成人发育性髋关节发育不良股骨近端的三维重建及测量

Three dimensional reconstruction and measurement of the proximal femur in adult developmental dysplasia of the hip

目的 探讨成人发育性髋关节发育不良（DDH）股骨近端的解剖学参数的特点及差异.方法 回顾性分析2012年1月至2014年12月于吉林大学中日联谊医院住院的38例（47髋）成人DDH患者的髋关节CT扫描数据和骨盆正位片,根据各型的解剖结构特点,将DDH髋分为CroweⅠ型组（n=21）、Crowe Ⅱ～Ⅲ型组（n=11）、CroweⅣ型组（n=15）.选择同期收治的无髋关节病变的30例患者（30髋）作为对照组.将髋关节CT数据导入Mimics 17.0软件进行三维重建,测量以下参数：颈干角、头颈长、偏心距、大粗隆高点高度、股骨头高度、峡部高度,峡部内径（Di）、小粗隆最突出点近侧10 mm髓腔内径（DT＋10）和小粗隆最突出点远侧20 mm髓腔内径（DT-20）;计算DT＋ 10/ DT-20、DT＋10/Di和DT-20/Di的值.四组间各参数的比较采用方差分析,两组间的差异的比较采用LSD法.结果 Crowe Ⅰ型、Crowe Ⅱ～Ⅲ型、Crowe Ⅳ型DDH和对照组颈干角的测量值分别为131.8° ±7.1°、131.7° ±6.5°、122.8°±11.4°和131.8°±5.9°,Crowe Ⅳ型颈干角小于其他三组（P值均＜0.05）.Crowe Ⅳ型DDH的头颈长[（44.6±6.6）mm]小于Crowe Ⅰ型[（48.6±6.7）mm]和Crowe Ⅱ～Ⅲ型[（50.4 ±4.7）mm] （P =0.038、0.010）.各组间偏心距的差异无统计学意义（F=2.392,P＞0.05）.Crowe Ⅳ型DDH的大粗隆高点高度的测量值[（12.1 ±6.1）mm]大于Crowe Ⅰ型[（8.9±7.2）mm]、Crowe Ⅱ～Ⅲ型[（7.5±3.3）mm]和对照组[（6.1±3.9）mm]（P值均＜0.05）.Crowe Ⅰ型、Crowe Ⅱ～Ⅲ型、Crowe Ⅳ型DDH股骨头高度的测量值分别为（39.6 ±6.5）mm、（39.1±4.2） mm、（38.8±8.6）mm,均小于对照组的（46.5 ±6.2）mm（P值均＜0.05）.Crowe Ⅰ型、Crowe Ⅱ～Ⅲ型、Crowe Ⅳ型DDH和对照组的Di测量值分别为（9.9±2.2） mm、（8.3±1.8）mm、（8.7±1.7）mm和（10.1±1.4）mm;其中Crowe Ⅱ～Ⅲ型和Crowe Ⅳ型DDH的Di测量值均小于对照组（P=0.004、0.010）,Crowe Ⅰ型DDH的Di测量值大于Crowe Ⅱ～Ⅲ型、Crowe Ⅳ型（P=0.016、0.038）.Crowe Ⅳ型DDH的DT＋10测量值[（17.2±5.3）mm]小于Crowe Ⅰ型[（25.2±3.4）mm]和Crowe Ⅱ～Ⅲ型[（21.9±4.2） mm]（P=0.000、0.001）.CroweⅣ型DDH的DT-20测量值[（12.2±3.0）mm]小于Crowe Ⅰ型[（17.1±2.3）mm]、Crowe Ⅱ～Ⅲ型[（16.3±3.2）mm]（P=0.000、0.000）.Crowe Ⅳ型DDH峡部高度的测量值[（94.1±19.7）mm]小于Crowe Ⅰ型[（106.2±13.8） mm]、Crowe Ⅱ～Ⅲ型[（108.8±10.5）mm]和对照组[（116.5±10.6）mm] （P =0.010、0.008、0.000）.各组DT＋10/DT-20间的差异无统计学意义（F=0.939,P＞0.05）.CroweⅣ型DDH的DT＋10/ Di测量值（2.0±0.4）和DT-20/Di测量值（1.4±0.2）均小于Crowe Ⅰ型（2.6±0.5、1.8±0.3）、Crowe Ⅱ～Ⅲ型（2.7±0.6、1.9±0.3）（P值均＜0.05）.结论 相对于Crowe Ⅰ～Ⅲ型DDH,Crowe Ⅳ型DDH的髓内和髓外参数变异更显著：大粗隆高点和峡部高度更高,小粗隆水平的近端髓腔缩窄更为显著.

