Innate Immunity in the Development of Connective Tissue Dysplasia: Pilot Study in Children with Congenital Hip Dislocation

Introduction: Observing and treatment of hip dysplasia in children have always been in the sphere of interest of modern molecular medicine. The role of molecular factors in the formation of connective tissue dysplasia in children is considered crucial for such multisystem disorders, and connective tissue dysplasia progressing involves immune system parameters and biochemical markers. The aim of this work was to establish the relationship between immune status indicators and biochemical markers of connective tissue using bioinformatics and modeling methods. Materials and Methods: 27 patients with congenital hip dislocation, admitted to the University Clinic of Privolzhsky Research Medical University, Department of children orthopedics for surgical treatment, were examined. Determination of 10 blood parameters was conducted by modern biochemical and immunological methods. Statistica 12.0 software from StatSoft was used for statistical data processing. Methods of nonparametric statistics were used since the samples in the control group partially follow the normal distribution. Correlation methods and regression modeling methods were used to evaluate the relationship of indicators. Results and Conclusion: In our investigation we have shown the presence of statistical and mathematical interactions between the parameters of innate immunity and indicators of connective tissue metabolism. The leading role of the immune system in the development of pathologies associated with connective tissue dysplasia is assumed. In further investigations it is necessary to clarify the role hypoxia in HIF-1 stimulated control of skeletal dysplasia, collagen modification, connective tissue dysplasia development.

Developmental dysplasia of the hip in the newborn: A systematic review

Developmental dysplasia of the hip(DDH) denotes a wide spectrum of conditions ranging from subtle acetabular dysplasia to irreducible hip dislocations. Clinical diagnostic tests complement ultrasound imaging in allowing diagnosis, classification and monitoring of this condition. Classification systems relate to the alpha and beta angles in addition to the dynamic coverage index(DCI). Screening programmes for DDH show considerable geographic variation; certain risk factors have been identified which necessitate ultrasound assessment of the newborn. The treatment of DDH has undergone significant evolution, but the current gold standard is still the Pavlik harness. Duration of Pavlik harness treatment has been reported to range from 3 to 9.3 mo. The beta angle, DCI and the superior/lateral femoral head displacement can be assessed via ultrasound to estimate the likelihood of success. Success rates of between 7% and 99% have been reported when using the harness to treat DDH. Avascular necrosis remains the most devastating complication of harness usage with a reported rate of between 0% and 28%. Alternative non-surgical treatment methods used for DDH include devices proposed by LeD amany, Frejka, Lorenz and Ortolani. The Rosen splint and Wagner stocking have also been used for DDH treatment. Surgical treatment for DDH comprises open reduction alongside a combination of femoral or pelvic osteotomies. Femoral osteotomies are carried out in cases of excessive anteversion or valgus deformity of the femoral neck. The two principal pelvic osteotomies most commonly performed are the Salter osteotomy and Pemberton acetabuloplasty. Serious surgical complications include epiphyseal damage, sciatic nerve damage and femoral neck fracture.

Developmental Dysplasia of the Hip (DDH) in Saudi Arabia: Time to Wake up. A Systematic Review (1980-2018)

The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. Methods: A systematic review was performed for all the published articles in the English language literature on DDH in Saudi Arabia. Data sources were PubMed Medline (1980-2018) (http://www.ncbi.nlm.nih.gov/pubmed/), Ovid Medline (1980-2018), EMBASE MEDLINE (1980 to May 2018), EMBASE (1991 to May 2018), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, the Science Citation Index (1966 to May 2018), published data from the Saudi Medical Journal (1985-2018) and Annals of Saudi Medicine (1985-2018). The author independently reviewed articles and abstracted the data. The key words used were Saudi Arabia developmental dysplasia of the hip ORDDH, congenital hip dislocation or congenital subluxation of the hip, and congenital dysplasia of the hip. Results: The authors identified 18 potentially relevant articles published in the last 38 years, and 10 met the inclusion criteria. The 10 studies analyzed included 2037 studies of infants diagnosed with DDH;and they gave an average incidence of 10.46/1000. Two studies (303 subjects) did not report the affected gender;in the remaining 338 were boys and 1396 were girls and one study did not report the side of affection. The majority presented after 12 months of age. The right side was affected in 532 (27.2%) affected, 734 (37.6%) were left side and 687 (35.2%) infants were affected bilaterally. Consanguinity, breech presentation, and family history were found to be the risk factors in 32.9%, 17.3%, and 23.6% of the patients, respectively. Conclusions: There is paucity of available literature on DDH in Saudi Arabia. New strategies have to be developed that include mandatory screening programs in all hospitals (private and public) so that more children can be treated by nonsurgical methods.

