发育性髋关节脱位术后再脱位的三维CT分析

目的 利用3DCT影像,来探讨DDH术后再脱位的髋臼及股骨近端的骨性病理形态改变,以分析术后再脱位的原因,从而指导和改进DDH的手术治疗.方法 对28例(28髋)DDH术后再脱位患儿的3DCT影像资料进行分析,测量其髋臼前外侧缘倾斜角、髋臼后外侧缘倾斜角、侧面髋臼上缘倾斜度、前髋臼指数、后髋臼指数、髋臼前倾角、股骨颈前倾角、颈干角等参数指标,并观察髋臼外上缘(中上缘)的形态及股骨头与髋臼是否为同心圆复位关系等,并与38例(51髋)手术成功患儿术后值以及正常组(健侧组)进行对比分析,来探讨术后再脱位的原因.结果 术后再脱位组患儿的颈干角为(158.4±10.1)°,与正常组的(138.1±7.2)°和手术成功组的(139.0±5.9)°比较,数值明显增大,差异均有统计学意义;术后再脱位组患儿髋臼外上缘重型缺损者所占比例为82.14%与手术成功组的3.92%比较,差异有统计学意义;术后再脱位组所有患儿均未能恢复髋关节的同心圆复位关系,而所有手术成功组患儿的髋关节均恢复或接近恢复了同心圆复位关系.结论 术后再脱位原因与颈干角的角度、髋臼外上缘形态、股骨头与髋臼是否恢复同心圆复位关系等密切相关.

Analysis of the causes for hip joint re-dislocation after triad-osteotomy in the patients with developmental dislocation of hip joint

Objective To analyze the causes for hip joint redislocation after triad-osteotomy in the patients with developmental dislocation of hip joint(DDH) using three-dimensional computed tomography(3D-CT)technique.Methods Twenty eight hips of 28 children with DDH underwent triad-osteotomy and had hip joint redislocation were recruited in this study as re-dislocation group.Pictures of 3D-CT was gained, and anterior lateral acetabular lip angle(ALAL),posterior lateral acetabular lip angle(PLAL),lateral acatabular incline(LAI),anterior aeetabular index(AAI),posterior acetabular index(PAI),acetabular anteversion(AA),femoral neck anteversion(FNA)and femoral neck shaft angle were measured.The morphology of latero-superior(mid-superior)part of acetabulum and concentric position of acetabulum and femoral head was also studied.Fifty hips of 38 DDH patients(non-redislocation group)who underwent surgery but without hip joint redislocation and normal hips were taken as controls.Results The neck shaft angle was significantly larger in the patients of redislocation group than that of controls.The ineidence of severe defects in latero-superior acetabulum was significantly higher in re-dislocation group than that of the non-redislocation group.In re-dislocation group.all the hips were abnormal in concentric position,while in the non-redislocation group,all the hips appeared normal or nearly normal concentric position.Conclusions The causes for redislocation after triad-osteotomy are associated with abnormal neck shaft angle,the morphology of laterosuperior acetabular rim and the concentric position of acetabulmn and femoral head.