成人髋臼发育不良性骨关节病的X线及CT表现分析

目的:探讨成人髋臼发育不良性骨关节病的X线及CT表现特征。方法:对73例92个成人髋臼发育不良性骨关节病的X线及CT资料进行回顾性分析,73例均拍摄标准的骨盆前后位X线片,42例行CT扫描。X线片上测量反映髋臼发育的指标:外侧中心边缘角(LCE角)、臼顶倾斜角(AI角)、髋臼角(Sharp角)及股骨头突出指数(FEI)。结果:92个成人髋臼发育不良性骨关节病的X线改变为:髋臼发育不良及继发性骨性关节炎,均符合髋臼发育不良的测量指标。42例53个髋CT显示髋臼顶发育不良16髋,髋臼前部发育不良28髋,髋臼前后部均发育不良9髋。结论:髋臼浅小、倾斜及髋臼关节面下囊变、股骨头骨赘是成人髋臼发育不良性骨关节病的常见及较特征性的表现,CT能够比X线片更早且更详细显示。髋臼指标测量能够量化评估髋臼发育不良的程度。     

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。     

急性骨盆创伤骨盆骨折的诊断:平片价值

作者在急性骨盆创伤的诊断中应用CT作为标准,评定平片的价值。共50例,男性36例,女性14例,年龄16～73岁,均于入院时摄前后位平片,25例依前后位平片所见,加拍入口(球管向尾侧倾斜)及出口(球管倾向头侧)平片。12例髋臼创伤加拍双侧斜位。入院24小时内行CT扫描,横断层面,间隔10mm,从髂嵴到髋臼顶,耻骨支用3～4 mm连续扫描。由骨放射学家观察平片与CT所见的差异,确定平片的误诊率。50例CT见162处损伤:10例骶髂关节分离,25例骶骨骨折,14例髂骨骨折,29例髋臼骨折,10例髋脱位,33例耻骨上支骨     

髋关节MR造影检查对发育性髋关节发育不良病人髋臼盂唇损伤程度的评价

目的评价髋关节MR造影检查对发育性髋关节发育不良(DDH)病人髋臼盂唇损伤的诊断价值。方法选取2015年12月—2016年10月进行髋关节MR造影检查的DDH病人16例,其中男3例,女13例,年龄10~20岁,平均(14.88±2.60)岁。对每例病人的患侧髋臼行超声引导下髋关节MR造影检查,分别对前、外上及后盂唇进行观察,由2名影像诊断医师评价盂唇损伤的部位及程度,并以术中诊断结果作为金标准进行对比。采用Kappa检验计算髋关节MR造影检查与术中诊断的一致性。结果 16例病人共48处盂唇,无撕裂37处(0期32处,Ⅰ期损伤5处),髋臼实质部撕裂3处,髋臼盂唇-软骨连接区撕裂8处。术中所见无撕裂38处,髋臼实质部撕裂3处,髋臼盂唇-软骨连接区撕裂7处。髋关节MR造影诊断髋臼盂唇撕裂的敏感度为100%,特异度为97.37%,阳性预测值为90.91%,阴性预测值为100%。MR髋关节造影检查与术中诊断的一致性较好(Kappa=0.939,P0.001)。髋关节MR造影显示盂唇肥大、内翻2例,均为前盂唇,与术中所见相吻合。结论髋关节MR造影检查对DDH病人髋臼盂唇损伤诊断的敏感性和特异性均较高,可作为术前常规检查手段。     

脊柱侧弯术前CT检查的应用价值

目的 :探讨脊柱侧弯术前CT检查的应用价值。材料和方法 :分析 97例脊柱侧弯患者术前CT平扫影像特征。结果 :其中椎体发育不良 2 8例 ;椎管发育不良 7例 ;小关节发育不良 15例 ;椎板及棘突发育不良 2 1例 ;脊柱裂 5例 ;椎管内骨嵴 10例 ;脊髓纵裂 4例 ;肋骨发育异常 2例。结论 :脊柱侧弯术前CT扫描检查可了解椎管发育的情况 ,为保证手术安全提供重要的依据     

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.     