One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip:A case report

BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip(DDH)and a drainage sinus is a rare condition.There are no previous reports of this condition,and it is a complex challenge for surgeons to develop a treatment scheme.CASE SUMMARY We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month.Approximately 40 years ago,a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy.After the sinus healed,gradual pain occurred in the left hip for 40 years.Approximately one month prior,hip pain was sharply aggravated,and a drainage sinus reoccurred in the left hip.The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur,as well as an acetabular deformity.The results of Mycobacterium tuberculosis antibody and Xpert were positive.Therefore,the patient was diagnosed with advanced TH combined with Crowe type IV DDH.After 22 d of treatment with anti-tuberculosis chemotherapy,the sinus healed,and the patient underwent one-stage total hip arthroplasty(THA)surgery consisting of debridement,osteotomy,and joint replacement.After surgery,the patient received anti-tuberculosis chemotherapy drugs for nine months,with no recurrent infection.After one year of follow-up,the Harris score of the patient increased from 21 pre-THA to 86.CONCLUSION Although drainage sinuses are a contraindication to one-stage THA,one-stage THA is still an effective and safe surgical method after the sinus heals.

Congenital Dislocation of the Hip in Children between the Ages of One and Three: Open Reduction and Modified Salter Innominate Osteotomy Combined with Fibular Allograft

Background: Innominate osteotomy procedures have been widely used as an integral component of combined surgery to treat developmental dysplasia of the hip in children. Autograft concern is further supported by authors who suggest the routine use of internal fixation. Problems such as graft extrusion, rotation and absorption, leading to loss of acetabular correction, were often noted in cases previously treated at our National Hospital for Pediatrics. This retrospective study reviewed the radiographic results of this treatment protocol in 106 hips developmental dislocated hips which met our inclusion criteria. The efficacy of this method to achieve and maintain a well covered and stable hip was the main objective of the study. Methods: This retrospective study reviewed the radiographs of 106 hips presenting with developmental dislocation which were treated by modified Salter’s innomiate osteotomy and using a fibular allograft as the interposition material. Dislocations of the hip were graded using the T?nnis system. Measurement of the acetabular index (AI) was the main variable. The minimum follow up period was 2 years. Possible complications such as loss of acetabular correction, hip redislocation, graft extrusion or resorption, the need for osteotomy internal fixation, delayed or non union, infection or avascular necrosis (AVN) were documented in this series. Results: Between January 2004 and December 2008, 106 surgeries were performed in 95 patients. Sixty-three (86.3%) of the patients were girls and ten (13.7%) were boys, thirteen patients (13.7%) were between twelve and eighteen months old at the time of the operation, the remaining eighty-two (86.3%) patients being between eighteen and thirty-six months old, with the mean age of 22.6 months at the time of surgery. There were eleven (11.6%) patients who had bilateral dislocation. Eighty-four (88.4%) patients were affected unilaterally. The right hip was involved in seventeen (17.9%) and the left hip in sixty-seven (70.5%) cases. T?nnis system Type 3 was in 34 hip (32.1%), and Type 4 was in 72 hip (67.9%). All patients combined open reduction and modified Salter’s innomiate osteotomy, inserting a fibular allograft as the interposition material. Acetabular index was improved, preoperation was 42.95°, and latest follow-up 19.15°, concentrical acetabulum 93.7%. All of the fibulat allografts were completely incorporated mean 14 weeks (range, 12 weeks - 17 weeks) post-surgery. There were five (4.7%) redislocation and subluxation, three AVN (2.8%) and five (4.7%) coxa magna Without graft infections, none of the osteotomies required internal fixation for stability. Final results: Excellent 70 (66.0%), Good 29 (27.4%), Fair 2 (1.9%), Poor 5 (4.7%). Conclusion: Open reduction and modified Salter’s innomiate osteotomy allow interposition material by fibular allografting with a short operative incision, renders excellent osteotomy stability that eliminates the need for internal fixation. Surgical technique are safe and effective for Children between twelve and thirty-six months old.

