儿童臀肌挛缩对骨骼发育的影响

目的 探讨儿童臀肌挛缩对骨骼生长发育的影响.方法 对1995年5月至2005年6月我院收治的368例臀肌挛缩症患儿骨盆平片其中30例骨盆CT扫描,及200例非臀肌挛缩症患儿进行骨盆平片其中25例骨盆CT作对照分析.比较两组的骨盆X线平片及髋关节、髋臼指数、颈干角、CE角、骨盆闭孔形态以及有无髂骨纵向密度增强影等数据,并进行统计分析处理.结果 病例组68例发生骨盆倾斜, 321例(87.23%)骨盆平片见骶髂关节旁髂骨致密线,对照组仅见5例(2.5%).368例臀肌挛缩症患儿中,髂骨致密线出现于7岁以上组和7岁以下组分别为306例(306/314)和15例(15/54);出现于臀大肌挛缩为主组和臀中肌挛缩为主组分别为313例(313/336)和8例(8/32),差异均有统计学意义(P＜0.01).对照组中无骨盆倾斜发生.30例CT扫描显示在臀肌挛缩症患者,髂骨后部增厚、变形,外缘皮质斜面变小,近乎前后走行,25例对照组均无上述改变.经统计学分析,病例组术前与对照组测量CE角、颈干角、闭孔纵、横径的均数以及骨盆骶髂旁致密线的差异均有统计学意义(P＜0.01),术后与对照组测量上述指标差异均无统计学意义(P＞0.01).病例组术前后与对照组测髋臼指数差异无统计学意义(P＞0.01).结论 儿童臀肌挛缩会影响儿童骨骼生长发育,臀肌挛缩可导致不同程度的骨盆倾斜、髋外翻、肢体假性不等长以及CE角变大等改变.髂骨致密线可能是臀肌挛缩的一种影像学上的特征性改变.

The Effect of Children's Gluteal Muscle Contracture on Skeleton Development

Objective To explore the effect of children's gluteal muscle contracture(GMC)on skeleton development.Methods The pelvic plain films of 368 GMC cases confirmed by operation from May 1995 to June 2005 and those of 200 individuals as control were analyzed for this research project.The pelvic CT scans were performed in 30 GMC cases and 25 controls.The data of both groups were used to comparison,analysis and statistics treatment in pelvic plain X-ray film,hip joint,acetabular index,neck shaft angle,centre-edge(CE)angle,the form of pelvic obturator foramen,the existence or nonexistence of the iliac hyperdense line.Results There were 68 cases with pelvis obliquity in the case group but no one in the control group.The iliac hyperdense lines at the side of sacroiliac joints were found on the pelvic plain films of 321 of 368 cases with GMC and 5 of 200 controls.In 368 cases with GMC,the iliac hyperdense lines were detected in 306 of 314 patients beyond 7-year-old,and 313 of 336 appeared mostly the contracture of gluteus maximus muscle,which showed to be significant in statistics.In GMC group,the oblique plane became steeper and almost oriented posteroanteriorly,while in control group,the pelvic CT showed that the outer codex of posterior ilium at the level of sacroiliac joint appeared as an oblique plane,oriented from posteromedial to anterolateral side.The data were processed with statistics software,found that compared with the control group,the results of pre-operation group's examines such as CE angle,neck shaft angle,longitudinal diameter,cross diameter,and the iliac hyperdense line had significant differences(P<0.01),the results of post-operation group's those examines showed no significant differences(P>0.01),and the acetabular index appeared no significant differences(P>0.01).Conclusion The children's gluteal muscle contracture has the significant effect on skeleton development,which could lead to pelvis obliquity,coxa valga,leg length pseudoinequality,CE angle increasing,etc.The iliac hyperdense line on the pelvic plain film is probably a characteristic change of GMC.