发育性髋关节发育不良髋臼旋转角对髋臼角度的影响研究

Effect of acetabular tilt angle on acetabular version in adults with developmental dysplasia of the hip

目的探讨发育性髋关节发育不良(developmental dysplasia of the hip,DDH)和正常髋关节的髋臼旋转角(acetabular tilt angle,ATA)是否存在差异,以及DDH中ATA对髋臼角度的影响。方法以2009年2月—2015年10月收治并符合选择标准的31例(39髋)女性DDH患者作为DDH组,患者年龄18~59岁,平均39岁;另选择31例(31髋)无髋关节疾患的膝关节骨性关节炎拟行人工膝关节置换术的女性患者作为对照组,患者年龄52~79岁,平均69岁。两组均行骨盆CT扫描及三维重建,测量ATA、髋臼前倾角(acetabular anteversion angle,AAA)、髋臼外展角(acetabular inclination angle,AIA)、髋臼近端前倾角(acetabular cranial anteversion angle,ACAA)及髋臼扇形角(acetabular sector angle,ASA);其中以ASA评估髋臼对股骨头的覆盖。采用Pearson相关分析ATA与AAA、AIA、ACAA的相关性,以及ATA、AAA及AIA与各方向ASA的相关性。结果 DDH组ATA、AAA、AIA均大于对照组,前侧、上侧、后侧ASA均小于对照组,比较差异有统计学意义(P<0.05);两组ACAA差异无统计学意义(t=1.918,P=0.523)。DDH组ATA与AAA和ACAA成正相关(r=0.439,P=0.001;r=0.436,P=0.002),与AIA无相关性(r=0.123,P=0.308);对照组ATA与AAA、ACAA、AIA均无相关性(r=–0.004,P=0.724;r=–0.079,P=0.626;r=–0.058,P=0.724)。髋臼覆盖方面,DDH组中,ATA、AAA与前侧ASA成负相关(P<0.05),与后侧ASA成正相关(P<0.05),与上侧ASA无相关性(P>0.05);AIA与前侧、上侧ASA成负相关(P<0.05),与后侧ASA无相关性(r=–0.092,P=0.440)。对照组中,ATA与各方向ASA均无相关性(P>0.05)。DDH前壁缺损18髋(46.2%)、侧方缺损15髋(38.5%)、后壁缺损6髋(15.3%)。前壁、侧方、后壁缺损的ATA分别为(22.91±5.06)、(21.59±3.81)、(15.70±10.00)°,后壁缺损的ATA明显小于前壁及侧方缺损(P<0.05),前壁及侧方缺损的ATA,比较差异无统计学意义(P>0.05)。结论 DDH的ATA影响髋臼角度,因此对于髋臼前外侧缺损的DDH行髋臼旋前截骨术合理,对于髋臼后壁缺损的DDH则应避免行髋臼旋前截骨术。

Objective To investigate the difference in acetabular tilt angle （ATA） between adults with developmental dysplasia of the hip （DDH） and normal adults and the effect of ATA on acetabular version. Methods Between February 2009 and October 2015, 31 adult female patients with DDH （39 hips） （DDH group） and 31 female patients with osteoarthritis of the knee （31 hips） who had no history of hip disease （control group） were included in this study. The average age was 39 years （range, 18-59 years） in the DDH group, and was 69 years （range, 52-79 years） in control group. The morphometric parameters of the acetabulum including ATA, acetabular anteversion angle （AAA）, acetabular inclination angle （AIA）, acetabular cranial anteversion angle （ACAA）, and acetabular sector angle （ASA） were measured by CT reconstruction; The ASA was used as an index for acetabular coverage of the femoral head. The correlation between ATA and other parameters was analyzed using Pearson correlation analysis. Results The values ofATA, AAA, and AIA of the DDH group were significantly larger than those of the control group （P〈0.05）. The ASA in all directions was significantly decreased in the DDH group when compared with the values in the control group （P〈0.05）. There was no significant difference in ACAA between two groups （t=1.918, P=0.523）. The ATA was positively correlated with AAA and ACAA in the DDH group （r=0.439, P=0.001; r=0.436, P=0.002）, but there was no correlation between ATA and AIA （r=0.123, P=0.308）. In the control group, the ATA was not correlated with AAA, ACAA, and AIA （r=0.004, P=0.724; r=-0.079, P=0.626; r=-0.058, P=0.724）. Regarding acetabular coverage of the femoral head, the ATA and AAA were correlated negatively with anterior ASA （P〈0.05） and positively with posterior ASA （P〈0.05）, but had no correlation with superior ASA （P〉0.05） in the DDH group; AIA was correlated negatively with anterior ASA and superior ASA （P〈0.05） and had no correlation with posterior ASA （r=-0.092, P=0.440）. In the control group, there was no correlation between ATA and ASA in any direction （P〉0.05）. In the DDH group, defects of the acetabular anterior wall, lateral wall, and posterior wall were observed in 18 hips （46.2%）, 15 hips （38.5%）, and 6 hips （15.3%）, respectively. ATA value of the posterior wall defect [（15.70± 10.00）°] was significantly smaller than those of the acetabular anterior wall and lateral wall defects [（22.91±5.06）° and （21.59±3.81） °] （P〈0.05）, but no signficant difference was found between anterior wall and lateral wall defects （P〉0.05）. Conclusion ATA will influence acetabular version in DDH. The anterior rotation of the acetabular fragment during periacetabular osteotomies is an anatomically reasonable maneuver for hips with anterolateral acetabular defect, while the maneuver should be avoided in hips with posterior acetabular defect.