Sun Qiang,Ye Jiajun,Zhou Ying.Epidemiological survey and influencing factors of developmental dysplasia of the hip in Tibetan children of Sichuan and Tibet[J].Journal of Clinical Pediatric Surgery,2023,22(11):1050-1054.[doi:10.3760/cma.j.cn101785-202204079-009]
川藏藏族儿童发育性髋关节脱位的影响因素分析
- Title:
- Epidemiological survey and influencing factors of developmental dysplasia of the hip in Tibetan children of Sichuan and Tibet
- 关键词:
- 发育性髋关节发育不良; 关节脱位; 流行病学研究; 藏族; 儿童
- Keywords:
- Developmental Dysplasia of the Hip; Joint Dislocations; Epidemiologic Studies; Tibetan Nationality; Child
- 摘要:
- 目的 探讨川藏藏族儿童发育性髋关节脱位的影响因素。方法 本研究为回顾性研究。以四川省骨科医院儿童骨科2013年1月至2021年12月收治的99例来自四川省甘孜藏族自治州、阿坝藏族羌族自治州、凉山彝族自治州及西藏自治区的藏族发育性髋关节脱位患儿作为研究对象,对患儿监护人进行问卷调查。按照受试者常住地分为四组:甘孜藏族自治州组(A组),阿坝藏族羌族自治州组(B组),凉山彝族自治州组(C组)和西藏自治区组(D组)。问卷调查内容包括受试者相关性因素(受试者是否早产,生产方式为顺产或剖宫产,生产时体位为头位或臀位,受试者是否为头胎或二胎及以上);以及监护人及家庭相关性因素[监护人是否为15岁以上、不识字且不会写字的成年人(以下简称文盲),受试者出生后襁褓方式是否绑腿,受试者是否定期接受儿童保健,受试者家庭经济情况]。结果 四组DDH患儿是否早产(χ2=7.564、P＜0.05)、生产方式(χ2=7.524、P＜0.05)、生产胎位(χ2=6.801、P＜0.05)、是否头胎(χ2=13.008、P＜0.05)、监护人文化程度(χ2=14.114、P＜0.05)、襁褓方式(χ2=13.080、P＜0.05)、是否定期进行儿童保健(χ2=11.107、P＜0.05),以及家庭经济状况(χ2=11.935、P＜0.05)等因素比较,差异均有统计学意义。儿童受试者相关因素中"早产和臀位产",监护人及家庭相关性因素中"监护人是文盲"、"襁褓方式为绑腿"、"未定期接受儿童保健"是川藏藏族儿童DDH发病的主要影响因素(P<0.05)。结论 早产、臀位生产、监护人是文盲、襁褓方式为绑腿、未规范进行儿童保健可能与藏族儿童DDH发病率升高有关。
- Abstract:
- Objective The construction of animal models of neonatal necrotizing enterocolitis (NEC) is still not uniform,and animal modeling approaches that are more relevant to the actual clinical situation of NEC childern should be clarified.Methods Fifty-four neonatal mice were randomly divided into five groups: control group (Ctrl),hypoxia + artificial feeding group (HF),hypoxia + artificial feeding + cold stimulation group (Cold),hypoxia + artificial feeding + lipopolysaccharide group (LPS),and hypoxia + artificial feeding + intestinal bacteria in NEC group (Bac).After the animal models of NEC were established,the intestinal pathology,NEC-related intestinal epithelial barrier proteins (β-catenin and Occludin),intestinal epithelial cell death (CC3,RIPK1 and PARP1) and pro-inflammatory cytokines (IL-6,TNF-α and MCP1) were evaluated.Results Nadler score ≥2 according to intestinal histology was considered as NEC-like intestinal injury.In this study,the intestinal histopathology of the three NEC-modeled groups met the criteria for NEC-like intestinal injury,except for the Ctrl and HF groups.Compared with the NEC modeling groups HF (30%),Cold (83.3%) and LPS (81.8%),the Bac group had the highest modeling success rate (100%),and the mental status,bloating and diarrhea,and mobility of the mice in the Bac group during the modeling period were more consistent with clinical NEC.Meanwhile,the expression of intestinal barrier proteins β-catenin and Occludin was decreased in the Bac group mice,and the difference was statistically significant compared with the Ctrl group (P<0.05).the expression of intestinal epithelial cell death marker molecules RIPK1 and PARP1 was upregulated in the LPS and Bac groups,and the expression levels of inflammatory factors IL-6,TNF-α and MCP1 were increased compared with the Ctrl group,with statistically significant differences (P<0.05).Conclusions In this study,we successfully compared four animal models of NEC and identified an animal modeling method,namely "hypoxia+artificial feeding+intestinal bacteria in NEC",that is more relevant to the actual situation of clinical NEC children.This modeling method has a high success rate,and the intestinal histopathological damage,intestinal barrier protein expression and systemic inflammatory response are more similar to the characteristics of clinical NEC children.
