婴幼儿股骨颈前倾角的测量及临床意义

股骨颈前倾角增大是婴幼儿发育性髋关节脱位主要的病理改变之一，正确的测量对临床的诊治具有指导意义。本文对股骨颈前倾角的测量方法及各种影像学测量方法的优缺点进行综述，探讨股骨颈前倾角的测量在婴幼儿发育性髋脱位中的应用价值。     

发育性髋关节脱位髋臼前倾角的CT研究

目的:研究发育性髋关节脱位髋臼前倾角的变化,为手术选择和判断预后提供依据。方法:选择手术前发育性髋关节脱位DunnⅠ型28髋,DunnⅡ型19髋,DunnⅢ型22髋。选取手术后为优的17髋。正常髋关节12髋。采用多层螺旋CT扫描,然后行髋臼三维重建,测量通过两侧Y形软骨中心O点的横断面测量髋臼前倾角。结果:髋臼前倾角度数正常组<术后相似文献   

Salter骨盆截骨术治疗儿童发育性髋关节脱位疗效观察

目的探讨Salter骨盆截骨术对儿童发育性髋关节脱位的疗效。方法对2009年3月—2012年3月在我院小儿骨科接受Salter骨盆截骨术治疗发育性髋关节脱位的患儿85例,90髋临床随访,采用Mckay髋关节功能评定标准;X射线随访,采用Severin标准。结果术后1³年随访结果为,按Mckay标准,术后无患儿出现髋痛,严重跛行的情况,优良率为96.5%;按Severin标准,术后无患儿再出现髋关节半脱位或脱位的情况,优良率为94.1%。结论 Salter骨盆截骨术可以很好地纠正儿童发育性髋关节脱位,并最大限度地保留关节功能。     

发育性髋关节脱位治疗后股骨头坏死的分型探讨

目的:探讨发育性髋关节脱位治疗后股骨头坏死的分型.材料和方法:对我院收治的发育性髋关节脱位治疗后股骨头坏死24例32个髋关节,根据股骨头坏死受累的不同部位,将其分为5型.结果:Ⅰ型股骨头坏死9个髋,股骨头骨骺发育基本正常.Ⅱ型2个髋,主要表现为髋关节外翻.Ⅲ型2个髋,股骨颈短缩,大粗隆高位.Ⅳ型8个髋,髋关节内翻,大粗隆高位.Ⅴ型11个髋,股骨颈短缩,股骨头畸形,大粗隆高位.结论:5型分型法可将全部股骨头坏死进行分类,并对其预后具有临床指导意义.     

MRI在婴幼儿先天性髋关节脱位中的应用

目的 探讨MRI在婴幼儿先天性髋脱位的应用价值,为临床提供合理的检查依据.方法 搜集47例3岁以内未经治疗的先天性髋关节脱位患儿行MR髋扫描,全部脱位髋按照Ogden和Dunn的标准分为3类.除Ⅲ型脱位髋外全部髋依照Fisher等描述的方法测量骨性髋臼指数(BAI)和软骨性髋臼指数(CAI)以及骨性髋臼商(BAQ)和软骨性髋臼商(CAQ).结果 正常髋、脱位髋、Ⅰ型脱位髋、Ⅱ型脱位髋的BAI分别是(25.24±3.70) °、(38.12±4.07)°、(35.59±2.86)°、(39.64±3.97)°;CAI分别是(8.49±2.15)°、(17.25±2.41)°、(15.85±2.00)°、(18.08±2.26)°;BAQ分别是0.199±0.026、0.126±0.028、0.131±0.028、0.124±0.028;CAQ分别是0.195±0.027、0.120±0.027、0.120±0.023、0.121±0.030.Ⅱ型脱位髋的BAI、CAI与Ⅰ型脱位髋相比呈升高变化,BAQ、CAQ呈减低变化.经统计分析,测量的 BAI和BAQ分别与CAI和CAQ呈线性相关(r值分别为0.876和0.706).MRI提示CDH主要改变为骨性髋臼失去正常的圆形轮廓,髋臼软骨增生外移.结论 MRI是临床评价婴幼儿髋关节骨、软骨结构和重要软组织的有效方法,是诊断和指导CDH治疗的良好手段.     

Graf法联合Harcke法筛查发育性髋关节发育不良的临床应用分析

目的:Graf法、Harcke法联合筛查发育性髋关节发育不良(DDH)的临床应用价值,探讨髋臼窝发育和关节稳定性的关系.方法:选择6004例(12008髋)为研究对象,均接受Graf法、Harcke法检查.应用Harcke技术评价髋关节外展程度和稳定性,应用Graf技术对髋关节分型,并与临床诊断比较,计算Graf法、H...     

