成人髋臼发育不良并发骨囊变的影像学研讨

Imaging study on adult acetabular dysplasia complicated with bone cyst

目的探讨成人髋臼发育不良(acetabular dysplasia,AD)并发骨囊变的临床及影像学表现特点,提高其影像诊断能力。方法回顾性分析66例成人AD的标准双髋关节前后位X线片、28例CT片、10例MRI片的影像学资料,并按有无髋周骨囊变进行分组:囊变组、无囊变组。测量方法有:髋臼指数、Sharp角、CE角、髋臼顶切线角、AHI(股骨头覆盖率)、髋关节内间隙、髋关节上间隙。数据均以平均值±标准差(珚x±s)方式表示,通过T检验进行统计学处理,以P<0.05为具有显著性检验。结果 66例成人AD中出现并发症的61例,占92.4%,其中髋关节脱位(含半脱位和脱位)49例,占74.2%,继发骨性关节炎18例,占27.3%。髋臼及股骨头囊状改变24例,占36.4%,其中单纯髋臼囊变14例,占21.2%,股骨头和髋臼同时囊变5例,占7.5%,单纯股骨头囊变5例,占7.5%.囊变组和无囊变组对照测量结果显示两组数据除髋臼指数和髋关节内间隙无差异外(P>0.05),其余均有显著性差异(P<0.05)。结论成人髋臼发育不良易并发髋周骨囊变(软骨下假囊肿),其发病率与年龄呈正相关,X线、CT、MRI检查是诊断成人AD并发髋周骨囊变(软骨下假囊肿)的有效检查手段,MRI在显示成人AD并发髋关节周围骨囊变方面优于X线平片和CT,尤其是早期显示软骨下小囊变。

Objective To investigate the clinical and imaging manifestations of aduh acetabular dysplasia complicated with bone cyst so as to improve the diagnostic ability. Methods The imaging data, including X-ray film of 66 cases of a- dult AD patients before and after standard double hip position, CT of 28 cases, and MRI of 10 cases, were retrospectively analyzed in work. According to whether there was lesion of hip bone cyst these data were divided into none cyst and cyst group. Measurement method included acetabular index, sharp angle, CE angle, acetahular roof tangent angle, AHI （fem oral head coverage）, hip joint, and hip joint gap clearance. Data were presented as mean ± standard deviation （ x±s ） representation. T test was used for statistical processing, and P d0. 05 was considered significant difference. Results The complications occurred in 61 cases of 66 cases of adult AD, accounting for 92.4%, the dislocation of the hip （inclu- ding subluxation and dislocation） in 49 cases, accounting for 74.2%, secondary osteoarthritis inl8 cases, accounting for 27.3%. The acetabulum and femoral head cystic changes were found in 24 cases, accounting for 36.4%, including simple acetabulum cystoid changes in 14 cases, accounting for 21.2%, femoral and acetabular and cystic change in 5 cases, ac counting for 7.5 %, simple cystic degeneration of the femoral head in 5 cases, accounting for 7.5 %. Cystic degeneration group and none cystic group measurements showed that the two sets of data in addition to the acetabular index and hip joint clearance were no significant difference （ P 〉0.05）, the rests were significant difference （ P d0.05）. Conclusion Adult acetabular dysplasia is apt to complicating with hip bone cyst （subchondral pseudocyst）, and the incidence was positively correlated with age. X-ray, CT, MRI assay are the effective methods in diagnosis of adult AD with hip bone cyst （sub- chondral pseudocyst）. As for displaying the adult AD complicated with cyst surrounding bone hip joint, MRI was superior to X-ray plain film and CT, especially, the early showing subchondral cystic component.