发育性髋关节发育不良闭合复位后髋臼盂唇软骨复合体对髋臼发育的影响

Study on the impact of labro-chondral complex on development of the acetabulum after close reduction in developmental dysplasia of the hip

目的：观察发育性髋关节发育不良（DDH）闭合复位后髋臼盂唇软骨复合体（LCC）形态改变对髋关节发育的影响。方法回顾2010年3月至2013年12月就诊于北京积水潭医院小儿骨科的 DDH 患儿61例72髋，男8例、女53例，平均年龄13（6～20）个月，行闭合复位、关节造影、人类位石膏固定，术中术后行髋关节正位 X 线片评价复位及髋臼盂唇软骨情况，根据造影后股骨头顶部充盈缺损的形态将盂唇软骨复合体分为Ⅰ、Ⅱ、Ⅲ、Ⅳ型，二期石膏更换时，依据造影后的盂唇软骨高差比值的大小将 LCC 的发育情况分为0～0．4、0．4～0．6、＞0．6，3组，分析二者之间的相互关系，末次随访时根据髋关节 X 线检查，使用髋臼指数及股骨头中点垂线与髋臼边缘的夹角（CE 角）评价髋关节发育情况，分析盂唇软骨形态结构及高差比值对于髋臼发育的影响。结果Ⅰ型髋臼在更换二期石膏时盂唇软骨高差比值最小，全部＜0．6，Ⅲ型和Ⅳ型比值最大，共有8例＞0．6，在末次随访时，Ⅰ型髋臼的髋臼指数显著低于其余各组（24．33°±3．12°），CE 角明显大于其余各组（15．22°±3．11°）。不同盂唇软骨高差比值组在末次随访时 CE 角差异有统计学意义，0～0．4组别的髋臼指数明显低于其余各组（14．24°±3．10°）。结论DDH 闭合复位时髋臼 LCC 形态结构有助于判断髋关节最终的发育情况，二期石膏更换时关节造影所获得的盂唇软骨高差比值可以较为灵敏地预测髋臼的发育。

Objective To explore the influence of the labro-chondral complex （ LLC） on the development of the acetabulum after close reduction in developmental dysplasia of the hip （DDH）.Methods Sixty-one cases （72 hips） with DDH presented in Beijing Jishuitan Hospital were reviewed, all the patients were treated by closed reduction, arthrogram and Spica casting from March 2010 to December 2013.The anterior-posterior pelvic radiography was performed to evaluate the morphology of the labro-chondral complex and reduction of the hip.The cases were divided into Ⅰ,Ⅱ,Ⅲ,Ⅳ four groups according to the shape of the LLC initially, and when performed the secondary Spica cast after 3 months, these cases were divided into 0 -0.4,0.4 -0.6,and 〉0.6, three groups based on the height difference ratio （HDR） of the LLC.The relationship between the shape and HDR of the LLC was analyzed.The AI and CE angle were used to evaluate development of the hip during the latest follow up.The impact of the shape and HDR of the LLC on the development of the acetabulum was explored as well.Results The HDR was the least in the type Ⅰhips,all cases were less than 0.6, the AI in this group was significantly lower than the others（24.33°± 3.12°）, and the CE angle was significantly higher in the type Ⅰ hips（15.22°±3.11°） during the latest follow up.The CE angle was significantly different among the three groups of HDR.The HDR was lower, the CE angle was higher.The AI in 0 -0.4 group was significantly lower than the others（14.24°±3.10°） .Conclusion The shape of the LLC is helpful to judge development of the acetabulum when closed reduction was performed in DDH.And the HDR in the secondary cast change could be used as a sensitive index to predict development of the hip.