超声扫查法在快速筛查婴儿发育性髋关节脱位中的应用价值

目的探讨超声扫查法在快速筛查婴儿发育性髋关节脱位中的应用价值。方法对2387例婴儿4774个髋关节进行超声检查,目测观察髋臼骨缘、骨顶形态、股骨头位置以及在基线以下的位置,并运用Graf方法对比分析。结果超声扫查法可以客观提示髋关节髋臼骨缘形态、骨顶形态及股骨头位置,目测观察4774个髋关节与Graf方法诊断符合率95.3%,两种测量经统计一致性良好有显著意义。其中,目测正常组与Graf法符合率100%,异常组符合率97.5%。与Graf方法对比一致性检验良好。结论超声扫查法在快速筛查婴儿发育性髋关节脱位中具有很高的应用价值。     

MRI对发育性髋脱位软组织病变的诊断价值及新技术的应用趋势

发育性髋关节脱位(DDH)是小儿骨科常见的四肢异常之一,对其骨骼方面的研究已日趋成熟,近年来对关节内外软组织病变的研究逐渐成为热点。MRI因其良好的软组织分辨力,能较好地显示出髋关节内所有临床上重要而其他影像检查难以显示的软组织及软骨结构,已成为DDH诊断及术前评估、预后评价的必要检查方法。同时,随着近年来MR新技术的不断出现,其对提示软骨及肌肉的早期病变具有潜在价值。探讨MRI对DDH软组织病变的诊断价值及一些MR新技术的应用趋势。     

婴幼儿先天性髋脱位的实时灰阶超声检查

小儿先天性髋脱位的早期诊断对于临床治疗很有意义。以往,对本病的婴幼儿期的检查基本上是采用X线平片,偶尔做髋关节造影。由于平片不能显示未钙化的软骨结构,故常难以作出早期诊断。此外,射线对小儿也易造成损伤。造影检查因方法复杂不便常规应用。自1979年Krams和Lenschow报道B超用于先髋的诊断以来,许多研究表明,此法无论在发现早期髋关节发育障碍或作为普查手段都优于常规X线检查。     

儿童颈椎外伤性无骨折脱位脊髓损伤--附22例报告

目的 :探讨儿童颈椎外伤性无骨折脱位与脊髓损伤的相关性。方法 :2 2例儿童颈椎外伤性脊髓损伤患者 ,均经X线前屈、后伸摄片 ,6例行断层摄片、16例行CT检查、8例行MRI检查。结果 :2 2例脊髓损伤患者 ,均未见骨折脱位影像学变化、均经急救处置。结论 :儿童颈椎弹力性大 ,椎体之间不稳 ,易产生一过性脱位 ,并可造成椎管相对变窄 ,导致脊髓损伤。建议临床体征、CT和MRI检查对儿童颈脊髓损伤的诊断具有重要价值     

The patellofemoral kinematics in patients with untreated developmental dislocation of the hip suffering from patellofemoral pain

Purpose

This study reviews the dynamic patellofemoral CT results of 39 patients with untreated developmental dislocation of the hip who are suffering from knee pain.

Method

The mean age of the patients with unilateral developmental dislocation of the hip was 33.3 (±7.9), for bilateral patients 36.2 (±11.3), and for the control group, it was 31.5 (±8.5). While 14 of them were bilateral, 25 were unilateral. The CT results of 24 asymptomatic adult knees served as the control group. The patellofemoral parameters of patients with unilateral and bilateral developmental dislocation of the hip, the control group’s parameters and the effect of femoral anteversion, limb length discrepancy, severity of dislocation, the mechanical axis deviation on patellofemoral parameters were analyzed.

Results

In patients with unilateral untreated developmental dislocation of the hip, although the patella was located more laterally at initial flexion degrees, it was located more medially at 30° and 60° flexion with respect to the control group. For the involved extremity, the PTA angles at 15°, 30°, and 60° flexion were significantly higher than in the control group corresponding to medial patellar tilt. In patients with bilateral developmental dislocation of the hip, the course of the patella during tracking in terms of patellar shift was similar to that of the unilateral patients. The amount of leg length discrepancy and the severity of dislocation, as well as the mechanical axis deviation, did not affect the patellofemoral parameters.

Conclusion

The patients with untreated developmental dislocation of the hip and suffering from knee pain should be analyzed not only for tibiofemoral abnormalities but also for patellofemoral malalignment.

Level of evidence

Case–control study, Level III.     

CT在髋关节脱位中的诊断价值

目的探讨CT在髋关节脱位中的诊断价值.方法分析并比较17例经X线平片及CT检查的髋关节脱位病例.结果X线平片显示髋关节脱位15例、骨折10例、软组织肿胀9例、复位后关节间隙增宽6例及关节内碎骨片3例.CT显示脱位及骨折17例、软组织肿胀15例、复位后关节间隙增宽11例及关节内碎骨片10例.结论CT对显示髋关节脱位的方向和程度、髋臼骨折、复位前后关节内骨碎片及软组织改变均有明显优势,我们认为可以将CT检查作为髋关节脱位,尤其是复位后的一种常规检查.     

Morphological analysis of the knee joint in patients with hip dysplasia

Purpose

The purpose of this study was to investigate the morphological changes of the knee in patients with untreated developmental dysplasia of the hip.

