3D-CT初步分析发育性髋臼发育不良患儿髋臼前倾的原因

3D-CT analysis of underlying reason of increased acetabular anteversion in DDH

[目的]观察发育性髋臼发育不良患儿病变髋是否存在髋臼过度前倾,并分析髋臼前倾的原因。[方法]回顾性收集50例单髋脱位患儿和30例正常对照组髋关节的3D-CT影像学资料。病例组:男11例,女39例;年龄6～60个月,平均18个月。左侧髋脱位29例,右侧髋脱位21例。对照组:男16例,女14例;年龄7～48个月,平均20个月。所有实验对象均测量髋臼前倾角(AA)、坐骨旋转角(IA)、耻骨旋转角(PA)、耻骨相对长度(PRL)和坐骨相对距离(IRD),统计学分析对比病例组和对照组上述指标是否存在统计学差异。[结果]正常对照组左侧髋和右侧髋的AA、IA、PA、PRL和IRD差别均无统计学意义(P>0.05)。单髋脱位患儿脱位侧髋和未受累侧髋的PA差别无统计学意义(P>0.05)。脱位侧髋的PRL值小于未受累侧髋,差异有统计学意义(P<0.05)。脱位侧髋的AA、IA和IRD均大于未受累侧髋,差异有统计学意义(P<0.05)。无论是在脱位侧髋还在未受累侧髋,IA均与AA和IRD呈正相关。[结论]发育性髋臼发育不良患儿髋臼过度前倾是普遍存在的,除了髋臼前壁缺陷外,患儿脱位侧髋的坐骨外侧旋转引起坐骨外侧移位也是髋臼发生过度前倾的原因之一。

[ Objective] To observe whether ineeased acetabular anteversion was a universal finding and analyze the under- lying reason of increased acetabular anteversion in DDH. [ Methods ] Fifty Patients with unilateral developmental dysplasia of the hip （DDH） were retrospectively reviewed, including 39 female patients and 11 male patients with an average age of 18 months （range, 6 to 60 months） . A total of 30 children were involved in the normal control group, including 14 girls and 16 boys with an average age of 21 months （range, 7 to 48 months） . The acetabular anteversion angle （AA）, pubic relative length （PRL）, ischiac relative distance （IRD）, lateral rotational angle of the ischium （IA）, and pubic rotational angle were compared between the affected hips and the unaffected hips in the unilateral DDH group and between the right hips and left hips in the norreal control group. [ Results ] No significant difference was found in AA, IA, PA, PRL and IRD between the left hips and the right hips in normal control group （P 〉 0. 05） . No significant difference was observed in PA between the affected hips and the unaffected hips in unilateral DDH. However, the PRL on the affected hips was shorter than that on the unaffected hips （ P 〈 0. 05 ） . In contrast, IA, AA and IRD on the affected hips were larger than that on the unaffected hips （P 〈 0. 05） . Moreover, IA was positively correlated with AA and IRD on the affected hips （r =0. 600 and r =0. 371, respectively, P 〈0. 05 ） or on the unaffected hips in unilateral DDH （ r = 0.713 and r = 0. 410, respectively, P 〈 0. 05 ） . [ Conclusion ] The inceased acetabular anteversion is a universal finding in DDH. Excessive lateral rotation of the ischium on the affected hips can induce lateral displacement of the posterior wall, as a result, leading to increased acetabular anteversion.