3D-CT评价18至48个月单髋脱位DDH患儿股骨颈前倾角和结合前倾角

3D-CT measurement of femoral neck anteversion and combined anteversion in unilateral

目的使用3D-CT观察DDH患儿脱位侧髋关节股骨颈是否存在过度前倾，测量分析DDH患儿结合前倾角，并对结合前倾角在股骨去旋转截骨中的作用进行初步探讨。方法回顾性收集74例单髋脱位DDH患儿的三维CT影像学资料。男14例，女60例。年龄18-48个月，平均22．5个月。左髋受累42例，右髋受累32例，未受累髋74例。所有患儿均测量股骨颈前倾角和结合前倾角。结果在Ⅰ和Ⅱ度脱位型组，DDH患儿脱位侧髋的股骨颈前倾角和健侧髋之间差异无统计学意义（Ⅰ、Ⅲ度脱位型组脱位侧髋和未脱位髋的股骨颈前倾角分别为32．61°±6．91°和35．45°±7．36°，34．76°±7．11°和32．60°±7．94°；P=0．066，P=0．093）。然而在Ⅲ度脱位组，患儿脱位侧髋的股骨颈前倾角明显大于健侧髋，差异有统计学意义（36．37°±9．70°比31．15°±7．72°，P=0．024）。脱位侧髋的结合前倾角大于未受累侧髋，差异有统计学意义（51．97°±8．24°比45．14°±8．48°，P=0．001）。结论对Ⅰ和Ⅱ度脱位型组DDH患儿进行股骨去旋转截骨也许并不是必要的，应该慎重考虑。结合前倾角也许可作为指导DDH患儿去旋转截骨的指标。

Objective To observe the femoral neck on dislocated hips presented excessive ante- version in unilateral DDH using 3D-CT. Methods Seventy-four Patients with unilateral dislocation of hip were involved in the study, including 60 females and 14 males with a mean age 22. 5 months （range, 18-48 months）. Left hip was involved in 42 cases, and right hip in 32 cases. Femoral antever- sion （FA） and combined anteversion （CA） were measured and compared between the dislocated hips and the uninvolved hips. Results Although no significant difference was observed in FA between 1st and 2nd degree dislocated hips and the uninvolved hips, FA was significantly increased in 3rd disloca- ted hips when compared with the uninvolved hips （36. 37° ± 9. 70° vs 31.15° ± 7. 72°,P = 0. 024）. The CA was larger in the dislocated hips when compared with the unaffected hips （51.97°± 8. 24° vs 45.14° ± 8. 48°, P = 0. 001）. Conclusions Femoral derotational osteotomy seems not to be necessary in 1st and 2nd degree dislocated hips in unilateral DDH. CA may be a more meaningful index for determi- ning the use of femoral de-rotational osteotomy.