 将异常髋关节筛查出来 将正常髋关节区别开来 将可疑髋关节监控起来,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,通过儿童保健专业开展新生儿和小婴儿发育性髋关节异常DDH筛查工作的进一步目的 为临床干预和临床治疗提供量化监测数据,Shanghai C

21、hildrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,承认学习曲线的存在，循序渐进 紧密联系和依靠儿童骨科专业 从小于3月的新生儿和小婴儿入手 先报告正常、可疑和异常 再尝试进行分类诊断 干预性尝试安全、有效 治疗性工作风险重重,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋关节检查的诊断标准,合作开展课题研究 多中心、随机性、前瞻性研究是目前研究级别最高的种类,Shanghai Childrens Medical Center Medical School of Shanghai Jioatong University,超声波髋