成人髋臼发育不良并骨性关节病的X线诊断

目的:通过对髋关节正位平片的检查和测量,探讨成人髋臼发育不良并骨性关节病的X线诊断。方法:回顾性分析我院40例,共69个髋关节成人髋臼发育不良继发退行性骨关节病的X线表现,测量其CE角(中心边缘角)、sharp角(髋臼角)和髋顶切线角。结果:CE角最大27°,最小-25°,平均11.2°。sharp角最大59°,最小49°,平均55.6°。髋顶切线角全部为零度和负角,零度28髋,负角41髋。继发退行性骨关节病,表现为髋臼顶及边缘骨质增生硬化,髋臼和/(或)股骨头囊变,以髋臼更为明显。结论:X线正位平片可良好地显示髋关节骨结构,结合CE角、sharp角、髋顶切线角等相关测量,骨盆正位片目前仍是放射科诊断髋臼发育不良并骨性关节病最简单实用的方法。     

成人髋臼发育不良性骨关节病的影像学表现

目的　探讨成人髋臼发育不良性骨关节病的影像学表现。方法　对 5 1例 87个髋成人髋臼发育不良的影像资料进行回顾性分析。患者除男性 4例外均为女性 ,年龄 2 2～ 78岁 ,平均42 6岁。所有患者均摄有标准的骨盆前后位X线片 ,18例行CT扫描 ,10例行MR扫描。结果　 87个发育不良髋臼的主要X线改变为髋臼浅小 ,倾斜度增加和对股骨头覆盖不全。测量中心边缘角 (CE)为 - 10°～ 3 0°,平均 12 9°。测量髋臼指数为 3 5°～ 67° ,平均 45 3°。其中 75髋 (84 2 % )有继发性骨关节炎 ,5 4髋 (62 1% )出现髋臼或股骨头负重区软骨下囊性变 19髋 ,伴有髋关节半脱位。CT和MRI发现平片不能显示的小囊变和股骨头向前移位者分别为 13髋和 10髋。结论　髋臼或股骨头囊样病变是髋臼发育不良性骨关节病的常见表现 ,CT或MRI能显示其早期征象     

成人髋臼发育不良的X线分析

目的:探讨成人髋臼发育不良(AD)的X线表现。方法:回顾性分析67例89个AD的标准骨盆前后位X线片影像资料,选择髋关节测量方法中的中心边缘角(CE角)、髋臼角、Sharp角、髋臼指数、股骨头覆盖率、髋顶切线角、沈通氏线,运用DR软件系统进行测量分析。结果:89个髋CE角范围0°～33°(不含负角),平均20.8°;髋臼角范围12°～46°,平均24°;Sharp角范围40°～57°,平均47°;髋臼指数范围28%～69%,平均47%;股骨头覆盖率范围34%～81%,平均65%;髋顶切线角零度和负角占90%,正角占10%;沈通氏线不连续占86%,连续占14%。结论:成人AD的X线表现为髋臼变浅,臼口部变大、顶唇短缺,臼顶变平或向内下倾斜,臼顶最高点外移,倾斜度增大,股骨头覆盖不全、裸露区增大、形态改变及不同程度的脱位,继发髋关节退行性变或股骨头坏死。骨盆前后位X线平片是诊断成人AD简单而实用的影像检查方法。     

髋臼发育不良患者髋臼周围截骨术前的三维CT测量

目的 使用三维CT测量无晚期骨关节炎的髋臼发育不良患者的髋臼,并分析覆盖缺损类型和程度.资料与方法 30例患者共46个髋关节于髋臼周围截骨术前行X线片和三维CT扫描,分别测量外侧中心边缘角、臼顶倾斜角和前方中心边缘角,及三维CT上的髋臼前倾角、髋臼前角、髋臼后角.应用Harris评分对患者进行临床评估.结果 三维CT和X线片测得的外侧中心边缘角、臼顶倾斜角和前方中心边缘角差异无统计学意义(P＞0.05).根据髋臼覆盖缺损部位分为外侧缺损(7个髋)、外侧+前方缺损(12个髋)、外侧+后方缺损(9个髋)和完全缺损(18个髋)04组前方中心边缘角、髋臼前倾角、髋臼前角和髋臼后角差异有统计学意义(P＜0.01),而外侧中心边缘角、臼顶倾斜角、髋臼覆盖率及Harris评分差异无统计学意义(P＞0.05).结论 三维CT能更直接显示和精确测量不同类型的髋臼发育不良改变.     

