髋臼周围损伤对髋关节发育的影响(英文)

Effect of periacetabular injury on hip development

背景:影响髋关节发育的因素很多,目前有关Y形软骨、盂唇等损伤对髋臼发育影响的报道较多,但有关髋臼软骨及周围骨膜受损对髋关节发育影响的报道很少。目的:探讨髋臼软骨及周围骨膜损伤对髋关节发育的影响。设计:完全随机、自身对照、重复测量设计。地点和对象:本研究在中国医科大学第二临床学院动物实验室进行,实验对象为20只4～5周龄日本大耳白兔。干预:随机分组后,取右侧髋关节为手术侧,分别切除其部分髋臼软骨(A)组及臼缘上方骨膜(B组),左侧髋关节不做处理,作为对照。主要观察指标:术后第2天,3,6,9,12周行射线检查,测量双侧XSharp角及臼头指数。术后12周处死动物,行形态学及组织学观察。结果:术侧全部出现髋关节发育不良,半脱位发生率:A组80%,B组40%,术后12周Sharp角B组62.30±3.37)°与A组58.70±3.50)°((比较差异有显著性意义(P<0.05)。臼头指数A组在,,,周,36912B组在,,6912周与对照侧比较差异均有显著性意义(P<0.01或0.05)。组织形态学可见髋臼变浅,股骨头变扁,关节软骨层变薄,部分骨细胞呈坏死样改变。结论:髋臼软骨及臼缘上方骨膜破坏可导致髋关节发育不良和半脱位。

BACKGROUND:The hip development is influenced by many factors.However there were few reports about the effect of acetabular cartilage or periacetabular periosteal injury on hip development despite most reports on injuries to triradiate cartilage or glenoid limbus. OBJECTIVE:To study the effect of acetabular cartilage and periacetabular periosteum injury on hip development. DESIGN:A completely randomized self controlled repeated measures design. SETTING and PARTICIPANTS:The trial was conducted in the Laboratory for Animals,the Second Affiliated Clinical Hospital of China Medical University.The subjects were 20 Japanese flap eared white rabbits,aged 4-5 weeks. INTERVENTION:The rabbits were randomly divided into 2 groups,and then the acetabular cartilage(group A) and supra acetabular periosteum(group B) on the right hip was resected.The opposite nonoperated hips served as controls. MAIN OUTCOME MEASURES:X ray examination of both hips was taken on the 2nd postoperative day and the 3rd,6th,9th,12th week after operation to measure the Sharp angle and acetabular head index.All rabbits were sacrificed on the 12th week.The morphological and microscopic histological changes of the hip joint were subsequently assessed. RESULTS:A series of radiography and morphological observation showed all the operated hips appeared hip dysplasia.Eight hips(80%) in group A and 4 hips(40%) in group B manifested subluxation.The Sharp angle in group B[(62.30±3.37)°] was significantly different from that in group A[(58.70±3.50)°](P< 0.05).The acetabular head index on the 3rd,6th,9th,12th week in group A and on the 6th,9th,12th week in group B was significantly different from that in corresponding control hips(P< 0.01 or 0.05).Morphological observation showed that the acetabulum became shallow,the femoral head became flat,articular cartilage became thin,and some osteocytes were necrotic. CONCLUSION:The damage to acetabular cartilage and supra acetabular periosteum leads to hip dysplasia and subluxation.