Lessons learned from study of congenital hip disease in adults

Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease(CHD). To achieve better communication among physicians,better treatment planning and evaluation of the results of various treatment options,an agreed terminology is needed to describe the entire pathology. Furthermore,a generally accepted classification of the deformities is necessary. Herein,the authors propose the use of the term "congenital hip disease" and its classification as dysplasia,low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease,which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD,especially those with low and high dislocation,are: Wide exposure,restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.

双轨正性暗示在发育性髋关节发育不良患者手术室等候期间的应用研究

目的 探讨双轨正性暗示在发育性髋关节发育不良(DDH)患者手术室等候期间的应用效果。方法 选取医院2021年8月-2023年10月拟行手术治疗的DDH患者108例,以随机数字表法分为对照组(54例)、观察组(54例);对照组于手术室等候期间行常规护理,研究组基于对照组行双轨正性暗示护理;对比两组生理应激反应、焦虑程度、心理等候时间及满意度。结果 观察组麻醉成功时心率(HR)、平均动脉压(MAP)较对照组低,差异有统计学意义(P<0.05);观察组入手术室时、术后1d焦虑自评量表(SAS)评分较对照组低,差异有统计学意义(P<0.05);观察组心理等候时间较对照组短,总满意度较对照组高,差异有统计学意义(P<0.05)。结论 DDH患者手术室等候期间采用双轨正性暗示护理可减轻生理应激反应,改善焦虑程度,缩短心理等候时间,提高满意度。

发育性髋关节脱位闭合复位后残余髋臼发育不良骨盆截骨时机与指征的多中心前瞻性非随机对照试验研究方案

全身麻醉下闭合复位加髋人位石膏固定是治疗24月龄以下发育性髋关节脱位(developmental dislocation of the hip,DDH)的通用方法,但闭合复位后仍有约1/3的患儿存在残余髋臼发育不良。尽管骨盆截骨术正越来越多地应用于残余髋臼发育不良的治疗,但其手术时机和手术指征仍不明晰。本研究拟通过一项多中心前瞻性非随机对照试验探讨DDH闭合复位后残余髋臼发育不良的手术干预时机和指征。研究设计拟纳入283例DDH闭合复位后残余髋臼发育不良患儿,包括观察组183例,手术组(采用骨盆截骨术)100例。手术组根据患儿年龄采用Salter、Pemberton、骨盆三联或髋臼周围截骨术。所有患儿随访10年,拟在DDH闭合复位后8个时间点(闭合复位术后1、2、3、4、5~6、7~8、9~10年以及10年以上)拍摄髋关节正位X线片,测量髋臼指数(acetabular index,AI)、中心边缘角(center-edge angle of wiberg,CEA)和Reimer指数(Reimer's index,RI),根据末次随访时正位X线片上髋关节Severin分级分为满意组(Severin分级为Ⅰ、Ⅱ级)和不满意组(Severin分级为Ⅲ、Ⅳ级),利用Logistic回归和Cox回归分析残余髋臼发育不良的风险因素,比较两组患儿AI、CEA、RI及Severin分级情况。这一多中心前瞻性研究可以为DDH闭合复位后残余髋臼发育不良的手术干预时机和指征提供循证医学证据。