正常成人髋关节间隙与髋臼角相关性研究

目的 通过CT测量髋关节,探讨正常成人髋臼前唇连线头距、骨关节间隙与髋臼角的相关性.方法 对216例因盆腹部病变行CT检查而无髋部症状患者的髋关节进行数据重建、测量,从中挑选X线和CT表现正常的400例髋关节作为统计对象,测量髋臼前唇连线关距、髋关节前、后间隙及LCE角、髋臼角、股骨头覆盖率、臼顶切线角.结果 髋臼前唇连线头距与LCE角、股骨头覆盖率呈正相关,与髋臼角负相关;髋关节前间隙与LCE角、股骨头覆盖率呈负相关,与髋臼角不相关;髋关节后间隙与CE角呈负相关,与髋臼角、股骨头覆盖率不相关.根据臼顶切线角的不同,将髋臼分为三种类型,髋臼前唇连线头距及髋关节前后间隙三型之间存在显著性差异,Ⅰ型、Ⅱ型均与Ⅲ型有显著性差异,而Ⅰ型与Ⅱ型之间没有显著性差异.结论 CT测量的正常成人髋关节间隙指标与X线测量的髋臼角等指标之间有一定的相关性,二者结合对髋关节的评价更为准确.     

CT测量髋臼前唇连线诊断髋臼发育不良性股骨头前脱位

目的:研究成人髋臼发育不良性股骨头前脱位的CT诊断标准.方法:随机调查100例正常髋关节CT表现,观察和测量髋臼前唇连线与股骨头的关系以及股骨头前间隙和后间隙,与28例髋臼发育不良的CT片作对照.对正常组和髋臼发育不良组所得数据采用t检验作统计学分析.结果:髋臼前唇连线与股骨头前缘的关系的测量值和股骨头前后间隙测量值在正常组和髋臼发育不良组之间对比具有统计学差异.结论:正常成人在股骨头中点层面上,股骨头前缘不超出髋臼前唇连线的延长线.测量髋臼前唇连线与股骨头的关系可作为诊断股骨头前脱位的客观标准.     

成人髋臼发育不良并发骨囊变的影像学研究

目的:探讨成人髋臼发育不良(acetabular dysplasia,AD)并发骨囊变的临床及影像学表现特点,提高其影像诊断水平。方法:回顾性分析50例成人AD的标准双髋关节前后位X线片、12例CT片、5例MRI图像,并按有无髋周骨囊变分为囊变组和无囊变组。分别测量髋臼指数、Sharp角、CE角、股骨头覆盖率、髋关节内间隙、髋关节上间隙。数据均以x±s形式表示,并行t检验。结果:50例(86髋)成人AD中出现骨囊变20例(28髋),占40%(33%),其中单纯髋臼囊变14髋(占17%),股骨头和髋臼同时囊变12髋(占14%),单纯股骨头囊变2髋(占2%)。囊变组和无囊变组对照测量:CE角分别为15.73°±9.08°和22.18°±4.69°;Sharp角分别为48.8°±1.88°和45.2°±2.26°,髋臼指数分别为(39.6±5.31)%和(44.4±10.85)%,股骨头覆盖率分别为(55.4±7.41)%和(66.4±3.93)%,髋关节内间隙分别为(10.68±3.80)mm和(8.56±1.86)mm,髋关节上间隙分别为(2.56±1.36)mm和(4.14±0.53)mm。2组数据除Sharp角和髋关节内间隙差异无统计学意义(P>0.05),其余差异均有统计学意义(P<0.05)。结论:影像学检查是成人AD并发髋周骨囊变的有效检查手段,且CT和MRI明显优于X线平片,尤其是MRI可早期显示软骨下小囊变。     

成人髋臼结构不良CT应用价值

目的　探讨CT对成人髋臼结构不良的诊断价值。方法　对 2 8例髋臼结构不良患者的 5 6个髋关节CT资料进行回顾性分析。结果　成人髋臼结构不良的CT影像中 ,75 .0 %髋臼表现有前部发育不良 ,而髋臼前后部均发育不良 ( 14 .4% )和臼窝形态异常 ( 14 .9% )者少见 ,5 7.1%髋臼顶部有发育不良。此外 ,CT发现继发性骨关节病和股骨头缺血坏死分别为 91.1%和 16 .1% ,均高于平片所见。结论　CT有助于全面了解髋臼发育状况及其与股骨头相互适应情况 ;确定髋臼结构不良的基本类型 ;早期发现继发性骨关节病和股骨头缺血坏死及评估髋关节病变的严重程度。     

