儿童发育性髋关节脱位MRI表现与病理对照研究  

Correlation study of MRI and pathology findings of children with developmental dislocation of the hip

作　　者：王亮[1] 盛茂[1] 张闽[2] 方林[1] 袁泉文[3] 张明常[1] 

机构地区：[1]苏州大学附属儿童医院放射科,江苏215003 [2]苏州大学附属儿童医院病理科,江苏215003 [3]苏州大学附属儿童医院骨科,江苏215003

出　　处：《放射学实践》2015年第3期282-285,共4页Radiologic Practice

摘　　要：目的:探讨MRI对儿童发育性髋关节脱位(DDH)的诊断价值。方法:回顾性分析63例经手术证实的DDH的MRI表现。根据Dunn标准将63例DDH分为三型(Ⅰ型、Ⅱ型、Ⅲ型),观察影响DDH复位的因素(关节积液、关节内脂肪增生、盂唇、圆韧带、髂腰肌)。结果:正常髋关节数共为53个,脱位髋关节数共为73个,其中Ⅰ型30个、Ⅱ型20个、Ⅲ型23个。Ⅱ型和Ⅲ型脱位髋关节中观察到盂唇内翻外翻、圆韧带粗大、髂腰肌挛缩、关节积液、脂肪增生等病理变化。MRI对病变盂唇显示的敏感度、特异度、阳性预测值、阴性预测值、符合率分别为70.9%、75.0%、88.0%、50.0%、72.1%(Kappa值为0.3986);对圆韧带显示的敏感度、特异度、阳性预测值、阴性预测值、符合率分别为60.0%、66.7%、71.4%、54.5%、62.7%(Kappa值为0.2586);对髂腰肌挛缩的显示敏感度、特异度、阳性预测值、阴性预测值、符合率分别为80.0%、91.3%、88.9%、84.0、86.0%(Kappa值为0.7177),对关节积液及脂肪增生显示的符合率为100%。结论:MRI能较准确地显示关节积液、关节内脂肪增生、盂唇病变、髂腰肌挛缩,能为外科手术提供有价值的信息。Objective：To assess the value of MRI in the diagnosis of developmental dislocation of hip（DDH）.Methods：MRI findings of 63 children with DDH proved by surgery were retrospectively analyzed.The 63 cases were classified into TypeⅠ,TypeⅡ and TypeⅢ according to the standard of Dunn.The influential factors in embole of DDH including joint effusion,intra-articular fat hyperplasia,labrum,ligamentum teres,iliopsoas were studied.Results：Of the 63 cases,there were 53 normal hip joints and 73 dislocated hip joints including typeⅠ（n=30）,typeⅡ（n=20）and type Ⅲ（n=23）.Pathological changes such as labrum enstrophe or ecstrophy,thickened ligamentum teres,ilio-psoas contracture,joint effusion,fat hyperplasia could be observed in the dislocated hip joints of typeⅡandⅢ.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the affected labrum of MRI was 70.9%,75.0%,88.0%,50.0% and72.1%,respectively（Kappa=0.3986）.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of of MRI in displaying thickened ligamentum teres was 60.0%,66.7%,71.4%,54.5% and 62.7%,respectively（Kappa=0.2586）.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of MRI in showing ilio-psoas contracture was 80.0%,91.3%,88.9%,84.0% and 86.0%,respectively（Kappa=0.7177）.The accuracy of the diagnosis of fat hyperplasia and joint effusion by MRI was 100%.Conclusion：MRI can accurately display joint effusion,intra-articular fat hyperplasia,labrum changes and ilio-psoas contracture,which can provide reliable information for surgery treatment.

关 键 词：儿童 发育性髋关节脱位 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R726.8[医药卫生—诊断学]