成人髂骨、股骨一次延长术

 目的设计髂骨延长术和股骨上端延长术在一个切口内联合应用.达到一次延长短肢的同时,改善髋臼发育不良和股骨前倾角畸形.方法自1996年7月～2002年7月用该方法共实施成人脊髓灰质炎后遗症严重短肢畸形合并髋臼发育不良和股骨上端畸形9例.结果9例中,髂骨延长从1.3～4.0 cm,平均2.5 cm;股骨延长从1.2～3.5 cm,平均2.3 cm;髋臼CE角术前平均6.88°,术后36.1°;股骨前倾角进一步改善.结论髂骨股骨一次延长术是纠正严重短肢合并髋臼发育不良和股骨上端畸形的一种新的有效的治疗方法.     

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     

2岁以下小儿发育性髋关节发育不良髋关节软骨T2 mapping分析

目的探讨2岁及2岁以下发育性髋关节发育不良(DDH)患儿股骨头软骨及髋臼软骨T2值的变化规律。方法回顾性收集2岁及2岁以下行髋关节MR T2 mapping检查的幼儿59名,其中临床和MR检查异常并确诊DDH的患儿34例(年龄5~24个月),同期MRI检查正常且临床明确除外DDH的正常幼儿25名(年龄5~24个月)。全部幼儿按年龄分为3组:组1,年龄≤6个月(DDH 7例,对照7名);组2,6个月<年龄≤12个月(DDH 4例,对照6名);组3,12个月<年龄≤24个月(DDH 23例,对照12名)。在T2 mapping横断面影像上将股骨头软骨分为8个亚区(F1~F8),髋臼软骨分为6个亚区(A1~A6),在每个亚区选取兴趣区(ROI)并测量其T2值。DDH患儿和对照者间的T2值比较采用独立样本t检验。3组DDH患儿各软骨亚区间T2值比较采用单因素方差分析,组间两两比较采用SNK法。采用Spearman相关分析DDH患儿软骨T2值与年龄的相关性。结果与正常对照者软骨T2值比较,组1中DDH患儿A1、A3亚区的T2值较高(均P<0.05);组2中DDH患儿F3~F5亚区及A1、A3、A4亚区T2值较高(均P<0.05);组3中DDH患儿F1~F8亚区及A1~A4亚区T2值较高(均P<0.05);其他各软骨亚区T2值在正常幼儿与DDH患儿间的差异均无统计学意义(均P>0.05)。3组DDH患儿各软骨亚区间T2值比较差异均有统计学意义(均P<0.05),股骨头软骨中F3~F6亚区的T2值在组2最高,其余4个亚区的T2值均为组1最高(均P<0.05);髋臼软骨各亚区T2值均为组1最高(均P<0.05)。DDH患儿股骨头软骨和髋臼软骨各亚区T2值与年龄呈中度或高度负相关。结论应用T2 mapping成像可定量评价DDH患儿的股骨头软骨及髋臼软骨的生长发育情况,为髋关节软骨的评估提供重要指导。     

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...     

Avascular osteonecrosis of the acetabulum

 Objective. To investigate the possible occurrence of osteonecrosis in the acetabulum in patients with non-traumatic necrosis of the femoral head. Design and patients. One hundred and seventy-nine patients with non-traumatic femoral head necrosis were assessed by MRI and radiography for the presence of acetabular necrosis. Three criteria were established to differentiate between osteonecrosis and osteoarthritic changes: (1) heterogeneous morphology and irregular contours of the lesion; (2) typical demarcation lines of osteonecrosis; (3) deficient accumulation of intravenous gadolinium in the affected regions. Results. In four patients histological confirmation of acetabular necrosis was obtained. The MR analysis of 22 acetabula (9.5% of those examined) showed changes which suggested osteonecrosis. No cystic lesions were demonstrated in the subchondral bone of any patient. Two cases of acetabular necrosis were found without an ipsilateral femoral head necrosis. In two patients of the 14 who had undergone total hip replacement following necrosis of the femoral head, aseptic loosening of the acetabular component was found. Conclusion. The study suggests that acetabular necrosis may be an accompaniment to aseptic necrosis of the femoral head. Further work is required to assess its importance in premature loosening of the acetabular element of total hip arthroplasty.     