参考文献/References:
[1] Karnik A,Lawande A,Lawande MA,et al.Practice essentials of imaging in early diagnosis of DDH[J].Indian J Orthop,2021,55(6):1466-1479.DOI:10.1007/s43465-021-00539-7.
[2] Wenger DR,Bomar JD.Historical aspects of DDH[J].Indian J Orthop,2021,55(6):1360-1371.DOI:10.1007/s43465-021-00470-x.
[3] 吉士俊,潘少川,王继孟.小儿骨科学[M].济南:山东科学技术出版社,1998:142-143. Ji SJ,Pan SC,Wang JM.Pediatric Osteology[M].Jinan:Shandong Science & Technology Press,1998:142-143.
[4] Zinchenko V,Kabatsii M,Hertsen I.Clinical diagnostics of DDH and peculiarities of hip joint development in children throughout the first year of life[J].Georgian Med News,2021,(316-317):114-118.
[5] Lee SW,Ye HU,Lee KJ,et al.Accuracy of new deep learning model-based segmentation and key-point multi-detection method for ultrasonographic developmental dysplasia of the hip(DDH)screening[J].Diagnostics(Basel),2021,11(7):1174.DOI:10.3390/diagnostics11071174.
[6] Roof MA,Gibon E,Rios-Ruíz G,et al.Has there been a change in the age of presentation of patients with DDH after the implementation of a dedicated ultrasound-screening program?[J].J Pediatr Orthop,2021,41(7):433-436.DOI:10.1097/bpo.0000000000001871.
[7] Terjesen T,Horn J.Management of late-detected DDH in children under three years of age:49 children with follow-up to skeletal maturity[J].Bone Jt Open,2020,1(4):55-63.DOI:10.1302/2633-1462.14.BJO-2019-0005.R1.
[8] 吕学敏,郭源,边臻,等.婴儿发育性髋关节发育不良自然发育过程研究[J].中华小儿外科杂志,2014,35(11):848-852.DOI:10.3760/cma.j.issn.0253-3006.2014.11.012. Lyu XM,Guo Y,Bian Z,et al.Natural progression of infantile developmental dysplasia of hip[J].Chin J Pediatr Surg,2014,35(11):848-852.DOI:10.3760/cma.j.issn.0253-3006.2014.11.012.
[9] 刘帅,林伟枫,惠涛涛,等.联合应用Graf和Harcke超声技术评价DDH早期诊治的临床效果[J].中华小儿外科杂志,2020,41(11):1010-1015.DOI:10.3760/cma.j.cn421158-20190801-00470. Liu S,Lin WF,Hui TT,et al.Combining Graf and Harcke ultrasounds for evaluating the clinical outcomes of DDH in early diagnosis and treatment[J].Chin J Pediatr Surg,2020,41(11):1010-1015.DOI:10.3760/cma.j.cn421158-20190801-00470.
[10] George H,Nikolaos T,Enges?ter I?.Total hip replacement in young adults with hip dysplasia[J].Acta Orthop,2011,82(5):635-636.DOI:10.3109/17453674.2011.627495.
[11] Woodacre T,Ball T,Cox P.Epidemiology of developmental dysplasia of the hip within the UK:refining the risk factors[J].J Child Orthop,2016,10(6):633-642.DOI:10.1007/s11832-016-0798-5.
[12] Bram JT,Gohel S,Casta?eda PG,et al.Is there a benefit to weaning pavlik harness treatment in infantile DDH?[J].J Pediatr Orthop,2021,41(3):143-148.DOI:10.1097/BPO.0000000000001753.
[13] Yu J,Shi Q.Efficacy evaluation of 3D navigational template for salter osteotomy of DDH in children[J].Biomed Res Int,2021,2021:8832617.DOI:10.1155/2021/8832617.
[14] Shi Q,Sun DY.Efficacy and safety of a novel personalized navigation template in proximal femoral corrective osteotomy for the treatment of DDH[J].J Orthop Surg Res,2020,15(1):317.DOI:10.1186/s13018-020-01843-y.
[15] 李燕华,吕学敏,张宇辰,等.早期筛查对发育性髋关节发育不良的预防意义及其影响因素分析[J].临床小儿外科杂志,2019,18(5):395-399.DOI:10.3969/j.issn.1671-6353.2019.05.011. Li YH,Lyu XM,Zhang YC,et al.Preventive significance of early screening for developmental dysplasia of the hip and its influencing factors[J].J Clin Ped Sur,2019,18(5):395-399.DOI:10.3969/j.issn.1671-6353.2019.05.011.
相似文献/References:
[1]姜海,苗武胜,吴革,等. 发育性髋关节发育不良儿童髋臼形态学病理分型的探讨[J].临床小儿外科杂志,2016,15(02):179.
