髋关节造影、动态影像监测下治疗先天性髋关节脱位

Arthrography Under Image Intensifier Control in Reduction of Congenital Dislocation Hip

目的探讨髓关节造影、动态影像监测先天性髋关节脱位闭合复位前后的影像变化及其临床意义，并提出复位成功的指征。方法对２３例３４髋先天性髋关节脱位患儿进行髋关节造影，同时进行手法复位，对比研究复位前后影像变化并记录安全区限。结果３４髋中除４髋复位失败外，其余均一次复位成功。复位前２３髋显示盂唇内翻，髋臼内“叉状”影像１６髋，其中充盈缺损为圆韧带。２３髋有“葫芦”状关节囊。中心复位后，盂唇内翻消失，并有“玫瑰刺”征出现。复位失败的４髋中有明显的囊颈狭窄，无一例股骨头坏死发生。结论髋关节造影、动态影像监测闭合复位先天性髋关节脱位能动态地确定复位的安全区限、髋关节是否中心复位及复位失败的内在障碍。髋关节中心复位的影像指征为股骨头顶点对向髋臼“Ｙ’字软骨中心，“玫瑰刺”征出现，盂唇无内翻，髋关节内侧间隙变小，申通氏线连续。

Objective To assess the arthrographic changes under the image intensifier control and correlate them clinically. Methods Arthrographies were performed on 23 Patients (34 hips) before and after closed reduction under image intensifier. The zones of safety were recorded. Results With the excep-non of 4 hips, all reductions were successful. Inverted Iimbuses were present in 23 hips. The redundant andhypertrophied ligamentum teres were shown as fork-shaped filling defect. Twenty-three hips had hour-glass:appearance. After reduction, the inverted limbuses disappeared. 'Rose-thorn' feature appeared. Arthrography of the 4 failed reductions demonstrated hour-glass constriction of capsule. Conclusions Arthrographywith image intensifier provides visualisation of safety zone and anatomical abnormalities during reduction of congenital dislocation of hip.