早产与Graf超声髋臼形态：5255例髋筛查转诊婴儿回顾分析
该回顾性队列纳入5255例因髋筛查转诊行Graf超声的婴儿，早产儿异常髋臼形态（Graf≥IIb）频率低于足月儿（13.3% vs 28.9%，P<0.001），多因素分析中早产与DDH风险降低独立相关（aOR=0.45，95%CI 0.37-0.54），多胎妊娠无独立关联。
要点
- 早产儿Graf≥IIb频率低于足月儿，且随胎龄增加α角呈下降趋势。
- 多因素分析中早产与DDH风险降低独立相关（aOR=0.45），女性风险升高（aOR=2.74）。
- 多胎妊娠与异常髋臼形态无独立关联（aOR=0.81，95%CI 0.53-1.23）。
关键影像表现/征象
- 早产儿异常髋臼形态频率低于足月儿（13.3% vs 28.9%，P<0.001）。
- 髋α角随胎龄增加呈下降趋势（Kendall's τ=-0.10，P<0.001），独立于检查时实际年龄（P=0.21）。
诊断标准与关键数值
- 异常髋臼形态定义为Graf≥IIb。
- 早产与DDH风险降低独立相关（aOR=0.45，95%CI 0.37-0.54）。
- 女性与DDH风险升高独立相关（aOR=2.74，95%CI 2.37-3.17）。
- 多胎妊娠与DDH无独立关联（aOR=0.81，95%CI 0.53-1.23）。
临床应用与阅片要点
- 阅片报告Graf超声时，早产儿出现Graf≥IIb的概率较低，但不应因此忽略对早产儿的必要评估。
- 女性婴儿髋臼形态异常风险较高，报告时需结合性别综合判断。
- 多胎妊娠本身不构成独立风险，不应仅凭多胎病史提高Graf分级或过度报告。
局限性
- 回顾性研究，仅纳入转诊行髋超声的婴儿，存在选择偏倚。
- 结论基于转诊人群，需人群为基础的前瞻性研究证实。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: Traditional paradigms classify prematurity and multiple gestation as risk factors for developmental dysplasia of the hip (DDH). However, recent evidence suggests prematurity may reduce DDH risk via reduced intrauterine mechanical stress.
OBJECTIVE: To examine whether prematurity and multiple gestation are independently associated with acetabular morphology in infants referred for Graf ultrasonography.
MATERIALS AND METHODS: This retrospective cohort study included 5,255 infants (1,230 preterm, 4,025 term) referred for hip ultrasonography from three clinical sources (neonatal ward, child health outpatient clinic, and paediatric orthopaedic clinic) between January 2022 and October 2024. Infants with genetic syndromes, neuromuscular diseases, or congenital malformations were excluded. Abnormal acetabular morphology was defined as Graf ≥IIb using standardised techniques. Three nested multivariable logistic regression models were adjusted for prematurity, sex, multiple gestation, foetal presentation, and delivery mode. Sensitivity analyses verified robustness.
RESULTS: Abnormal acetabular morphology frequency was lower in preterm versus term infants (13.3% vs 28.9%, P<0.001), with a dose-response across gestational ages. Hip α-angles showed a decreasing trend with increasing gestational age (Kendall's τ=-0.10, P<0.001), independent of chronological age at examination (P=0.21). In multivariable analysis (n=5,201), prematurity was associated with lower DDH odds (adjusted OR=0.45, 95% confidence interval (CI) 0.37-0.54), female sex was associated with higher odds (aOR=2.74, 95% CI 2.37-3.17), and multiple gestation showed no association (aOR=0.81, 95% CI 0.53-1.23).
CONCLUSIONS: Preterm birth showed lower abnormal acetabular morphology, while multiple gestation showed no independent association. Within referral settings, prematurity alone may not warrant routine DDH screening; population-based prospective studies are needed to confirm these findings.
引用
- Xiao H, Wu Z, Liu X, et al. Prematurity and acetabular morphology on Graf ultrasonography: a retrospective analysis of 5,255 infants referred for hip screening. Pediatr Radiol. 2026. PMID: 42118284. doi:10.1007/s00247-026-06633-y
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。