基于3D重建技术探讨发育性髋关节发育不良患者膝关节形态差异

目的本研究通过3D重建技术探讨发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者膝关节参数的差异,为DDH患者行髋膝手术提供数据参考。方法2019年1月至2022年12月前瞻性招募127例DDH患者,其中单侧DDH组98例,双侧DDH组29例(58膝),对照组(健康体检者)110例。单侧DDH组男28例,女70例;平均年龄(35.40±11.62)岁。双侧DDH组男7例,女22例;平均年龄(36.17±12.58)岁。对照组男32例,女78例;平均年龄(35.82±11.49)岁。收集三组患者CT数据进行三维重建,基于三维重建模型下测量膝关节相关参数,股骨内侧髁宽度(width of medial femoral condyle,WMFC)、股骨外侧髁宽度(width of lateral femoral condyle,WLFC)股骨内侧髁高度(height of medial femoral condyle,HMFC)、股骨外侧髁高度(height of lateral femoral condyle,HLFC)、胫骨内侧平台宽度(width of medial tibial platform,WMTP)、胫骨外侧平台宽度(width of lateral tibial platform,WLTP)、股骨前关节边缘距离(femoral anterior joint edge distance,FAJED)、股骨后关节边缘距离(femoral posterior joint edge distance,FPJED)、胫骨前关节边缘距离(tibial anterior joint edge distance,TAJED)、胫骨后关节边缘距离(tibial posterior joint edge distance,TPJED)、胫股角(femorotibial angle,FTA)、股骨远端外侧角(lateral distal femoral angle,LDFA)、胫骨近端内侧角(medial proximal tibial angle,MPTA)、胫骨近端后侧角(posterior proximal tibial angle,PPTA)、股骨远端后侧角(posterior distal femoral angle,PDFA)。对比三组膝关节正视位图、侧视位图及角度相关参数。结果对照组WLFC、WLTP、LDFA显著大于单侧DDH组、双侧DDH组(P<0.05),单侧DDH组WLFC、WLTP、LDFA显著大于双侧DDH组(P<0.05)。对照组HMFC显著小于单侧DDH组、双侧DDH组(P<0.05),双侧DDH组HMFC大于单侧DDH组(P<0.05)。对照组WMTP显著小于单侧DDH组(P<0.05),单侧DDH组WMTP显著大于双侧DDH组(P<0.05),双侧DDH组WMTP与对照组比较差异无统计学意义(P>0.05)。三组WMFC、HLFC、MPTA比较,差异无统计学意义(P>0.05)。三组FTA比较差异有统计学意义(P<0.05),对照组FTA显著小于单侧DDH组、双侧DDH组(P<0.05);此外,三组FAJED、PDFA、PPTA比较差异有统计学意义(P<0.05),对照组FAJED、PDFA、PPTA显著大于单侧DDH组、双侧DDH组(P<0.05),单侧DDH组FAJED、PDFA显著大于双侧DDH组(P<0.05)。对照组FPJED显著大于单侧DDH组,双侧DDH组与单侧DDH组FPJED比较差异无统计学意义(P>0.05)。三组TAJED比较差异有统计学意义(P<0.05),单侧DDH组TAJED显著小于对照组及双侧DDH组(P<0.05)。三组TPJED比较,差异无统计学意义(P>0.05)。结论DDH患者膝关节外翻角增加,其机制与HMFC增加有关。DDH患者膝关节股骨远端后侧角和胫骨近端后侧角均减少。髋臼发育不良严重程度与膝关节外翻、胫骨后倾斜度相关。

有限元法在儿童发育性髋关节发育不良及治疗中的作用

背景:发育性髋关节发育不良常易导致患儿肢体畸形,其诊疗的相关研究已逐渐明确;近来有限元法因其优势在发育性髋关节发育不良的相关研究中受到学者重视。目的:通过文献检索综述有限元法在儿童发育性髋关节发育不良及治疗中的研究进展,分析总结其优势与不足,并探讨未来进一步研究的方向及应用前景。方法:应用计算机在Pub Med、SCI、CBM和中国知网数据库中检索2014年1月至2023年11月发表的相关文献,以“developmental dysplasia(dislocation) of the hip,dysplasia of the hip,finite element analysis(method),pavlik harness,fixation in herringbone position,biomechanics,pelvic osteotomies,pemberton,salter,dega,periacetabular osteotomy,children”为英文检索词,以“发育性髋关节发育不良,发育性髋关节脱位,髋关节发育不良,儿童,有限元,Pavlik吊带,人字型固定,生物力学,骨盆截骨术,髋臼周围截骨术”为中文检索词,同时纳入少量远期文献,通过筛选最终纳入62篇文献进行分析。结果与结论:(1)儿童发育性髋关节发育不良髋关节力学环境异常,髋臼内部压力不均匀、应力增大并集中,关节接触面积减小,股骨颈局部应力集中;(2)在Pavlik吊带及人字型固定位患髋力学环境改善,集中的高应力区域消失,关节接触面积增加,但外展角度过大会导致髋臼及股骨头外侧应力增加;(3)骨盆截骨术治疗后髋关节及骶髂关节应力环境得到改善,3种截骨术没有单一的铰链,其应力负载部位因患儿年龄而存在差异;(4)髋臼周围截骨术治疗后关节接触压力接近正常,而非球形股骨头者恢复困难;(5)术后X射线片表现不能说明关节接触力学达到最佳;(6)提示利用有限元法可以获得体内无法测量的信息,其在虚拟环境中操作不受时间和伦理的限制;能直观地看到正常与发育性髋关节发育不良患者髋关节应力变化的区域,从力学角度说明治疗的有效性,为需要截骨手术治疗的患者建立特定的有限元模型、量身定做手术计划;发育性髋关节发育不良的有限元建模及儿童髋关节材料特性参数尚无规范、统一的标准,由于有限元固有的局限性,目前还不能分析同时包含骨骼、软骨、韧带、肌肉等元素的模型;有限元分析操作难度较大,虽有优势但不具普适性,且目前的研究样本量较少,还需进一步扩大及验证。