[2]李大进,张彬,高强,等.股骨截骨联合Salter骨盆截骨治疗残余髋臼发育不良的疗效分析[J].临床小儿外科杂志,2022,21(12):1159.[doi:10.3760/cma.j.cn101785-202112051-011]
Li Dajin,Zhang Bin,Gao Qiang,et al.Efficacy of femoral osteotomy for residual acetabular dysplasia with Salter pelvic osteotomy[J].Journal of Clinical Pediatric Surgery,2022,21(11):1159.[doi:10.3760/cma.j.cn101785-202112051-011]
[3]刘万林,孙亮,赵振群,等.骨化核与发育性髋关节发育不良闭合复位后股骨头缺血坏死相关性的研究进展[J].临床小儿外科杂志,2023,22(06):584.[doi:10.3760/cma.j.cn101785-202010041-017]
Liu Wanlin,Sun Liang,Zhao Zhenqun,et al.Research advances on the relationship of ossification nucleus with avascular necrosis of developmental hip dysplasia after closed reduction[J].Journal of Clinical Pediatric Surgery,2023,22(11):584.[doi:10.3760/cma.j.cn101785-202010041-017]
[4]李杰,龙江涛,王倩倩,等.发育性髋关节脱位患儿不同股骨颈前倾角对股骨生物力学的影响研究[J].临床小儿外科杂志,2023,22(08):757.[doi:10.3760/cma.j.cn101785-202205019-011]
Li Jie,Long Jiangtao,Wang Qianqian,et al.Effect of different femoral neck anteversion angles on femoral biomechanics in children with developmental dislocation of the hip[J].Journal of Clinical Pediatric Surgery,2023,22(11):757.[doi:10.3760/cma.j.cn101785-202205019-011]
[5]赵振辉,熊竹,曾帅丹,等.发育性髋关节发育不良遗传学及分子调控机制的研究进展[J].临床小儿外科杂志,2023,22(11):1095.[doi:10.3760/cma.j.cn101785-202210022-019]
Zhao Zhenhui,Xiong Zhu,Zeng Shuaidan,et al.Research progress on the genetics and molecular regulatory mechanisms of developmental hip dysplasia[J].Journal of Clinical Pediatric Surgery,2023,22(11):1095.[doi:10.3760/cma.j.cn101785-202210022-019]
[6]乔怡,张福勇,甄允方,等.儿童肱骨近端骨折合并肩关节脱位的治疗探讨[J].临床小儿外科杂志,2024,(02):190.[doi:10.3760/cma.j.cn101785-202302001-017]
Qiao Yi,Zhang Fuyong,Zhen Yunfang,et al.Treating proximal humeral fractures plus glenohumeral joint dislocation in children[J].Journal of Clinical Pediatric Surgery,2024,(11):190.[doi:10.3760/cma.j.cn101785-202302001-017]
[7]黎艺强,刘行,郭跃明,等.儿童发育性髋关节发育不良闭合复位术后结局预测模型的构建[J].临床小儿外科杂志,2024,(06):509.[doi:10.3760/cma.j.cn101785-202404061-003]
Li Yiqiang,Liu Hang,Guo Yueming,et al.Prediction model of final outcomes in children with developmental dysplasia of the hip treated by closed reduction[J].Journal of Clinical Pediatric Surgery,2024,(11):509.[doi:10.3760/cma.j.cn101785-202404061-003]
[8]李敬春,刘雁寒,黎艺强,等.发育性髋关节脱位闭合复位后残余髋臼发育不良骨盆截骨时机与指征的多中心前瞻性非随机对照试验研究方案[J].临床小儿外科杂志,2024,(06):527.[doi:10.3760/cma.j.cn101785-202405072-005]
Li Jingchun,Liu Yanhan,Li Yiqiang,et al.A multicenter prospective non-randomized controlled protocol on timing and indications of pelvic osteotomy for residual acetabular dysplasia after closed reduction of developmental dislocation of the hip[J].Journal of Clinical Pediatric Surgery,2024,(11):527.[doi:10.3760/cma.j.cn101785-202405072-005]
[9]裴胤志,黄鹏,吴春星,等.MRI-骨性泪滴眉弓线预测发育性髋关节发育不良闭合复位后残余髋臼发育不良的研究[J].临床小儿外科杂志,2024,(10):940.[doi:10.3760/cma.j.cn101785-202403002-008]
Pei Yinzhi,Huang Peng,Wu Chunxing,et al.Application of MRI-Bony teardrop and sourcil line in predicting residual acetabular dysplasia after closed reduction of developmental dysplasia of the hip[J].Journal of Clinical Pediatric Surgery,2024,(11):940.[doi:10.3760/cma.j.cn101785-202403002-008]
备注/Memo
收稿日期:2022-4-26。
基金项目:四川省医学会医学科研课题(S19065); 四川省中医药管理局四川省名中医周英工作室活态传承建设项目(川中医药办发[2022]16号)
通讯作者:孙强,Email:2357401669@qq.com.