成人髋臼发育不良并发骨囊变的影像学研讨

目的探讨成人髋臼发育不良（acetabulardysplasia,AD）并发骨囊变的临床及影像学表现特点,提高其影像诊断能力。方法回顾性分析66例成人AD的标准双髋关节前后位X线片、28例CT片、10例MRI片的影像学资料,并按有无髋周骨囊变进行分组：囊变组、无囊变组。测量方法有：髋臼指数、Sharp角、CE角、髋臼顶切线角、AHI（股骨头覆盖率）、髋关节内间隙、髋关节上间隙。数据均以平均值±标准差（x±s）方式表示,通过了检验进行统计学处理,以P〈O．05为具有显著性检验。结果66例成人AD中出现并发症的61例,占92．4％,其中髋关节脱位（含半脱位和脱位）49例,占74．2％,继发骨性关节炎18例,占27．3％。髋臼及股骨头囊状改变24例,占36．4％,其中单纯髋臼囊变14例,占21．2％,股骨头和髋臼同时囊变5例,占7．5％,单纯股骨头囊变5例,占7．5％．襞变组和无囊变组对照测量结果显示两组数据除髋臼指数和髋关节内间隙无差异外（P〉O．05）,其余均有显著性差异（P〈O．05）。结论成人髋臼发育不良易并发髋周骨囊变（软骨下假囊肿）,其发病率与年龄呈正相关,X线、CT、MRI检查是诊断成人AD并发髋周骨囊变（软骨下假囊肿）的有效检查手段,MRI在显示成人AD并发髋关节周围骨囊变方面优于x线平片和CT,尤其是早期显示软骨下小囊变。     

成人重度髋关节发育不良继发性骨关节炎的CT表现

目的:探讨成人重度髋关节发育不良继发性骨关节炎的CT表现.方法:对23例41个髋成人重度髋关节发育不良继发性骨关节炎的CT资料进行回顾性分析,男2例,女21例,年龄46～72岁,平均约52.2岁.结果:23例41个髋成人重度髋关节发育不良继发性骨关节炎的CT表现为41髋可见明显的髋臼发育不良(100%);其继发性骨关节炎表现为骨质增生硬化、软骨下假囊肿、关节间隙狭窄(100%);36髋可见髋关节再塑型(87.8%),即:发育不良的髋臼边缘骨质再生形成新髋臼,股骨头变形对应再生髋臼.所有病例均伴发邻近部位骨关节炎.结论:成人重度髋关节发育不良继发性骨关节炎的CT影像表现典型,髋关节再塑型是其特征性表现,反映了其生物力学的改建.     

Acetabular angles and femoral anteversion in dysplastic hips in adults: CT investigation

Transpelvic CT was used to quantify the relationship between the acetabulum and proximal femur in 21 adult patients (33 hips) with congenital hip dysplasia (defined by a center edge angle of less than 20 degrees). The anterior and posterior acetabular sector angles (AASA and PASA) were measured, as well as the degree of acetabular and femoral anteversion. The results demonstrated deficient anterior acetabular support (i.e., decreased AASA) in approximately two-thirds of the dysplastic hips and reduced posterior support (i.e., decreased PASA) in one-third. The acetabular anteversion was normal. The femoral anteversion. however, was greater than normal in most hip. As important additional information is obtained by CT compared with conventional radiography, CT is recommended when operative procedures aimed at preventing or postponing osteoarthrosis are considered.     