髋关节镜手术治疗临界型髋关节发育不良的临床疗效

目的:探讨髋关节镜治疗临界型髋关节发育不良并髋臼盂唇损伤的临床疗效。方法:回顾性分析2019年12月~2021年12月在广东省中医院诊断为临界型髋关节发育不良(borderline developmental dysplasia of the hip,BDDH)并髋臼盂唇损伤行髋关节镜手术的患者共32例,其中男8例、女24例,年龄39.41±16.27岁(18~59岁),平均髋臼外侧中心边缘角(lateral centre-edge angle,LCEA):21.25°±2.96°(18°~25°)。匹配同期的行髋关节镜手术治疗的髋臼股骨撞击症(femoral acetabular impingement,FAI)患者32例作为对照组,男15例、女17例,年龄42.78±12.18岁(24~70岁),平均LCEA:32.97°±4.96°(26°~42°)。所有患者均采用髋关节镜下盂唇修复、头颈区成形、关节囊缝合术治疗。采用改良Harris髋关节评分(mHHS)、体育运动专用髋关节评分(HOS-SSS)、日常活动的髋关节功能评分(HOS-ADL)、视觉模拟评分(VAS),对患者术前、术后3月、术后12月、术后24月进行功能评分测量。结果:BDDH组和FAI组所有病例均获得随访,随访时间分别为27.6±5.4月、28.3±6.5月。FAI组和BDDH组术前m HHS、HOS-SSS、HOS-ADL和VAS评分的差异无统计学意义(P>0.05)。两组术后3月、12月、24月时mHHS、HOS-SSS、HOS-ADL评分均较术前明显提高,术后VAS评分均较术前明显降低,差异有统计学意义(P<0.001)。在术后3月、12月、24月时BDDH组的m HHS评分均较FAI组低,差异有统计学意义(P<0.05)。在术后3月时BDDH组的HOS-SSS、HOS-ADL分均较FAI组低,差异有统计学意义(P<0.05)。其他随访时间点,两组的各项评分指标无统计学差异(P>0.05)。所有患者在随访期间,均未因症状复发而行再次手术治疗。结论:髋关节镜技术治疗临界发育性髋关节发育不良可获得良好的短期疗效。

Graf法髋关节超声在诊断6月龄内婴幼儿先天性髋关节脱位及髋关节发育不良发病特点和年龄分布中的应用

目的评价观察对6月龄内婴幼儿先天性髋关节脱位以及髋关节发育不良诊断运用Graf法髋关节超声技术的临床价值,并对发病特点、年龄分布特点进行分析。方法选取2022年1月-12月在本院接受髋筛超声检查的500例6月龄内的婴幼儿,均接受Graf法髋关节超声检查,将高频超声检查结果作为标准,客观评估婴幼儿髋关节的基本形态,预判婴幼儿是否存在先天性髋关节脱位、髋关节发育不良等情况,且对髋关节发育异常的患儿总结年龄分布特点。结果在接受髋筛超声检查的500例6月龄内婴幼儿中,一共检查髋关节1000个,其中发现有8例婴幼儿出现髋关节发育异常情况,髋关节发育异常的概率达到1.6%(8/500),异常髋关节共计14个,所占比重达到1.4%(14/1000)。高频超声诊断8例婴幼儿髋关节功能显示异常,诊断有效率达到100%(8/8)。女患儿出现髋关节发育异常的概率75.00%(6/8),相较于男患儿25.00%(2/8)明显偏高,左侧发病概率51.14%(8/14),相较于右侧42.86%(6/14)明显偏高,8例髋关节功能检查显示发育异常的婴幼儿中,年龄处于5~6个月发生概率最高,次之为4~5个月、2~3个月。髋关节发育不良的婴幼儿经髋关节超声检测ɑ角,相较于正常髋关节明显偏小,且β角与正常髋关节相比明显偏大,差异有统计学意义(P<0.05)。结论在6月龄内婴幼儿先天性髋关节脱位与髋关节发育不良诊断中,利用Graf法髋关节超声技术,能够提高临床诊断有效性,为临床医师提供重要的诊断依据。

