三维CT评价骨盆内移截骨后青少年髋臼发育不良的效应  

Effect of Chiari’s osteotomy for adolescents with acetabular dysplasia evaluated by three-dimensional CT

作　　者：李连永[1] 吉士俊[1] 张立军[1] 李祁伟[1] 赵群[1] 

机构地区：[1]中国医科大学附属盛京医院小儿骨科,辽宁省沈阳市110004

出　　处：《中国组织工程研究与临床康复》2009年第22期4304-4308,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景：通过传统的X射线评价,Chiari截骨能明显改善股骨头的覆盖,但对截骨后效果的三维立体评价研究很少。目的：利用三维CT评价Chiari截骨术后髋关节的形态变化,同时比较X射线及三维CT方法测量股骨头覆盖是否存在差异。设计、时间及地点：测量性试验,病例来自2003-01/2006-12中国医科大学附属盛京医院小儿骨科。对象：选择中国医科大学附属盛京医院小儿骨科收治的髋臼发育不良患儿12例（12髋）,男5例,女7例;左侧8例,右侧4例;手术时年龄7.2～15.2岁,平均11.5岁。方法：12例患者（12髋）均行Chiari截骨治疗。5髋在关节囊外截骨，7髋行关节囊小切口紧邻髋臼外上缘截骨。根据Colton提出的评分方法进行临床功能评价；在前后位X射线平片测量手术前、后的股骨头覆盖率及截骨的高度；在三维CT图像上测量股骨头前1／4、中1，2、后1/4部位的覆盖率。主要观察指标：X射线测量截骨前后股骨头覆盖率、截骨高度；三维CT测量冠状面上股骨头前1／4、中1／2、后1／4的覆盖率及髋臼前倾角；Colton法测量髋关节的功能评分。结果：所有12髋术后临床功能评定，优6髋，良3髋，3髋为一般；在切开关节囊的7髋中，优2髋，良3髋，未行关节囊切开的5髋中，优良各2髋；在切开关节囊的髋中，截骨高度低于未行关节囊切开髋中的截骨高度[（3．64±1．54），（11．00±2．09）mm，P〈0．01]；不同截骨高度与临床评定结果之间差异无显著性意义（P〉0．05）。术前9例有明显的髋痛，随访时，5例已无疼痛（其中4髋截骨高度适宜），4髋截骨过高者仍有疼痛；无深部感染、坐骨神经损伤、骨不连等严重并发症发生。术后，X射线及三维CT测得的股骨头覆盖率较术前均明显增加（P〈0．01）；但三维CT测得的股骨头前外侧、中外侧覆盖率明显小于X射线测量结果（P〈0．01）；术后�BACKGROUND： Traditional radiographic evaluation has demonstrated that the Chiari＇s osteotomy can provlde a sufficient osseous cover over the femoral head. However, there are few studies on three-dimensional evaluation following Chiari＇s osteotomy. OBJECTIVE： To evaluate the morphological changes of the hips after Chian＇s osteotomy, and to compare the difference of the femoral head coverage measured by three-dimension computed tomography （3D-CT） and radiographic findings. DESIGN, TIME AND SETTING： Measurement. The patients included in this study were selected from the Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University between January 2003 and December 2006. PARTICIPANTS： A total of 12 patients （12 hips） with acetabular dysplasia were selected, including 7 females and 5 males; 8 cases of the left and 4 cases of the right. The average age at operation was 11.5 years （ranging 7.2-15.2 years）. METHODS： All the patients were treated by Chiari＇s osteotomy. In 5 hips, an extra-articular osteotomy was performed. In the remaining hips, a minimal opening was made into the anterosuperiorjoint capsule for locating the acetabular edge accurately. The clinical function was evaluated using Colton scoring method. The femoral head coverage （anterior 1/4, middle 1/2, and posterior 1/4） and osteotomy height were measured by X-ray method. MAIN OUTCOME MEASURES： The anterolateral, mediolateral and posterolateral femoral head coverage and acetabular anteversion angle were evaluated by 3D-CT method. Colton＇s score system was used to assess the clinical function of the hip. RESULTS： In the clinical function evaluation of 12 hips, 6 hips were excellent, 3 were good and 3 were general. Of the 7 hips undergoing joint capsule opening, 2 were excellent and 3 were good; of the 5 hips without joint capsule opening, 2 were excellent and 2 were good. The average osteotomy height was lower in the intra-articular osteotomy group than in the extra-articular osteotomy

关 键 词：髋臼发育不良 骨盆内移截骨术 青少年 三维CT 

分 类 号：R687[医药卫生—骨科学]