早产儿髋关节发育的早期演变进程△

Early evolution process of hip development in premature neonates and infants

摘要:

［目的］探讨早产儿髋关节早期演变进程。［方法］ 对 2019 年 1 月—2021 年 6 月扬州市妇幼保健院出生的 4 102 例新生儿进行前瞻性研究。分别于出生后 1、7、42 及 90 d 行 Graf 法髋关节超声检查，观察其髋关节早期发育及转归情况。［结果］ 依据早产儿诊断标准，早产儿 393 例，占总数 9.58%；足月儿 3 709 例，占 90.42%。早产儿体重低于足月儿 （P<0.05）， 早产儿组中多胎、母亲妊娠合并高血压、前置胎盘的比率显著高于足月儿组（P<0.05）。出生后 1、7 d 检查时，早产儿组 Graf Ⅰ型髋关节比例显著高于足月儿组（P<0.05），但 42、90 d 检查时两组Ⅰ型髋关节比例的差异已无统计学意义（P>0.05）。随出生后日龄增加，两组新生婴儿的 α 角显著增加（P<0.05），而 β 角显著减小（P<0.05）。出生后相应时间点，早产儿组的 α 角度数显著大于足月儿组（P<0.05），而 β 角度数显著小于足月儿组（P<0.05）。早产儿 393 例中，早期早产（28~31 周）32 例，中期早产（32~33 周）64 例，晚期早产（34~36 周）297 例。晚期早产组生后 1、7 d 检查时，Graf Ⅰ型髋关节比例显著小于早期早产组及中期早产组（P<0.05），而 42 d 后检查，三组间 Graf 评级差异无统计学意义（P>0.05）。［结论］ 早产儿出生时Ⅰ型髋关节比例较足月儿高，生后 42 d 是早产儿首次筛查的合理时点。

Abstract:

[Objective] To investigate the early evolution process of hip development in premature newborn and infants. [Methods] A prospective study was conducted on 4102 neonates who were born in Yangzhou Maternal and Child Health Hospital from January 2019 to June 2021. Graf hip ultrasound was conducted at 1, 7, 42 and 90 days after birth to observe the early development and conversion of the hip. [Results] According to the diagnostic criteria of premature neonate, 393 cases were of the premature, accounting for 9.58%, whereas 3709 cases were of the normal term neonates, accounting for 90.42%. The premature had significantly lower body weight (P<0.05) , and sig- nificantly higher ratios of multiple births, maternal hypertension and placenta previa than the mature (P<0.05) . At the 1 and 7 days after birth, the premature group had significantly higher proportion of Graf type I hip than the mature group (P<0.05), whereas which became not statistically significant between the two groups at 42 and 90 days after birth (P>0.05) . With the increase of postnatal age, the α angle signif- icantly increased (P<0.05) , while the β angle significantly decreased in both groups (P<0.05) . At all matching time point after birth, the premature group had significantly greater α angle, while significantly less β angle than mature group (P<0.05) . Among the 393 preterm in- fants, 32 were of early preterm (28~31 w) , 64 were intermediate preterm (32~33 w) , and 297 were late preterm (34~36 w) . At 1 and 7 days after birth, late preterm group had significantly lower proportion of Graf type I hip than the early preterm group and the intermediate pre- term group (P<0.05) , whereas which turned to be not statistically significant at 42 days after birth in Graf grades of the hip among the three groups (P>0.05) . [Conclusion] The preterm neonates have higher proportion of Graf type I hip than the matures, additionally, 42 days after birth is a reasonable time for the first screening of preterm neonates.