Objective To investigate characteristics and the differences of the anatomical parameters of the proximal femur of the developmental dysplasia of the hip （DDH）.Methods A total of 38 patients（47 hips） diagnosed as DDH with CT scan data and the pelvis radiograph from January 2012 to December 2014 in China-Japan Union Hospital of Jilin University were retrospectively analyzed.All the hips were divided into 3 groups according to Crowe classification method.Thirty normal hips were selected as controls who admitted at the same time.CT data of the patients were imported into Mimics 17.0.The threedimensional models of the proximal femur were then reconstructed,and the following parameters were measured：neck-shaft angle,neck length,offset,height of the centre of femoral head,height of the isthmus,height of greater trochanter,the medullary canal diameter of isthmus （Di）,the medullary canal diameter 10 mm above the apex of the lesser trochanter（DT＋10）,the medullary canal diameter 20 mm below the apex of the lesser trochanter （DT-20）,and then DT＋10/Di,DT-20/Di and DT＋10/DT-20 were calculated.Variance discrepancy analysis was used to compare the difference among the four groups,and LSD method was used to compare the difference between either two groups.Results The parameters of neck-shaft angle of DDH with Crowe Ⅰ,Crowe Ⅱ-Ⅲ,Crowe Ⅳ and the control group were （131.8° ±7.1°）,（131.7° ±6.5°）,（122.8°± 11.4°） and （131.8° ± 5.9°）,respectively;the parameters of neck-shaft angle of DDH with Crowe Ⅳ was smaller than that of DDH with Crowe Ⅰ,Crowe Ⅱ-Ⅲ and control group（all P 〈0.05）.The parameters of the neck length of DDH with Crowe Ⅳ（（44.6 ±6.6）mm） was smaller than that of DDH with Crowe Ⅰ （（48.6 ± 6.7） mm）,Crowe Ⅱ-Ⅲ （（50.4 ± 4.7） mm） （all P 〈 0.05）.There is no statistic difference in the offset among the groups （F =2.392,P 〉 0.05）.The parameters of the height of greater trochanter of DDH with Crowe Ⅳ （（12.1 ± 6.1） mm） was bigger than that of DDH with Crowe Ⅰ （（8.9 ± 7.2） mm）,Crowe Ⅱ-Ⅲ （（7.5 ± 3.3） mm） and control group （（6.1 ± 3.9） mm） （all P 〈 0.05）.The parameters of the height of the centre of femoral head of DDH with Crowe Ⅰ,Crowe Ⅱ-Ⅲ,Crowe Ⅳ were （39.6 ± 6.5） mm,（39.1 ± 4.2） mm,（38.8 ± 8.6） mm,which were smaller than that of the control group （（46.5 ± 6.2） mm） （all P 〈 0.05）.The parameters of Di of DDH with Crowe Ⅰ,Crowe Ⅱ-Ⅲ,Crowe Ⅳ and the control group were （9.9 ± 2.2） mm,（8.3 ± 1.8） mm,（8.7 ± 1.7） mm and （10.1 ± 1.4） mm;the parameters of Di of DDH with Crowe Ⅱ-Ⅲ and Crowe Ⅳ were smaller than that of the control group （all P 〈 0.05）.The parameters of DT ＋ 10 （（17.2 ± 5.3）mm） and DT-20 （（12.2 ± 3.0）mm） of DDH with Crowe Ⅳ were smaller than that of DDH with Crowe Ⅰ （（25.2 ±3.4）mm,（17.1 ±2.3）mm） and Crowe Ⅱ-Ⅲ （（21.9 ±4.2）mm,（16.3 ±3.2）mm） （all P 〈0.05）.The parameter of the height of the isthmus of DDH with Crowe Ⅳ（（94.1 ± 19.7）mm） was smaller than that of DDH with Crowe Ⅰ （（106.2 ± 13.8）mm）,Crowe Ⅱ-Ⅲ （（108.8 ± 10.5） mm） and control group （（116.5 ± 10.6） mm）,respectively （P =0.010,0.008,0.000）.The parameters of DT＋10/ Di（2.0 ±0.4） and DT-20/Di（1.4 ±0.2） of DDH with Crowe Ⅳ were smaller than that of DDH with Crowe Ⅰ （2.6 ± 0.5,1.8 ± 0.3）,Crowe Ⅱ-Ⅲ （2.7 ± 0.60,1.9 ± 0.3） （all P 〈 0.05）.Conclusions Comparing to DDH with Crowe Ⅰ-Ⅲ and control group,DDH with Crowe Ⅳ has a dramatic change in the intramedullary and extramedullary parameters.The isthmus and the great trochanter are higher and there is apparent narrowing of the medullary canal around the level of the lesser trochanter.