髋关节发育不良患者股骨颈前倾角的影像学观察

Imaging observation of the femoral neck anteversion in patients with developmental dysplasia of the hip

目的 研究Hartofilakidis Ⅰ型髋关节发育不良患者股骨颈前倾角的分布规律及相关因素.方法 选取2010年6月至2013年6月在解放军总医院第一附属医院骨科行保髋治疗的Hartofilakidis Ⅰ型髋关节发育不良患者资料进行研究,其中男性25例,女性161例,共340髋.年龄13.5 ～49.9岁,平均28.3岁.于影像学资料中测量股骨颈前倾角、中心边缘角、臼顶倾斜角、股骨头外移距离、股骨头上移距离,观察Shenton＇s线及Calve＇s线连续性.应用相关分析研究各因素之间相关性,并对具有相关性的因素进一步进行回归分析以明确与股骨颈前倾角关系最为密切的因素.结果 髋关节发育不良Hartofilakidis Ⅰ型患者,股骨颈前倾角较正常增大,平均28°±13°.相关与回归分析均显示股骨颈前倾角与就诊年龄呈显著负相关（r=-0.158,P=0.003;t=-6.892,P=0.000）;与性别相关（r=0.332,P=0.000;t=-4.376,P=0.000）;与股骨头外移距离呈显著正相关（r =0.092,P=0.000;t =3.766,P=0.000）;与中心边缘角呈显著负相关（r=-0.122,P=0.024;t=2.031,P=0.043）.股骨颈前倾角与臼顶倾斜角、Calve＇s线连续性及股骨头上移距离虽有相关性,但回归分析显示并无相关性.而股骨颈前倾角与侧别、Shenton＇s线连续性无明显相关.结论 髋关节发育不良Hartofilakidis Ⅰ型患者,股骨颈前倾角增大,可导致较患者因出现髋关节疼痛而就诊的时间提前,并可导致股骨头向髋关节外侧移位,在治疗中应受到关注.

Objective To observe the distribution law and study the factors related to the femoral neck anteversion angle among the patients with developmental dysplasia of the hip of Hartofilakidis type Ⅰ.Methods Among the patients with hip dysplasia of Hartofilakidis type Ⅰ who was admitted to Department of Orthopaedic Surgery,the First Affiliated Hospital of People＇s Liberation Army General Hospital from June 2010 to June 2013,a total of 340 hips （25 male and 161 female） were included in the study.The average age was 28.3 years,ranging from 13.5 to 49.9 years.The observation index included：femoral neck anteversion angle,lateral center-edge angle,acetabular index angle,lateral displacement of the femoral head,superior displacement of the femoral head,continuity of Shenton＇s line and Calve＇s line.The correlation between different factors was analyzed,and the factor closest to femoral neck anteversion angle was analyzed further by regression analysis.Results Among the patients of developmental dysplasia of the hip of Hartofilakidis type Ⅰ,the femoral neck anteversion angle increased,with an average of 28° ± 13°.Correlation and regression analysis showed significant negative correlation with treatment age （r =-0.158,P =0.003;t =-6.892,P =0.000）;positive correlation with gender（r =0.332,P =0.000;t =-4.376,P =0.000）;significant positive correlation with lateral displacement of the femoral head （r =0.092,P =0.000;t =3.766,P =0.000）;significant negative correlation with central-edge angle （r =-0.122,P =0.024;t =2.031,P =0.043）.The femoral neck anteversion angle showed correlation with acetabular index angle,continuity of Calve＇s line and superior displacement of the femoral head in correlation analysis,not in regression analysis,however,it did not show correlation with side and continuity of Shenton＇s line.Conclusion Among the patients of developmental dysplasia of the hip of Hartofilakidis type Ⅰ,the increasing of the femoral neck anteversion angle may not only lead to early onset and therefore early treatment of pain in the hip joint but also the lateral displacement of the femoral head that requires immediate medical attention.