325例发育性髋发育不良患儿延误确诊影响因素分析△

Factors impacting delayed diagnosis of developmental dysplasia of the hip in 325 children

摘要:

[目的] 分析本院发育性髋关节发育不良 (developmental dysplasia of the hip, DDH) 患儿延误确诊的影响因素，为 DDH 相关公共卫生政策的制定和推行提供科学依据。[方法] 2011 年 1 月—2020 年 12 月西京医院收治的 7 岁以下 DDH 患儿 325 例作为研究对象，根据确诊时患儿年龄分为非延误组(确诊年龄 0~6 个月)和延误组(确诊年龄 7~84 个月)。调查患儿的基本信息、家庭信息和诊疗信息。对不同确诊月龄与超声 Graf 分型和影像 Crowe 分型的关系进行 Spearman 相关性分析，而后根据分组进行单因素分析及多因素 logistic 回归分析。[结果] 325 例患儿 (432 髋) 中，非延误组 72 例，占 22.15%；延误组 253 例，占 77.85%。非延误组患儿确诊月龄与超声 Graf 分型呈负相关性 (R=-0.284，P=0.016)。延误组患儿确诊月龄与影像 Crowe 分型呈正相关性(R=0.144，P=0.023)。多因素逻辑回归表明，家庭经济条件差(OR=1.722，P=0.001)、母亲受教育程度低 (OR=1.429，P=0.047)、未进行早期髋筛查 (OR=7.215，P＜0.001) 是 DDH 患儿延误确诊的独立危险因素。[结论] 6 个月以下确诊患儿确诊月龄与超声 Graf 分型呈弱负相关，7 个月以上确诊患儿确诊月龄与影像 Crowe 分型呈弱正相关。家庭经济条件差、母亲受教育程度低、未进行早期髋关节筛查是 DDH 患儿延误确诊危险因素。

Abstract:

[Objective] To analyze the factors influencing the delayed diagnosis of developmental dysplasia of the hip (DDH) in our hos- pital, and to provide the scientific basis for the formulation and implementation of DDH-related public health policies. [Methods] A total of 325 children with DDH under 7 years old who were admitted to Xijing Hospital from January 2011 to December 2020 were enrolled into this study. According to the age of children at diagnosis, they were divided into the non-delayed group (0~6 months at diagnosis) and the de- layed group (7~84 months at diagnosis) . The basic information, including family history, birth, diagnosis, and treatment process of the chil- dren, were investigated. Spearman correlation analysis was performed on the relationship between the age at diagnosis and ultrasonic Graf scale, and radiographic Crowe grade. In addition, univariate comparison and multivariate logistic regression analysis were performed to ex- plore the factors related to the delayed diagnosis. [Results] Of the 325 patients (432 hips) , 72 children fall into the non-delayed group, ac- counting for 22.15%, while 253 cases were in the delayed group, accounting for 77.85%. The age at diagnosis was negatively correlated with ultrasonic Graf classification in the non-delayed group (R=-0.284, P=0.016) , whereas the age at diagnosis proved positively correlat- ed to imaging Crowe classification in the delayed group (R=0.144, P=0.023) . As results of multivariate logistic regression, poor family eco- nomic condition (OR=1.722, P=0.001) , poor maternal education (OR=1.429, P=0.047) , and lack of early hip screening (OR=7.215, P< 0.001) was the independent risk factor for delayed diagnosis of DDH. [Conclusion] There is a weak negative correlation between the age at the diagnosis under 6 months and ultrasonic Graf classification, and a weak positive correlation between the age at diagnosis over 7 months and radiographic Crowe classification. Poor family economic condition, poor maternal education level, and lack of early hip screening are the risk factors for delayed diagnosis of DDH in children.