成人DDH股骨近端CT影像学研究及临床意义

CT Image Study of Proximal Femur in Adults DDH Patients

目的本研究主要探讨四川地区成人发育性髋关节脱位（developmental dysplasia of the hip,DDH）患者股骨近端的解剖形态变异,为临床手术治疗提供解剖学依据。方法对23例（28髋）CroweⅢ~Ⅳ型成人DDH患者术前行CT＋三维重建,测量股骨的颈干角、前倾角,小转子中心上2 cm及下4 cm及股骨峡部髓腔横径和前后径等,计算股骨髓腔闪烁指数（canal flare index,CFI）,将结果与正常对照组进行对比。结果 DDH组的股骨颈干角为（117.33±3.70）°,前倾角为（32.16±4.11）°,股骨髓腔横径和前后径在小转子中心上2 cm平面分别为（29.28±2.03）mm和（26.28±1.49）mm,在小转子下4 cm平面分别为（12.99±1.46）mm和（13.88±1.03）mm,在峡部平面分别为（9.86±0.77）mm和（12.68±1.87）mm,CFI值为（3.56±0.68）,DDH组的股骨近端形态学参数与正常组间对比有显著性差异,有统计学意义。结论成人DDH行全髋关节置换术时,应考虑股骨侧的解剖形态变异,靠外后扩髓以纠正前倾角,选用适合的假体柄并注意防止股骨骨折。

Objective To investigate the morphological anatomical abnormalities of proximal femur of high developmental dysplasia of hip（ DDH） in adults in Sichuan province,and provide anatomical basis for the total hip arthroplasty（ THA）.Methods 28 hips in 23 adult patients with Crowe Ⅲ ~ Ⅳ DDH were acquired through pre-operative CT images. The neckshaft angle,anteversion angle,trans-diameter and anteroposterior diameter of femoral medullary cavity of proximal and superior segment and isthmus were measured,and calculated to get the canal flare index（ CFI）. The results were then compared with normal hips. Results In DDH cases,the neck-shaft angle was（ 117. 33 ± 3. 70） °,anteversion angle was（ 32. 16 ± 4. 11） °.The trans-diameter and anteroposterior diameter of femoral medullary cavity of proximal segment was（ 29. 28 ± 2. 03） mm and（ 26. 28 ± 1. 49） mm,superior segment was（ 12. 99 ± 1. 46） mm and（ 13. 88 ± 1. 03） mm,the isthmus was（ 9. 86 ± 0. 77） mm and（ 12. 68 ± 1. 87） mm. The canal flare index was（ 3. 56 ± 0. 68）. There were significant differences in the morphological parameters of femur between suffering hips and normal hips. The differences were highly statistically significant. Conclusion For THA on Adult with DDH,efforts should be make to take its anatomical morphological variation into full consideration. The femoral medullary cavity should be expanded in the posterior and exterior part,and select the correct femoral prosthesis to rectify anteversion angle and prevent the fracture of femur.