儿童发育性髋关节发育不良治疗现状

发育性髋关节发育不良(DDH)是儿童常见的先天畸形之一。患儿1.5岁之前如能获得早期诊断,并给予相应处理措施,则有可能避免后期的手术治疗,预后良好。但往往在明确诊断时,患儿已出现明显的临床体征,需要实施股骨截骨术、Salter骨盆截骨术、Pemberton截骨术、Ganz髋臼周围截骨术等外科治疗。本文以DDH自然发展病程为时间轴,对儿童DDH不同年龄阶段的主要治疗方式进行综述,重点阐述股骨截骨术和不同方式的骨盆截骨术,以期为临床治疗策略的制定提供参考。

高频超声筛查发育性髋关节发育不良及吊带治疗疗效评估中应用价值

目的:探究高频超声在婴幼儿发育性髋关节发育不良(DDH)筛查及吊带治疗效果评价中的应用价值。方法:选取2021年1月—2023年12月在北京儿童医院新疆医院行高频超声筛查的发育性髋关节发育不良患儿作为研究对象。以Graf检查结果作为金标准,分析超声检查在筛查DDH中的应用价值,探讨超声检查诊断DDH的诊断效能,并比较Pavlik吊带治疗前后DDH患儿的超声参数[骨顶角(α)、软骨顶角(β)、骨性髋臼覆盖率]的差异以及不同Graf分型患儿的治愈率差异。结果:124例DDH患儿(共计223个患髋)中男婴50例,女婴74例,平均年龄(74.88±22.61)天,超声检查结果显示:Ⅱa型髋关节144个,Ⅱb型髋关节71个,Ⅱc型髋关节4个,D型髋关节2个,Ⅲ型髋关节2个;超声诊断DDH的灵敏度为98.7%,特异度为88.0%,阳性预测值为98.7%,阴性预测值为88.0%,准确率为97.6%,Kappa值=0.866,一致性良好;与治疗前相比,DDH组治疗后的α角、骨性髋臼覆盖率均升高,β角减小(P<0.05);不同Graf分型患儿的治愈率比较,差异有统计学意义(P<0.05);其中Ⅱa、Ⅱb型、Ⅱc型、D型患儿的治愈率均高于Ⅲ型患儿(P<0.05)。结论:超声在DDH患儿的筛查中,具备较高的灵敏度、特异度和准确率,并且可评估DDH患儿吊带治疗的疗效,可为临床中DDH患儿的诊疗提供参考。

人工智能技术用于超声筛查婴儿发育性髋关节发育不良

目的构建人工智能(AI)自动识别髋关节超声标准冠状切面及测量相关参数模型,观察其辅助超声筛查婴儿发育性髋关节发育不良(DDH)的价值。方法回顾性分析2164名婴儿共4328侧髋关节超声视频,由5名超声科主治医师采用SonoKit标注软件以统一标准于每段视频中选取1幅标准、2幅非标准髋关节冠状切面声像图,并于标准冠状切面图中标注关键解剖结构。经2名超声科主任医师审核,共获得11100幅声像图(3665幅标准、7435幅非标准),以其中8100幅为训练集(2665幅标准、5435幅非标准)、3000幅为验证集(1000幅标准、2000幅非标准)。基于训练集数据构建AI模型,自动识别髋关节超声标准冠状切面,并于其中自动测量α角、β角和股骨头覆盖率(FHC);以验证集验证AI模型识别标准切面的效能。另选取110名健康婴儿的220幅髋关节标准冠状切面声像图,分别由超声科医师手动测量、以AI模型自动测量其α角、β角和FHC,分析测量结果的一致性及相关性。结果对于验证集髋关节超声标准冠状切面,AI模型与超声科主任医师识别结果的一致性较好(Cohen’s Kappa=0.925);AI模型自动测量与医师手动测量α角、β角及FHC的一致性均较好,组内相关系数分别为0.814、0.730和0.953,均具有强相关性(r=0.826、0.731、0.967)。结论AI模型能有效自动识别髋关节超声标准冠状切面并自动测量相关参数,可辅助超声筛查婴儿DDH。

