髋关节功能位数字化断层融合成像观察髋关节撞击综合征相关征象的价值

The Application of Digital Tomosynthesis of Hip at Functional View in Observing Hip Impingement Syndrome

目的探讨髋关节屈曲外展外旋功能位下行数字化断层融合(DTS)成像观察髋关节撞击综合征(FAI)相关征象的价值。方法对临床症状、体征、数字X线摄影(DR)前后位平片表现均符合FAI诊断的42例患者在髋关节屈曲外展外旋功能位下行DTS检查,以配对四格表χ2检验比较DR前后位和DTS功能位对FAI各个相关征象检出的差异。结果 DTS功能位对股骨颈疝窝、股骨头颈交界处骨质突起、髋臼盂唇骨化、髋臼囊变4个征象的检出率(24%、43%、22%、19%)高于DR前后位(13%、22%、7%、6%)(二项分布确切概率法P=0.031、0.001、0.008、0.016);两种检查方法对髋臼骨赘、深髋臼、关节间隙狭窄、后壁征的检出差异没有统计学意义(DTS:72%、57%、11%、13%,DR:67%、57%、11%、13%,二项分布确切概率法P=0.25、1、1、1)。结论髋关节屈曲外展外旋功能位下行DTS可细致地观察撞击试验阳性患者髋关节的解剖结构异常及继发性骨质改变,并对相关征象进行精确定位。

Objective To discuss the clinical value of digital tomosynthesis （DTS） of hip at flexion abduction and ex- ternal rotation functional view in observing the relevant signs of femoro-acetabular impingement （FAI）. Methods Forty- two patients were enrolled in this study. Their clinical symptoms, signs, digital radiography （DR） findings were consistent with FAI diagnosis. DTS of hip at flexion abduction and external rotation functional view was performed. The detection rates of FAI-related signs were compared between DTS and anteroposterior DR image by using matching four-table chi-square test. Results The detection rates of herniation pit of femoral neck, femoral head-neck junction bone protrusion, ossification of labrnm and acetabular cyst by functional view of DTS were 24%, 43% , 22% and 19% respectively, which were significantly higher than those detected by anteroposterior DR image （ 13%, 22%, 7% and 6% respectively）. The binomial distribution exact test indicated that the differences between the two method were statistically significant （P=0. 031, P = 0. 001, P =0. 008 and P = 0.016 respectively. No statistically significant differences in the detection rates of acetabular osteophytes, coxa profunda, joint space narrowing and posterior wall sign existed between the two examination methods （DTS：72%, 57%, 11% and 13% respectively; DR：67%, 57%, 11% and 13% respectively; binomial distribution exact test： P = 0. 25, P = 1, P = 1 and P = 1 respectively）. Conclusion DTS of hip at flexion abduction and external rotation functional view can clearly display slight changes of bone of FAI. Besides, the related signs can be precisely positioned.