双侧对比下髋关节腔造影在儿童发育性髋关节发育不良复位术中的临床价值

The Clinical Value of Bilateral Contrast Arthrography in Reduction of Dysplasia Dislocation of the Hip in Children

目的根据健、患双侧髋关节造影的影像学表现对比评价儿童发育性髋关节发育不良（DDH）及脱位的程度,为手法复位提供影像学解剖指征。方法搜集确诊为DDH患儿168例中,单侧发育不良109例,双侧59例。复位前41例行双下肢皮牵引,时间7~15天。选取单侧DDH 109例（109髋）进行双侧（健侧、患侧）关节腔内造影,常规先行健侧造影,再行患侧造影。分析造影结果后进行闭合手法复位,复位后摄正位片了解复位效果。结果所有病例均成功穿刺入双侧关节腔并顺利造影,手法复位均获成功。其中,健侧造影示髋臼发育正常,髋关节对位正常,对比剂沿关节腔流动走行自然,关节囊正常,未见纤维填塞等异常征象。在健侧对比下,患侧造影证实关节囊松弛患儿104例,关节囊肥厚粘连89例,关节盂唇软骨肥厚内翻（玫瑰刺征） 85例,关节囊内条索状充盈缺损32例;骨性髋臼块状充盈缺损（纤维填塞） 77例、关节囊下缘凹陷（髂腰肌腱短缩压迫） 56例。结论双侧对比下髋关节造影,操作简单,虽然有创,但可以动态显示,为临床治疗方案的选择起着指导性作用,现有无创检查仍不能完全取代。

Objective To comparatively evaluate the degree of dysplasia disposition of the hip（ DDH） and dislocation according to the imaging of hip arthrography in the contralateral and affected side and to provide imaging anatomical indications for manual reduction. Methods 168 cases of diagnosed DDH in children,unilateral 109 cases,bilateral 59 cases. 41 cases were treated with double lower limb traction before reduction on 7 to 15 days. Select the unilateral side of the DDH109 cases 109 hip for bilateral（ contralateral,ipsilateral） intra-articular angiography,first contralateral angiography,and then ipsilateral angiography. To analyse the results after the closure of the manual reduction,reset the shot after the film to understand the reduction effect. Results All cases were successfully punctured into the bilateral joint cavity and successfully imaged. The manual reduction was successful. Among them,the contralateral angiography showed that the acetabular development was normal,the hip joint was normal,the contrast agent flowed along the joint cavity,the joint capsule was normal,and no abnormal signs such as fiber packing were observed. In the contralateral contrast,the ipsilateral angiography confirmed 104 children with joint capsule relaxation,89 cases of joint capsule hypertrophy and adhesion,85 cases of joint labial cartilage hypertrophy varus（ rose sensation）,and 32 cases of joint capsule filling defect There were 77 cases of acetabular acetabular filling defect（ fiber packing） and 56 cases of lower edge of the joint capsule（ short compression of the iliopsoas）. Conclusion Bilateral contrast hip arthrography is simple and easy to operate. Although it is invasive,it can be displayed dynamically,which plays a guiding role in the choice of clinical treatment plan. The existing non-invasive examination can not be completely replaced.