Degeneration in dysplastic hips

Background Hip dysplasia is considered pre-osteoarthritic, causing degeneration in young individuals. Objective To determine the pattern of degenerative change in moderate to severely dysplastic hips in young patients. Design and patients One hundred and ninety-three consecutively-referred younger patients with hip pain believed to be caused by hip dysplasia constituted the study cohort. The average age was 35.5 years (range, 15–61 years). They were examined by close-cut transverse pelvic and knee computed tomography and antero-posterior radiographs (CT). We identified 197 hips with moderate to severe dysplasia, and 78 hips with normal morphology in the study cohort, whilst 111 hip joints were borderline dysplastic according to preset definitions. Comparative analyses of anatomy and distribution of degeneration between dysplastic and normal hips in the study cohort were performed. Results In dysplastic hips the anterior acetabular sector angle was significantly and inversely associated to femoral anteversion (p<0.001). The center-edge (CE) angle, the acetabular angle (AA), and the acetabular depth ratio (ADR) were significantly interrelated (p<0.001; correlation coefficients ranging from −0.8 to 0.7). Fifty-one hips were subluxated (24R/27L). There were no cases of complete dislocation. The formation of subchondral cysts or osteophytes in dysplastic hips was significantly associated with reduced minimum joint space width (p ranging from 0.005 to 0.02). However, in 67 hips with acetabular cysts, only 6 hips had minimum joint space widths =2.0 mm (8.9%) in the coronal plane. In 96 cases with acetabular cysts found in the sagittal plane, 43 cases had minimum joint space widths =2.0 mm (44.7%). Bony rim detachment at the site of labral insertion was recorded in 30 hips. Twenty-three of these were dysplastic (p=0.01). Conclusions Degeneration was most often found in the anterolateral part of the dysplastic hip joints. Most cysts were located above the transition zone between the bony and the fibrocartilaginous acetabulum, and we found a significantly- increased number of cases with avulsed bony fragments at the antero-lateral labral insertion in dysplastic hips compared to normal hips. It seems likely that the early degenerative process in dysplastic hips originates at the watershed zone between the acetabular labrum and the acetabular cartilage in response to subluxation and femoroacetabular impingement.     

Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study

Objective

Morphological correlation between the acetabulum and femur at the hip joint is still controversial. We tested the hypothesis that femoral anteversion correlates with acetabular version and coverage in patients with developmental dysplasia of the hip (DDH).

Materials and methods

Using pelvic computed tomography (CT) images of 79 hips in 49 Asian women with DDH and 49 normal hips, we measured femoral anteversion, the axial and vertical acetabular version and the acetabular sector angle (ASA) to demarcate femoral head coverage. Depending on the location of the acetabular bone defect, dysplastic hips were divided into three subgroups: the anterior, global and posterior deficiency groups. We performed a comparative analysis between dysplastic and normal hips using the Wilcoxon rank sum test, and a relative analysis between femoral anteversion and acetabular measurements in dysplastic hips using Pearson’s correlation coefficient.

Results

The amount of femoral anteversion in dysplastic hips was greater and more variable than in normal hips (p?p?=?0.0277 respectively). Femoral anteversion in dysplastic hips correlated significantly with acetabular anteversion in the groups with anterior and global deficiency subgroups (p?p?Conclusions Our results showed significantly greater and more variable femoral anteversion in DDH, and a significant correlation between femoral anteversion and acetabular version and coverage in DDH with anterior and global acetabular bone deficiency.     

Radiographic measurements of dysplastic adult hips

 Hip dysplasia is a not uncommon feature in adults and can vary from subtle acetabular dysplasia to complex sequelae of developmental dysplasia of the hip. This review article describes the most useful radiographic measurements used to evaluate the adult hip. The frontal projection of the pelvis permits measurement of the center-edge angle (CE angle) and ”horizontal toit externe” angle (HTE angle), both of which assess the superior coverage of the acetabulum. The femoral neck-shaft angle (NSA) is also measured on this view. The false profile radiograph of the pelvis is described. It allows measurement of the vertical-center-anterior angle (VCA angle), which determines the anterior acetabular coverage and detects early degenerative hip joint disease. When surgery is contemplated, computed tomography (CT) is useful to better determine the anterior acetabular coverage by use of the anterior acetabular sector angle (AASA), and the posterior acetabular coverage by use of the posterior acetabular sector angle (PASA). CT also permits measurement of femoral anteversion. These measurements are particularly useful in the evaluation of acetabular dysplasia and for the preoperative assessment of the dysplastic hip.     

