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目的:通过使用CT三维测量髋臼发育情况及髋臼对股骨头覆盖率对比性观察,整体反映髋臼发育情况。方法:①观察对象:选择2003-06/2005-04对41例发育性髋关节脱位患者55个髋关节。其中男12例,女29例;年龄18个月～6岁。患髋右侧23例,左侧32例,其中双侧12例。健康侧27髋。患儿家属均知情同意。②实验方法:所有患儿使用PQ6000型多层螺旋CT扫描,扫描数据进行骨组织三维重建。将测量数据制成图表,显示三维的髋臼发育情况,并量化表示髋臼的缺损情况。③实验评估:计算不同截面正常侧髋臼指数、中心边缘角(假设符合正态分布)的均数、标准差、分布范围及95%可信区间。观察发育性髋关节脱位术前术后骨骼形态学变化。分别在术前、术后测量患者患侧髋臼指数、中心边缘角和前倾角,测量值均分别与正常值进行对比。结果:患侧55个髋,健康侧27髋,均进入结果分析。①发育性髋关节脱位术前术后骨骼形态学变化:术前55侧发育性髋关节脱位髋关节脱位程度为,参照T“nnis分类方法,Ⅰ度5髋(9.1%),Ⅱ度11髋(20%),Ⅲ度32髋(58.2%),Ⅳ度7髋(12.7%)。术后患者均表现髋臼α角均>90°,头臼呈同心圆对位,Shenton线连续,股骨头较术前明显发育,原先未出现头骺的患者,出现头骺,但较正常仍偏小;髋臼口呈类圆形,髋臼边缘欠光滑,髋臼整体呈一定程度前倾。②术前术后髋臼指数、中心边缘角和前倾角变化对比:术后患者的髋臼指数和前倾角与正常对照组之间差异无显著性(P>0.05),术后患者的中心边缘角大于正常对照组[(33.4±2.6)°(29.1±2.0)°,P<0.01],术后患者的髋臼指数和前倾角测量值均小于术前(P<0.01)。结论:介绍了一种对髋臼形态测量的新方法,它能够全面反映髋臼的发育情况,不但增加了对中心边缘髋臼病理改变的认识程度,还为手术提供了精确的可信度较高的矫形设计方案。
OBJECTIVE: To observe the development of acetabulum by three-dimensional CT and observe the coverage of femoral head with acetabulum. Methods: ①Objective: To select 55 hip joints in 41 patients with developmental dislocation of hip from 2003-06 / 2005-04. Including 12 males and 29 females; aged 18 months to 6 years. 23 cases of right hip suffering from the left side of 32 cases, including bilateral in 12 cases. 27 hips on the healthy side. Children and their families are informed consent. ② experimental methods: All children using PQ6000 multi-slice spiral CT scan, scan the data for three-dimensional reconstruction of bone tissue. The measurement data is tabulated to show the three-dimensional acetabular development and to quantify the acetabular defect. ③ Experimental evaluation: Calculate the mean, standard deviation, distribution range and 95% confidence interval of the normal acetabular index and center edge angle (assuming normal distribution) of different sections. To observe the bone morphological changes before and after developmental dislocation of the hip. The ipsilateral acetabular index, center edge angle and anteversion angle were measured preoperatively and postoperatively, and the measured values were compared with those of the normal values respectively. Results: 55 hips on the affected side and 27 hips on the healthy side were involved in the result analysis. ① Developmental hip dislocation before and after surgery skeletal morphological changes: 55 preoperative hip dislocation of the development of dislocation of the degree of dislocation, according to T ”nnis classification, Ⅰ degree 5 hip (9.1%), Ⅱ degree 11 Hip (20%), Ⅲ degree 32 hips (58.2%), Ⅳ degree 7 hips (12.7%) .All patients showed acetabular angle α> 90 °, the acetabulum was concentric circle position, Shenton line continuous, The femoral head was obviously developed compared with that before operation. The patients who did not appear epiphyseal first appeared epiphyseal, but still smaller than normal. The acetabulum was round, the edge of acetabulum was not smooth, and the acetabulum presented a certain degree of anteversion. ② The changes of acetabular index, center edge angle and anteversion before and after operation: There was no significant difference between the acetabular index and anteversion angle after operation and the control group (P> 0.05). The center margin (33.4 ± 2.6) ° (29.1 ± 2.0) °, P <0.01], and the measured values of acetabular index and anteversion were all less than those of preoperative (P <0.01) .Conclusion: A new method of measuring the shape of the acetabulum, which can fully reflect the development of the acetabulum, not only increased the understanding of the central edge of the acetabular pathological changes, but also for the operation to provide accurate and credible Degree of orthopedic design.