1~15岁单侧髋关节发育不良患儿坐骨厚度演变探讨

Evolution of ischial thickness in unilateral developmental dysplasia of the hip in 1-15 years old

目的探讨1~15岁未经治疗的单侧髋关节发育不良(DDH)患儿坐骨骨性厚度的自然演变过程及相关因素。方法回顾性分析符合标准的329例单侧脱位未经治疗的1~15岁DDH患儿,在CT冠状面和轴面对坐骨进行取点连线分区,两侧Y型软骨中心连线为H线,两侧坐骨最下缘连线为b线,两连线中间部分被a线平分,由患侧至健侧,坐骨厚度冠状位定义为CL1-CL4,轴位定义为AL1-AL4。测量双侧不同截面、不同分区坐骨厚度、骺板厚度、髂骨厚度、股骨头骺商等,并进行相互比较和相关性分析。结果冠状位坐骨厚度CL1-CL4在1~10岁时随着年龄的增长逐渐增加,在11~15岁时坐骨厚度逐渐降低,骨性坐骨厚度CL1-CL4的范围为2.1~16.7 mm、3.3~18.9 mm、2.4~13.6 mm和3.0~14.9 mm。轴位坐骨厚度AL1-AL4在1~13岁时随着年龄的增长逐渐增加,13岁时达到顶峰。骨性坐骨厚度AL1-AL4的范围为4.6~20.4 mm、2.5~17.2 mm、3.4~16.3 mm和2.4~14.2 mm。1~15岁各年龄段不同截面和不同区域患侧坐骨厚度均大于对侧,差异有统计学意义(P<0.05)。患侧冠状位骺板宽度、轴位骺板宽度、髂骨厚度等大于对侧,差异有统计学意义(P<0.05),骺商小于对侧,差异有统计学意义(P<0.05)。冠状位和轴位髋关节中心区域的差异大于边缘区。冠状位和轴位坐骨厚度与年龄呈中度正相关(r=0.413~0.570,P<0.05),和脱位程度基本无相关性(r=0.024~0.073,P>0.05)。坐骨厚度和同侧相应的骺板厚度、冠状位髂骨厚度等呈正相关(r=0.427~0.681,P<0.05),坐骨厚度和骺商呈一般强度负相关(r=0.130~0.241,P<0.05)。结论1~10岁单侧DDH患儿坐骨厚度的发育随着年龄增长逐渐增加,11~15岁以后增速逐渐下降。相同年龄患侧坐骨厚度大于对侧,在冠状位和轴位,髋关节中心区域的差异大于边缘区。坐骨厚度和髋臼软骨指数、骺板厚度、冠状面髂骨厚度等指标同步演变。

Objective To investigate the natural evolution of the sciatic bone thickness in pediatric untreated unilateral developmental dysplasia of the hip(DDH)aged 1-15 years.Methods 329 cases of DDH children aged 1-15 years with unilateral dislocation were retrospectively recorded.The connection lines were defined on the coronal plane or axial plane of CT.The connection lines of the Y-shaped cartilage center on both sides were line H,the connection lines of the lowest edge of the ischia on both sides were line b,and the middle part of the two lines were divided into Zone 1 and Zone 2.Zone 1 represented the marginal area,and Zone 2 represented the central area.The thickness of ischium,epiphyseal plate,iliac bone thickness and epiphyseal quotient of femoral head on both sides were measured and compared.Results In coronal CL1-CLA,the ischial thickness gradually increased with age from 1 to 10 years old,and decreased from 11 to 15 years old.The range of ischial thickness of CL1-CL4 was 2.1-16.7 mm,3.3-18.9 mm,2.4-13.6 mm and 3.0-14.9 mm,respectively.The width of the epiphyseal plate in coronal position,the width of the epiphyseal plate in axial position,and the thickness of the iliac bone in the affected side were greater than those in the opposite side and had statistical differences.In the correlation test of ischial thickness with age and degree of dislocation,the thickness of ischial bone in coronal and axial positions was moderately correlated with age(r=0.413-0.570,P<0.05),and had no correlation with the degree of dislocation(r=0.024-0.073,P>0.05).In the correlation tests of ischial thickness and epiphyseal thickness CD,epiphyseal quotient,coronal iliac thickness IL on the affected side,the thickness of ischial bone in different parts and sections were positive(r=0.427-0.681,P<0.05),and the thickness of ischial bone was negatively correlated with the epiphyseal quotient(r=0.130-0.241,P<0.05).Conclusion The ischial thickness in coronal zone 1 and zone 2 of 1-10 years old children with unilateral DDH increased at a stable rate with age,and the growth rate decreased gradually in 11-15 years old.The thickness of ischia on the affected side in different sections and areas were greater than that on the opposite side.The difference in the central area of the hip joint was greater than that in the marginal area.The thickness of ischia was positively correlated with acetabular cartilage index,epiphyseal plate thickness,and coronal iliac bone thickness.