发育性髋关节发育不良(DDH)患儿髋臼前倾角的影像学研究-外科学(骨外)专业论文.docx

摘要 摘 要 目的：通过 3D-CT 和 MRI 对发育性髋关节发育不良（DDH）儿童和髋关节 正常儿童的髋臼骨性前倾角（OAA）及软骨性前倾角（CAA）进行测量，明确 DDH 儿童髋关节的 CAA 是否与 OAA 一样存在过度的前倾，CAA 和 OAA 是否 存在相关性，并进一步探讨 OAA 能否反映 DDH 真实的髋臼前倾畸形；同时， 利用 MRI 对不同年龄髋关节正常儿童的髋臼 CAA 进行测量，分析正常儿童 CAA 的生长发育过程。 方法：回顾性收集 55 例 DDH 儿童（平均年龄 19 个月，6-60 月）的 CT 和 MRI、30 例髋关节正常儿童（平均年龄 20 个月，7-60 月）的 CT 以及 222 例髋 关节正常儿童（平均年龄 6.2 岁，3 月-15 岁）的 MRI 等影像学资料，通过 3D-CT 测量 OAA、MRI 测量 CAA，对测量数据进行统计学分析。 结果：DDH 脱位与半脱位髋 OAA 和 CAA 均大于正常髋 OAA 和 CAA，差 异具有统计学意义（P 0.05）；OAA 与 CAA 具有相关性，但 OAA 小于 CAA（P 0.05）；正常儿童髋臼 CAA 与年龄未呈现出相关性。所有病例均未发现髋臼后 倾现象。 结论：DDH 患者的软骨性髋臼同样是存在过度前倾的，并且软骨性髋臼的 前倾畸形往往大于骨性髋臼的前倾畸形，CAA 更能反映髋臼的真实前倾角；此 外，正常的 CAA 在人们出生时就已完全形成，并且不随年龄的增长而发生明显 改变。DDH 儿童和髋关节正常儿童均未发现髋臼后倾现象。DDH 髋关节的 MRI 影像更能反映真实的髋臼形态学畸形，对于制定合理的矫形治疗方案具有重要 指导意义。 关键词：发育性髋关节发育不良；3D-CT；MRI；骨性前倾角；软骨性前倾角 II ABSTRACT Objective：The osseous and cartilaginous acetabular anteversion were respect- tively measured in the DDH and normal control individuals using 3D-CT and MRI. To observe whether the acetabular anteversion (AA) on the basis of 3D-CT measurement is positive correlation with the AA on the basis of MRI measurement, and whether the AA on the basis of CT measurement could reflect the true AA. To observe the CAA in normal children with different ages and analyze its development and growth. Methods：55 CT and MRI images of DDH patients with an average age of 19 months (range 6 to 60 months) and 30 CT images of normal control individuals with a mean age of 20 months (range 7 to 60 months) and 222 MRI images of normal control individuals with a mean age of 6.2 years (range from 3 month to 15 years) were involved in the study. The osseous and cartilaginous acetabular anteversion were respectively measured in the DDH and normal control individuals using 3D-CT and MRI. The data were statistically analyzed. Results：Cartilaginous AA on the dislocated and subluxated hips in DDH based on MRI measurement is also larger than that on the unaffected hips (P 0.05). Positive correlation was observed between the CT-based AA and t