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.     

人工髋臼接触力学特性的有限元分析

目的 考察人工超高分子量聚乙烯髋关节臼的接触力学特性.方法 建立人工髋臼模型,对模型进行网格划分,在接触区域建立接触对,按真实人体关节对模型进行边界条件的设定后进行有限元接触力学分析.对不同条件下(摩擦系数0～0.25,髋臼厚度6～12 mm,髋臼直径26～32 mm)的髋臼分别进行步态分析.结果 计算结果显示压缩变形量在接触面摩擦系数增大、髋臼直径增加情况下均呈现下降趋势.接触层厚及接触面积受髋臼厚度的影响在不同尺寸处体现不同的特性,接触面积和层厚对于植入假体的稳定性及磨粒的产生有重要影响.结论 综合考虑两者的作用效果认为7～9 mm厚的髋臼表现效果较好.     

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.     

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.     

Arthroscopic labral repair concomitantly performed with curved periacetabular osteotomy

A 23-year-old female presented with pain in the left hip. Radiological examination showed developmental dysplasia of the hip (DDH) combined with acetabular retroversion and posterior wall deficiency. Findings in the physical examination were coincident with femoroacetabular impingement. At surgery, we performed curved periacetabular osteotomy concomitant with arthroscopic labral repair and osteochondroplasty, simultaneously addressing dysplastic acetabulum and femoroacetabular impingement. The final follow-up examination at 18 months showed satisfactory outcome with the D’Aubigne and Postel hip score of 17/18. In addition to accurate diagnosis, the arthroscopic procedure for associated intra- and peri-articular problems seems to help improve the surgical outcome of periacetabular osteotomy performed for patients with DDH. Level of evidence IV.     

Acetabulum protrusio and center edge angle: new MR-imaging measurement criteria—a correlative study with measurement derived from conventional radiography

Objective  The goal of this study was to identify a method of measurement for acetabulum protrusio and center edge angle (CEA) using MR imaging of the pelvis that correlated with classic methods using radiographic landmarks. Materials and methods  MR images and radiographs of the pelvis in 67 patients (132 hips) were used to identify reliable MR-imaging methods for measuring protrusio acetabulum and CEA that correlated strongly with established radiographic measurements. Protrusio acetabulum was determined using the radiographic criterion that the acetabular line projects medial to the ilioischial line by 3 mm or more in men and 6 mm or more in women. Pearson correlation factor was used to determine inter-observer variability and those methods that demonstrated the strongest correlation. The mean and standard deviation of MR-imaging and radiographic measurements for both the normal and protrusio hips were established. Results  Several MR methods correlated strongly with radiographic measurements. The preferred method employed axial MR images at the level of the ischial spine with measurement of the distance between the medial most point of the acetabular fossa and a line perpendicular to the horizontal axis that passed through the lateral margin of the posterior inner pelvic wall. The Pearson’s correlation factor between radiographic and MR measurements using this method was 0.84, and inter-observer correlation was 0.80. There were 126 hips in 63 patients (17 female and 44 male) that did not meet the radiographic criteria for protrusio acetabula. In this group of normal hips, the mean and standard deviation of radiographic measurements were 1.9 and 2.8 mm in male patients and −0.5 and 1.7 mm in female patients, and the mean and standard deviation for the preferred MR method was 1.3 and 2.5 mm in male patients and −0.8 and 1.9 mm in female patients. A total of six hips in four patients (two female and two male) met the radiographic criteria for protrusio acetabula. In this group of patients, the mean and standard deviation of radiographic measurements were −3.7 and 1 mm in male patients and −5.4 and 0.9 mm in female patients, and the mean and standard deviation for the preferred MR method was −4.1 and 0.4 mm in male patients and −6.5 and 0.3 mm in female patients. Our study also showed that the CEA was best measured using anterior to middle coronal MR images. Posterior coronal MR-imaging measurements correlated poorly with radiographic measurements. Conclusion  MR imaging can be used to assess acetabular morphology and measure acetabulum protrusio. The research was performed at VASDHS, La Jolla, CA.