单侧髋关节完全脱位患者下肢不等长及膝关节畸形的特点

Radiological characteristics of leg length discrepancy and knee varus/valgus deformity among unilateral developmental hip dislocation patients

目的观察骨骼发育成熟的单侧发育性髋关节完全脱位的患者脱位侧下肢长度的变化特点及伴随膝关节畸形的情况。方法选择2011年3月至2012年12月因单侧髋关节完全脱位接受治疗且符合纳入排除标准的28例患者作为观察对象，其中男性6例，女性22例；年龄13．4～66．2岁，平均29．8岁。脱位侧为中低位脱位（Hartofilakidis Ⅱ型）17例（60．7％），高位脱位（HartofilakidisⅢ型）11例（39．3％）。患者均行站立位双下肢全长正位X线检查，于X线片上进行双侧股骨及胫骨绝对长度、下肢相对长度的测馈，并观察脱位侧与非脱位侧膝关节畸形情况．对股骨绝埘长度、胫骨绝对长度、双下肢相对长度及双侧膝外翻角采用配对资料t检验进行统计学分析；对膝外翻分布规律及不同脱化程度下肢相对长度的分布规律采用χ^2或校正χ^2检验。结果脱位侧股骨绝对长度较非脱位侧延长者17例（60．7％），最长延长32．7nm，平均延长9．5mm，差异无统计学意义（t=1．328，P=0．197）。脱位侧胫骨绝对长度较非脱位侧延长者21例（75．0％），最长延长10．9mm，平均延长4．5mm，差异有统计学意义（t=3．039，P=0．006）。脱位侧下肢相对长度较非脱位侧延长者20例（71．4％），最长延长25．0mm，平均延长9．4mm，差异有统计学意义（t=2．451，P=0．022）脱位侧膝外翻角为3°±4°，非脱位侧膝外翻角为-3°±4°，双侧对比差异有统计学意义（t=5．642，P=0．000）；其中脱位侧膝外翻畸形12例，膝内翻1例；而非脱佗侧膝内翻畸形15例，膝外翻畸形1例，差异有统计学意义（χ^2=18．139，P=0．000）。结论大多数单侧髋父节完全脱位患者脱位侧患肢长度较非脱位侧延长，其中股骨和胫骨均有延长。脱位侧出现膝外翻畸形的发生率较高，而非脱佗侧膝内翻的发生率高。

Objective To observe the leg length discrepancy and accompanied knee varus/valgus deformity in matured patients with unilateral dislocation of the hip. Methods From March 2011 to December 2012, 28 patients who had unilateral dislocation of hip （Hartofilakidis classification Ⅱ 17 cases and Ⅲ11 cases） were involved in this study. There were 6 male patients and 22 female patients, the age of the patients were 13.4-66.2 years, with mean age of 29. 8 years. The standing anteroposterior full leg length X-ray fihns were obtained. Leg length discrepancy, the length of the femur, the length of the tibia and identified the varus/valgus knee deformities were measured. Statistical analysis was performed. A student＇s t test for paired samples was done fnr comparison of the parameters in the same patient between dislocated and undislocated leg, and the χ2 test were used to assess valgus and varus knees, leg length discrepancy in high dislocation and low dislocation groups. Results Seventeen （60. 7%, ） cases had longer femur length on the dislocated side than that on the undislocated side （t = 1. 328 ,P =0. 197 ） , with the maxinmm lengthening of 32.7 mm and a mean lengthening of 9. 5 mm. Twenty-one （ 75.0% ） cases had longer tibia length on the dislocated side （ t = 3. 039,P = 0. 006） , with a maximum lengthening of 10. 9 mm and a mean lengthening of 4.5 mm. Twenty （71.4%） cases had hmger relative leg length on the disloeated side （t = 2. 451,P = 0. 022） , with a maximum lengthening of 25.0 mm and a mean lengthening of 9.4 ram. On the dislocated side of the leg, the degree of valgus angle was 3° ± 4°, while on the undislocated side, that was -3° ± 4°（ t =5. 642, P =0. 000）. On the dislocated side, 12 cases （42.9%） were of valgus deformities and 1 case was of varus deformity. On the contralateral side, 15 cases of varus deformities （53.6%） and 1 case of valgus deffirmity were observed（ χ2 = 18. 139,P = 0. 000）. Conclusions Most dislocated legs are longer in length than the contralateral side, both femur and tibia have also lengthened accordingly. Many knees on the dislocated side present valgus deformity, half of the knees on the contralateral side present varus deformity.