磁共振前方和侧方软骨性头臼覆盖率对髋关节发育不良术后患儿髋关节功能的评估

Assessment of hip joint function in children suffered with hip dysplasia after operation by magnetic resonance imaging coverage of anterior and lateral cartilaginous capitulum

目的探讨磁共振前方和侧方软骨性头臼覆盖率对髋关节发育不良术后患儿髋关节功能的评估价值。方法选择2020年7月-2021年10月本院收治的先天性髋关节发育不良接受手术治疗患儿30例为研究对象。治疗过程中定期复查双侧髋关节X线片,根据X线片检查结果,决定实施Salter截骨术时机。术前及术后1个月接受磁共振,比较治疗前和术后1个月髋关节Harris评分和单次独立行走距离,比较治疗前和术后1个月前方和侧方软骨性头臼覆盖率,分析前方、侧方软骨性头臼覆盖率及两者联合诊断髋关节功能异常的诊断价值,并针对前方软骨性头臼覆盖率与侧方软骨性头臼覆盖率水平与髋关节Harris评分变化相关性分析。结果术后1个月,入组者髋关节Harris评分为(75.8±13.6)分,高于治疗前的(35.8±6.9)分(Z=14.366,P<0.05),单次独立行走距离为(168.5±15.7)米,大于治疗前的(20.7±2.2)米(Z=51.064,P<0.05);术后1个月,入组者前方软骨性头臼覆盖率和侧方软骨性头臼覆盖率分别为(82.7±8.2)%和(78.1±7.8)%,均大于对照组的(59.8±6.4)%和(53.7±5.9)%(t=12.058和13.665,P<0.05),前方与侧方软骨性头臼覆盖率联合诊断髋关节功能异常的诊断灵敏度、诊断特异度和约登指数分别为86.5,78.0,0.735,均高于单纯前方或侧方软骨性头臼覆盖率检查者,且联合诊断的AUC值达到0.795,其数值最大,前方软骨性头臼覆盖率、侧方软骨性头臼覆盖率水平与髋关节Harris评分变化均呈正相关性(r=0.8634和0.7596,P<0.05)。结论磁共振高分辨成像测量前方和侧方软骨性头臼覆盖率,在评价发育性髋关节发育不良接受手术治疗患儿髋关节功能恢复中有一定实际意义。

Objective To explore the evaluation value of the coverage rate of anterior and lateral cartilaginous capitulum on the hip joint function of children suffered with hip dysplasia after operation.Methods 30 children suffered with congenital hip dysplasia those were admitted to our hospital from July 2020 to October 2021 were selected study subjects.During the treatment,X-ray films of bilateral hip joints were reviewed regularly and the timing of Salter osteotomy was decided according to the results of X-ray examination.MRI was performedbefore operation and one month after operation.Harris score of hip jointand single independent walking distance were compared.The coverage rate of anterior and lateral cartilaginous capitulum were compared at before treatment and one month after treatment.Then the diagnostic value of anterior and lateral cartilaginous capitulum and joint diagnosis on hip joint dysfunction were analyzed,and the correlation between anterior and lateral cartilaginous capitulum coverage and Harris score of hip joint were analyzed.Results One month after operation,the Harris score of hip joint of the enrolled patients was(75.8±13.6),it is higher than that before treatment(35.8±6.9)(Z=14.366,P<0.05);the single independent walking distance was(168.5±15.7 meters)was longer than that before treatment(20.7±2.2 meters)(Z=51.064,P<0.05).The coverage rates of anterior cartilaginous capitulum and lateral cartilaginous capitulum in the group were(82.7±8.2)%and(78.1±7.8)%,which were higher than(59.8±6.4)%and(53.7±5.9)%of control group(t=12.058 and 13.665,P<00.5).The diagnostic sensitivity,diagnostic specificity and Joden's index of the joint diagnosis on hip joint dysfunction by using the coverage rate of anterior or lateral cartilaginous capitulum were 86.5,78.0 and 0.735,which were higher than single use of them,and the AUC value of the combined diagnosis reached 0.795,which was the largest.The coverage of anterior cartilaginous capitulum and the coverage of lateral cartilaginous capitulumwere positively correlated with Harris score of hip joint(r=0.8634 and 0.7596,P<0.05).Conclusions High-resolution magnetic resonance imaging measure the coverage rate of anterior and lateral cartilaginous acetabulum performs certain practical significance in evaluating the recovery of hip joint function in children suffered with developmental dysplasia of hip undergoing surgery.