发育性髋关节脱位患儿不同股骨颈前倾角对股骨生物力学的影响研究

目的利用计算机仿真技术模拟发育性髋关节脱位(developmental dislocation of the hip,DDH)患儿不同股骨颈前倾角时股骨的应力分布,以明确DDH患儿股骨颈前倾角矫正的意义,并指导手术方案的制定。方法回顾性分析2021年6月在山西省儿童医院骨科住院治疗的1例右侧DDH患儿影像学资料。患儿女,6岁,提取正常侧(左侧)髋关节股骨扫描数据,通过三维CT扫描重建股骨三维模型,分别设计股骨颈前倾角35°、25°、15°时的力学仿真模型,通过有限元软件进行仿真计算,观察不同股骨颈前倾角度时股骨的生物力学分布。结果DDH患儿股骨三维模型上股骨颈前倾角为35°、25°、15°时股骨模型受到的最大应力分别为21.18 MPa、17.36 MPa、9.85 MPa。股骨颈前倾角为35°时,股骨干应力集中;股骨颈前倾角为25°时,股骨远端骨骺的应力降低25%;股骨颈前倾角为15°时,股骨应力主要集中在股骨头颈至股骨干上段。股骨颈前倾角为35°时,位移大于1 mm的区间是股骨头至股骨干中段;股骨颈前倾角为25°时,位移大于1 mm的区间是股骨头至股骨干中上端;股骨颈前倾角为15°时,位移大于1 mm的区间是股骨头至股骨颈。股骨颈前倾角为35°、25°、15°时其股骨远端骨骺的最大位移分别为0.0041 mm、0.0018 mm、0.0012 mm。结论股骨颈前倾角对DDH患儿的股骨力学有着重要影响。股骨的应力分布随着股骨颈前倾角改变而改变,股骨颈前倾角度增大,股骨干应力逐渐增加,在股骨干位置出现应力集中现象;股骨颈前倾角越大,应力传递在股骨干区域受到的遮挡效应越大,股骨远端骨骺在横断面的变形也增加。股骨颈前倾角为15°时股骨应力分布较为理想。

3D打印多孔钽金属治疗发育性髋关节发育不良:现状及应用前景

背景:发育性髋关节发育不良患者常有一个浅髋臼、笔直狭窄的股骨管等解剖结构的广泛扭曲,尤其是面对高度脱位的发育性髋关节发育不良患者,实施手术治疗时具有很大的挑战性。近年来,3D打印多孔钽金属个体化治疗发育性髋关节发育不良的效果及预后较好,可用于术前诊断、术前手术规划、术中建立3D导航模板、明确术前髋臼严重程度及术后髋臼重建矫正评估,具有良好的发展前景。目的:探讨3D打印多孔钽金属治疗髋关节发育不良的最新研究进展。方法:采用计算机检索中国知网、PubMed、MDPI、BMC Biotechnology、Web of Science和Springer link数据库中有关3D打印多孔钽金属个体化治疗发育性髋关节发育不良的研究资料,检索时限为1970-2022年。根据纳入和排除标准,最终共选取58篇文献进行综述。结果与结论:(1)多孔钽金属主要有生物兼容性、骨整合性和骨诱导性等生物学特性及生物力学特性,有效地促进了新骨、新的血管及神经的良好生长。(2)3D打印多孔钽金属是由3D打印成型技术、天然金属材料-多孔钽金属联合运用方案,目前主要在发育性髋关节发育不良及髋关节骨缺损患者中评价这一方案的有效性。(3)3D打印多孔钽金属良好的术前计划能有效改善发育性髋关节发育不良、髋关节骨缺损的术后效果,并为假体植入物做好术前个体化规划的准备,能有效避免术中障碍和充分解决患者特异性畸形,直接影响手术结果,应用前景较好。(4)目前,应用3D打印多孔钽金属个体化治疗发育性髋关节发育不良的短期疗效在动物模型及部分文献中得到验证,但缺乏中长期随访结果。