Methods

Morphological analysis of 150 knee joints in 75 patients with developmental dysplasia of the hip was performed by examining computed tomographic (CT) images. Of these patients, 36 had unilateral developmental dysplasia of the hip and 39 had bilateral developmental dysplasia of the hip. Therefore, 36 hips were normal, and 114 hips were dislocated. CT images ranged from the iliac crest to 2 cm inferior to the tibial tuberosity.

Results

Compared with the knees in patients with normal hips, the femoral condyles in patients with dislocated hips were smaller and exhibited greater medial and lateral condylar asymmetry. The anterior femoral condylar angle of the femur was increased, as was the groove angle, while the trochlear groove was shallower in patients with dislocated hips. Furthermore, the lateral patella shift was reduced and the patellar tilt angle was increased in patients with dislocated hips compared with patients with normal hips. The extent of changes in these variables differed with the degree of dislocation. However, the posterior condylar angle of the femur was not affected by the degree of dislocation.

Conclusion

These findings suggest that developmental dysplasia of the hip is associated with morphological changes in the knee joint. These changes should be considered during hip and knee surgery.

Level of evidence

Prospective study, Level II.     

Computed tomography arthrography in traumatic hip dislocation

The newer diagnostic modalities such as computed tomography and magnetic resonance imaging are becoming increasingly used in the evaluation of joint trauma. The combination of computed tomography and arthrography can also be of significant diagnostic value in certain specific situations. In our case report, we describe its use in post-traumatic recurrent hip dislocation and its value, not only in depicting a posterior capsular tear, but also in the diagnosis of an internal joint derangement which may contribute to incongruous reduction of the hip joint.     

Ultrasound of the neonatal hip: initial evaluation and follow-up

Developmental dysplasia of the hip can arise in utero due to a dislocating posture, sometimes associated with predisposing genetic factors. The ideal time for diagnosis is during the neonatal period and adequate screening procedures must be in place. Indeed, the plasticity of hyaline cartilage and fibrocartilage combined with the growth potential at this age nearly always result in rapid complete resolution of the deformity. Ultrasound, when indicated, is the best imaging modality for diagnostic confirmation. It allows evaluation of the osteocartilaginous structures, joint space and soft tissues. Ultrasound provides the clinician with a reliable morphologic and dynamic evaluation tool improving the diagnostic accuracy and guiding orthopedic treatment. Our experience, dating back to 1985, is based on a population imaged between 2007 and 2009. From a total of 2480 neonates screened because of abnormal finding or risk factors, we identified 257 cases of dislocation (10%) in 191 neonates : 14 cases of nonreducible dislocation (10 neonates), 30 cases of reducible hip dislocation (24 neonates), 97 cases of dislocatable hip (73 neonates) and 116 cases of subluxable hip (84 neonates). Clinical and sonographic follow-up demonstrated therapeutic success in 237 cases (93%) and failure in 20 cases (one case of subluxable hip, two cases of dislocatable hip, three cases of dislocated hip, 14 cases of nonreducible hip dislocation). Imaging follow-up (6 to 24 months) showed asymmetry in the size of the proximal femoral epiphyses in 20 cases (with resolution in 10 cases), three cases of dysplasia and one case of post-reduction osteochondritis.     

高频超声Graf法与Terjesen法对发育性髋关节发育不良诊断一致性研究

目的 探讨Graf超声检查法和Terjesen超声检查法在发育性髋关节发育不良(DDH)诊断中的诊断一致性.方法 回顾性分析2019年1月至6月,在我院超声科行DDH检查的婴幼儿共108例,其中男孩41例,女孩67例,共216个髋关节.每位进行DDH检查患儿均进行双侧髋关节扫查.参照Graf方法,测量α角度及β角度,再...     

全髋关节置换术后脱位21例临床分析

目的分析全髋关节置换术后脱位的影响因素,探讨术中如何准确置人髋关节假体以减少髋关节脱位。方法分析我科2005年1月—2012年12月全髋关节置换术后脱位病例的影响因素。结果本组病人脱位发生率为1．3％。女性占脱位人数的比例为62％,男性占38％。早期脱位占脱位人数的比例为90％,晚期脱位占10％。前方脱位占脱位人数的比例为19％,后方脱位占81％。假体位置不良占脱位人数的比例为52％,精神神经功能不全者占29％,术后活动范围过度者占脱位人数的比例为19％。结论患者因素、术者因素及髋关节假体因素都对人工髋关节置换术后脱位产生影响,术中准确置人髋关节假体是影响髋关节脱位的关键因素。     

外伤性髋关节脱位CT诊断

目的：探讨外伤性髋关节脱位的特点，合并症及半脱位形成的原因，资料与方法：测量40例健康成人的髋关节间隙对照分析34例外伤性髋关节脱位的CT表现，结果：后脱位15例占44．12％，中心型脱位9例占26．47％，半脱位8例占23．53％，陈旧性脱位2例占5．88％，结论：CT对发现外伤性髋关节脱位及其合并症能提供有力的诊断依据。