三维表面遮盖法结合多平面重建在成人髋关节发育不良全髋关节置换术前髋臼评估中的应用  

COMBINATION SURFACE SHADED DISPLAY WITH MULTIPLANAR RECONSTRUCTION IN THE EVALUATION OF ACETABULAR MORPHOLOGIES IN PATIENTS WITH DEVELOPMENTAL DYSPLASIA OF THE HIP BEFORE TOTAL HIP ARTHROPLASTY

作　　者：刘瑞宇[1] 王坤正[1] 王春生[1] 同志勤[2] 宁文德[3] 杨想春[3] 

机构地区：[1]西安交通大学医学院第二附属医院骨科,西安710004 [2]西安交通大学医学院第二附属医院影像中心,西安710004 [3]西安市中心医院影像中心

出　　处：《中国修复重建外科杂志》2008年第6期643-645,共3页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：陕西省科技计划资助项目[2007K12-02(16)]~~

摘　　要：目的探讨成人髋关节发育不良行全髋关节置换术前应用螺旋CT三维表面遮盖法(surface shaded display,SSD)结合多平面重建(multiplanar reconstruction,MPR),评估髋臼形态的方法及临床应用价值。方法2003年10月-2006年11月,对17例19髋拟行全髋关节置换术的成人髋关节发育不良伴骨性关节炎的患者进行螺旋CT扫描。男3例,女14例;年龄35～61岁。双侧2例,单侧15例。CroweⅠ型4髋,Ⅱ型9髋,Ⅲ型6髋。对扫描获取的原始髋关节图像应用SSD结合MPR技术,观察髋臼的空间位置和髋臼壁骨贮备情况。结果患髋脱位程度按照Crowe等的方法测量为25%～89%,Sharp角均>45°。患侧髋臼均存在不同程度骨缺损,5髋位于髋臼前上方,11髋位于髋臼外上方,3髋位于髋臼后上方。MPR冠状面和轴面成像示髋臼内侧壁最薄处的厚度为2.0～10.9 mm。15例单侧脱位患者患侧与健侧髋臼比较,髋臼开口相差2.7～19.1 mm,深度相差2.3～13.1 mm。结论螺旋CT的SSD结合MPR技术是评估髋臼形态学的有效手段,对成人髋关节发育不良行全髋关节置换术中的髋臼重建具有重要指导意义。Objective To explore the methods and application value of surface shaded display （SSD） and multiplanar reconstruction （MPR） in the evaluation of acetabular morphology in patients with developmental dysplasia of the hi p （DDH） before total hip arthroplasty （THA）. Methods From October 2003 to November 2006, 17 patients （3 males and 14 females, aging from 35 years to 61 years） with osteoarthrifis secondary to DDH were scanned with spiral CT preoperatively. According to the Crowe standard, 19 dysplasia hips were classified as type I in 4 hips, type II in 9 hips, type III in 6 hips. The obtained hip CT data were developed with SSD and MPR to observe spational position and bone stock of the acetabula. Results The dislocated extent was 25%-89% in these dysplasia hips according to the Crowe method and their sharp angles all exceeded 45°. Bone defect occurred to each of the acetabula, among which it was located in anterosuperior acetabulum in 5 hips, in superolateral acetabulum in 11 hips and in posterosuperior acetabulum in 3 hips. The hi p images made with MPR showed that the minimum thickness of the medial wall of acetabula ranged from 2.0 mm to 10.9 mm. Among 15 unilateral dysplasia patients, the opening difference and depth difference between the dysplasia acetabulum and the contralateral one ranged from 2.7 mm to 19.1 mm and from 2.3 mm to 13.1 mm, respectively. Conclusion SSD and MPR of spiral CT are effective methods in evaluating acetabular morphology preoperation and contribute to intraoperative acetabular reconstruction in patients with DDH performed THA.

关 键 词：髋关节发育不良 髋臼形态学 螺旋CT 全髋关节置换术 

分 类 号：R687.3[医药卫生—骨科学]