发育性髋关节发育不良患者不同髋关节外展角度下髋部应力分布的有限元分析

背景:目前对于髋关节发育不良的有限元研究相对较少,髋关节外展角度对髋关节生物力学分布的影响也不明确。目的:应用有限元方法分析不同外展角度下髋关节发育不良患者健侧及患侧的髋关节应力分布,为髋关节发育不良的预防、治疗、康复等提供方案。方法:选取1例左侧髋关节发育不良患者双侧髋关节CT薄层扫描数据,利用Mimics软件建立髋关节模型,Geomagic Wrap软件完成实体化,Solidworks软件进行皮质骨与松质骨的装配,然后应用Ansys Workbench软件加载关节负荷,分析不同外展角度下单足着地条件下髋关节应力分布情况。结果与结论:(1)该研究所建模型与实际情况相符合,随着髋关节外展角度增加,正常髋关节的股骨颈最大应力值逐渐增大,且一直位于股骨颈内侧,当健侧髋关节外展为15°时股骨头最大应力值最小,当髋关节外展20°时髋臼上方最大应力值最小;(2)发育性髋关节发育不良患者患侧髋最大应力值一直位于髋臼上方,且当髋关节外展为25°时,髋臼最大应力值最小,当髋关节外展20°时,股骨头最大应力值最小,当髋关节外展0°时,股骨颈部最大应力值最小,且位于股骨颈后方,随着髋关节外展角度增大,股骨颈最大应力点逐渐向股骨颈内下侧移动。

川藏藏族儿童发育性髋关节脱位的影响因素分析

目的探讨川藏藏族儿童发育性髋关节脱位的影响因素。方法本研究为回顾性研究。以四川省骨科医院儿童骨科2013年1月至2021年12月收治的99例来自四川省甘孜藏族自治州、阿坝藏族羌族自治州、凉山彝族自治州及西藏自治区的藏族发育性髋关节脱位患儿作为研究对象,对患儿监护人进行问卷调查。按照受试者常住地分为四组:甘孜藏族自治州组(A组),阿坝藏族羌族自治州组(B组),凉山彝族自治州组(C组)和西藏自治区组(D组)。问卷调查内容包括受试者相关性因素(受试者是否早产,生产方式为顺产或剖宫产,生产时体位为头位或臀位,受试者是否为头胎或二胎及以上);以及监护人及家庭相关性因素[监护人是否为15岁以上、不识字且不会写字的成年人(以下简称文盲),受试者出生后襁褓方式是否绑腿,受试者是否定期接受儿童保健,受试者家庭经济情况]。结果四组DDH患儿是否早产(χ^(2)=7.564、P<0.05)、生产方式(χ^(2)=7.524、P<0.05)、生产胎位(χ^(2)=6.801、P<0.05)、是否头胎(χ^(2)=13.008、P<0.05)、监护人文化程度(χ^(2)=14.114、P<0.05)、襁褓方式(χ^(2)=13.080、P<0.05)、是否定期进行儿童保健(χ^(2)=11.107、P<0.05),以及家庭经济状况(χ^(2)=11.935、P<0.05)等因素比较,差异均有统计学意义。儿童受试者相关因素中"早产和臀位产",监护人及家庭相关性因素中"监护人是文盲"、"襁褓方式为绑腿"、"未定期接受儿童保健"是川藏藏族儿童DDH发病的主要影响因素(P<0.05)。结论早产、臀位生产、监护人是文盲、襁褓方式为绑腿、未规范进行儿童保健可能与藏族儿童DDH发病率升高有关。

高频超声在小儿髋关节发育不良中的诊断价值及影像学特征分析

目的探讨高频超声对小儿髋关节发育不良(DDH)的诊断价值。方法选取2021年1月至6月我院超声科接诊的51例(102个髋关节)疑似DDH小儿(设为观察组)及51例(102个髋关节)健康体检小儿(设为对照组)为研究对象,采用高频超声对所有小儿进行髋关节检查。以临床体格检查及X线最终检查结果为金标准,评估高频超声对DDH的诊断灵敏度、特异度、准确度及其对髋关节正常、髋臼发育不良、髋关节半脱位及髋关节完全脱位的检出率;比较两组的α角、β角;分析不同类型小儿髋关节的高频超声图像特征。结果高频超声诊断DDH的灵敏度为95.12%(78/82),特异度为90.00%(18/20),准确度为94.12%(96/102)。高频超声对髋关节正常、髋臼发育不良、髋关节半脱位及髋关节完全脱位的检出率分别为90.00%、96.00%、90.91%及100.00%。观察组的α角明显小于对照组,β角明显大于对照组(P<0.05)。结论高频超声对小儿DDH的诊断效果显著,其具有较高的灵敏度、特异度及准确度,且对髋关节正常、髋臼发育不良、髋关节半脱位及髋关节完全脱位的检出率较高,能够精确测量小儿髋关节的α角及β角,清楚显示髋关节的解剖形态,为临床提供可靠的诊断依据,值得推广与应用。