Three-dimensional computed tomography analysis of non-osteoarthritic adult acetabular dysplasia

OBJECTIVE: Little data exists on the original morphology of acetabular dysplasia obtained from patients without radiographic advanced osteoarthritic changes. The aim of this study was to investigate the distribution and degree of acetabular dysplasia in a large number of patients showing no advanced degenerative changes using three-dimensional computed tomography (3DCT). MATERIALS AND METHODS: Eighty-four dysplastic hips in 55 consecutive patients were studied. All 84 hips were in pre- or early osteoarthritis without radiographic evidence of joint space narrowing, formation of osteophytes or cysts, or deformity of femoral heads. The mean age at the time of CT scan was 35 years (range 15-64 years). 3D images were reconstructed and analyzed using recent computer imaging software (INTAGE Realia and Volume Player). Deficiency types and degrees of acetabular dysplasia were precisely evaluated using these computer software. RESULTS: The average Harris hip score at CT scans was 82 points. Twenty-two hips (26%) were classified as anterior deficiency, 17 hips (20%) as posterior deficiency, and 45 hips (54%) as lateral deficiency. No significant difference was found in the Harris hip score among these groups. The analysis of various measurements indicated wide variations. There was a significant correlation between the Harris hip score and the acetabular coverage (p < 0.001). CONCLUSION: Our results indicated wide variety of deficiency type and degree of acetabular dysplasia. Hips with greater acetabular coverage tended to have a higher Harris hip score.     

CT false-profile view of the hip: a reproducible method of measuring anterior acetabular coverage using volume CT data

Objective

To devise a simple, reproducible method of using CT data to measure anterior acetabular coverage that results in values analogous to metrics derived from false-profile radiographs.

Materials and methods

Volume CT images were used to generate simulated false-profile radiographs and cross-sectional false-profile views by angling a multiplanar reformat 115° through the affected acetabulum relative to a line tangential to the posterior margin of the ischial tuberosities. The anterolateral margin of the acetabulum was localized on the CT false-profile view corresponding with the cranial opening of the acetabular roof. Anterior center edge angle (CEA) was measured between a vertical line passing through the center of the femoral head and a line connecting the center of the femoral head with the anterior edge of the condensed line of the acetabulum (sourcil). Anterior CEA values measured on CT false-profile views of 38 symptomatic hips were compared with values obtained on simulated and projection false-profile radiographs.

Results

The CT false-profile view produces a cross-sectional image in the same obliquity as false-profile radiographs. Anterior CEA measured on CT false-profile views were statistically similar to values obtained with false-profile radiographs. CT technologists quickly mastered the technique of generating this view. Inter-rater reliability indicated this method to be highly reproducible.

Conclusions

The CT false-profile view is simple to generate and anterior CEA measurements derived from it are similar to those obtained using well-positioned false-profile radiographs. Utilization of CT to assess hip geometry enables precise control of pelvic inclination, eliminates projectional errors, and minimizes limitations of image quality inherent to radiography.     

MR imaging findings of acetabular dysplasia in adults

Objective To evaluate the diagnostic accuracy of MR imaging in the identification of labral and articular cartilage lesions in patients with acetabular dysplasia.Design and patients Pre-operative MR imaging was performed on 27 hips in 25 consecutive patients (16 males, 9 females, age range 19–52 years, mean age 31.2 years) with radiographic evidence of acetabular dysplasia (centre-edge angle of Wiberg <20 degrees). The average duration of symptoms was 16.2 months. Two musculoskeletal radiologists assessed MR images in consensus for the presence of abnormality involving the acetabular labrum and adjacent acetabular articular cartilage. A high resolution, non-arthrographic technique was used to assess the labrum and labral chondral transitional zone. Surgical correlation was obtained in all cases by a single surgeon experienced in hip arthroscopy and ten patients with normal hip MRI were included to provide a control group.Results The acetabular labra in the dysplastic hips demonstrated abnormal signal intensity, and had an elongated appearance when compared with the control group (mean length 10.9 mm vs 6.4 mm). Morphological appearances in the labra included surface irregularity, fissures and cleft formation. MR imaging correctly identified the severity of chondral abnormality in 24 of 27 hips (89%) when compared with arthroscopic findings.Conclusions MR imaging demonstrates an elongated labrum, focal intra-substance signal change and irregularity and fissuring of the margins in patients with acetabular dysplasia. Abnormality is also identified at the labral chondral transitional zone, where fissuring, focal clefts, chondral deficiency and subchondral cyst formation may be apparent. A high-resolution, non-arthrographic technique can provide an accurate preoperative assessment and evaluate the presence of premature osteoarthritis.