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在医院生产之后，就有医生来检查宝宝，说他在之前是臀位，后来成了头位顺产。需要在6周的时候做hip B超。结果出来是左腿股骨头的覆盖率小于50%。需要13-14周再次复查。下个月就会去复查。
有宝宝是DDH的妈妈吗？如果宝宝确诊之后，接下来医生会怎样处理？有什么好的儿科/骨科医生推荐的吗？
http://www.chw.health.nsw.gov.au/parents/factsheets/developj.htm
Developmental dysplasia of the hip (DDH)
What is DDH?
The hip joint is similar to a ball in a socket. DDH means the ball of the hip either comes out of the socket or the socket has not developed properly. This condition used to be known as congenital dislocation of the hip (CDH); however some of these problems may not be present at birth and can develop as the baby grows.
How common is it?
There are several risk factors for DDH. These may include:
Breech presentation - 10 times increased risk
Female baby - 4 times increased risk
A reduced amount of fluid surrounding a baby in the womb - 4 times increased risk
A baby over 4kg at birth - 2 times increased risk
First born baby - 2 times increased risk
A baby born over 42 weeks gestation - 1.5 times increased risk
A family history of DDH
Some foot deformities present at birth.
Will my next baby have DDH?
As above, the condition can run in the family. All future children should be carefully examined at birth and undergo an ultrasound of their hips at six weeks of age. Ultrasound may be used in conjunction with clinical examination to diagnose DDH at this age, but must be performed by an experienced examiner.
What treatment will be required?
Treatment is dependent on the age of the child at the time of diagnosis and the severity of the abnormality in the hip. If the condition is diagnosed at birth, most babies are successfully treated in a Pavlik harness for six to ten weeks so that the hip goes back into the joint and stays in. At first, ultrasounds and later x-rays are used to see what the hip looks like and how it should be treated. Some babies' hips diagnosed early may not be corrected with the Pavlik harness and need further treatment.
Will surgery be necessary?
Children not diagnosed until six to eight months of age, or those who don't do well with the Pavlik harness, may need an anaesthetic to allow the hip to be put back in. Sometimes an operation is needed. A plaster body cast (hip spica) is used to keep the hip in the correct position after the anaesthetic or operation.
How successful is the treatment?
Most hips improve and become normal after treatment. In a small number of children the hip is so delicate the child will lose the blood supply to the hip when the hip is placed back into its correct position. There is no way of seeing if this has happened at the time. Another x-ray will show if the hip is not growing normally.
Very few have any problem in their childhood or adolescence. Some children will develop arthritis much later in life if the hip does not develop fully.
How active will my child be?
Most children can lead a normal, active life after treatment for DDH.
http://www.babytree.com/forum/topic_424501
髋臼发育不良，对股骨头的包容不好，导致股骨头脱出中心，临床上称之为髋脱位，是导致儿童肢体残疾的主要疾病之一。此病在我国的发病率较高，尤其是我省农村的发病率高于全国平均水平。黑龙江省医院骨一科主任杨健告诉记者，此病诊治时间的早晚直接影响治疗效果的好坏，如果患儿在一周岁以内，保守治疗即可；如果超过一周岁，就只能采取手术治疗，且手术成功率随年龄增长而降低。
目前，小儿髋脱位的发病原因还不完全清楚，但主要有以下几个因素：遗传因素、胎位不正(尤其是臀位产)、母亲小骨盆、后天因素影响(如不正确捆绑包扎婴儿)、特发性(即排除以上因素)。根据病情，小儿髋脱位在临床上分为：髋关节发育不良、髋关节半脱位、髋关节全脱位。
据杨健主任介绍，小儿髋脱位的早期诊断和治疗至关重要。婴儿出生至一周岁以内被确诊称作早期诊断，这期间采用非手术治疗或辅助手术方法即可治愈。如果超过一周岁，治疗相对复杂，效果也随诊治时间早晚而不同。
——患儿出生后2—3个月确诊。只需采用挽具(吊带等)即可治愈，有很多几个月大的患儿在省医院采用吊带治疗9个月，症状基本消失。
——患儿出生后3—6个月确诊。可采用可调节外展支具或外展石膏(蛙式位石膏)治疗。
——患儿出生后6—12个月确诊。可采用内收肌切断加上支具或外展石膏治疗。病情严重者可通过切断内收肌、牵引复位(2周)加上支具或外展石膏治疗。
以上治疗方法比较容易，且会获得理想的治疗效果，1岁以内治愈率达95%。
——患儿超过一岁。多采取手术治疗，如内收肌部分切断、牵引、髋臼内清理、髋臼成形，必要时还需在股骨上端截骨矫正前倾角。省医院曾开展髋关节矫形手术两千多例。杨健主任指出，手术不仅给患儿带来很大创伤，且费用接近万元。
杨健主任称，小儿髋脱位手术的成功率随年龄增长而降低，1周岁左右手术成功率达80%，6岁左右手术成功率只有60%左右，七八岁时手术成功率仅有50%。一旦手术失败，患儿会不同程度地出现骨性关节炎、再脱位，以致终身残疾。
杨健主任强调，我省小儿髋脱位的发病率为千分之三，我省农村约有2万儿童患有该病。由于家长多抱有旧观念：小孩做手术太危险，等大一大再说；只要不是死人的病，就没必要花太多钱治疗。受此影响，农村新生儿的检诊意识差，加之农村医疗力量薄弱，导致很多农村小儿髋脱位患儿没能得到早期诊治。有的农村家庭觉得手术费高，甚至放弃治疗，让孩子带着残疾，在痛苦中度过一生。 |
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