发育性髋关节脱位的三维骨骼畸形病理及其手术治疗  

Role of 3 dimentional CT in the management of developmental dislocation of hip

作　　者：赵黎[1] 张劲松[2] 颉强[1] 宦怡[2] 孟杰[1] 李明全[1] 栗向东[1] 黄耀添[1] 

机构地区：[1]第四军医大学西京医院骨科,西安710032 [2]第四军医大学西京医院放射科,西安710032

出　　处：《中华小儿外科杂志》2005年第4期195-199,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的 1.通过采用螺旋CT三维重建(3D-CT)技术研究发育性髋关节脱位(DDH)的骨性病理改变,将术中发现与3D-CT研究发现进行对比,建立3D-CT影像表现与DDH骨骼畸形病理的对应关系;2.根据3D-CT影像和数据测量,指导设计个体化的、有针对性的手术治疗方案.方法 52例DDH手术治疗病例术前采用螺旋3D-CT研究其髋关节的骨骼病理改变;手术年龄13个月～13岁;共58个髋行手术治疗,按照Tnnis分类方法评价脱位程度,I°6髋,II°10髋,III°37髋,IV°5髋;采用 Picker公司PQ6000螺旋机,扫描双侧髋关节和双侧股骨髁部,扫描后的图像重建在独立工作站进行,分别对髋臼和股骨头颈部的形态做前方、后方、侧方和仰视位观察,分别测量髋臼指数(AI)和股骨头颈的前倾角(FNA)等指标.结果 1.DDH骨性病理包括髋臼、股骨头颈和两者的对应关系的变化,其中髋臼的病理可以表现为髋臼方向的变化或者是髋臼的骨性缺损(主要表现在外上缘部位),股骨头颈的前倾角变化是DDH的病理因素之一.测量患侧AI数值平均为32.5°,FNA数值平均为50.2°,明显大于对照侧.2.根据3D-CT影像表现和数据测量,针对不同DDH病例的病理特点不同,实施相应的手术治疗方案,行开放复位52髋,Pemberton或Salter术式32髋, San Diego或Staheli术式26髋,股骨粗隆下旋转截骨术50侧,股骨粗隆下短缩截骨术21侧,术后早期均获得满意头臼对位.结论 3D-CT重建影像所显示的骨骼病理改变与手术中所发现的骨骼病理改变是相互对应的,立体而直观,可以指导制定治疗方案用于骨性结构畸形的矫治,但3D-CT扫描图像仅能反映骨骼形态的改变,尚不能很好地获得软骨和软组织的病理改变的信息.Objective This study was designed to investigate the role of three-dimensional computed tomography(3D-CT)in imaging bony pathology of developmental dislocation of hip(DDH).Methods Fifty-two patients with DDH underwent CT study preoperatively. There were 17 males and 35 females. The age at the surgery ranged from 1~13 years old. Fifty-eight hips were operated. According to Tnnis classification,six hips were graded as I°,10 as II°,37 as III°,and 5 as IV°. PQ6000 spiral CT machine(Picker) was used for this study. The hips and femoral condyles were scanned and the 3D-CT images were constructed at an independent computer workstation. The acetabulum and femoral head were viewed anterior-posteriorly,laterally and cephalo-caudally. The acetabular index(AI) and femoral neck anteversion(FNA)were measured respectively using the MPR technique.Results The bony pathology of DDH included the abnormalities of acetabulum, femoral head and the congruous relationship between acetabulum and femoral head. FNA abnormality was one of the main elements in the DDH pathology. The value of AI was 32.5° and FNA was 50.2° at the involved side, which were significantly larger than that of the control. The surgical treatment was therefore required. 2. According to the 3D-CT imaging findings and geometric measurement, appropriate treatment was undertaken. Open reduction was performed in 52 hips. Pemberton or Salter type procedures were performed in 32 hips,San Diego or Staheli type procedures in 26 hips,derotational osteotomies in 50 femurs,shortening procedures in 21 femurs. The satisfactory congruity between acetabulum and femoral head was achieved in all the cases at the early stage postoperatively.Conclusions 3D-CT reconstruc-tion is a use-ful means for the preoperative recognition and planning for surgical correction of bony abnormalities because of the close correlation between the intra-operative findings and imaging. However, the pathologies of cartilage and soft tissue structures were not clearly shown by 3D-CT image.

关 键 词：发育性髋关节脱位 骨骼畸形 股骨粗隆下旋转截骨术 螺旋CT三维重建 Picker公司 CT影像表现 手术治疗方案 病理改变 3D-CT 股骨头颈 SALTER CT扫描图像 对应关系 数据测量 双侧髋关节 DDH 研究发现 术中发现 CT研究 治疗病例 

分 类 号：R726.8[医药卫生—儿科]