单侧发育性髋关节发育不良骨盆不对称的影像学研究  

Pelvic asymmetry in unilateral developmental dysplasia of the hip:radiologic study of anatomy

作　　者：李亚民[1] 李珏宏[1] 彭晓春[1] 陈云苏[1] LI Ya-min;LI Jue-hong;PENG Xiao-chun;CHEN Yun-su(Department of Orthopaedics,Sixth People＇s Hospital,Shanghai Jiaotong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《骨科》2018年第5期347-353,共7页ORTHOPAEDICS

基　　金：上海市卫生和计划生育委员会课题(201840032)

摘　　要：目的研究单侧发育性髋关节发育不良(developmental dysplasia of the hip, DDH)病人双侧骨盆是否对称,以及骶髂远侧关节连线是否适合作为全髋关节置换术(total hip arthroplasty, THA)时髋臼假体植入和下肢长度平衡的参考。方法回顾性分析我院2012年9月至2015年8月的165例单侧DDH病人的影像学资料,其中,男31例,女134例。在165例DDH病人的标准骨盆正位X线片上,利用骶髂远侧关节连线和双侧髋臼泪滴连线将骨盆分成三部分(髂翼部分、髋臼部分和坐骨部分),测量骨盆高度及其骨盆各部分的高度值,测量骶髂远侧关节连线分别与过L4椎体下缘直线、髂嵴最高点连线、髋臼泪滴连线和坐骨结节连线之间的夹角值(分别为角α、β、γ、δ)。选择40例正常人作为对照组,比较CroweⅠ~Ⅳ型DDH病人及对照组之间各项指标的差异。结果 Crowe Ⅲ、Ⅳ型单侧DDH病人患侧和健侧的骨盆高度差异有统计学意义(P<0.001);但CroweⅠ、Ⅱ型病人患侧和健侧的骨盆高度差异无统计学意义(P>0.05)。在髂翼部分、髋臼部分、坐骨部分,Crowe Ⅱ、Ⅲ、Ⅳ型DDH病人患侧与健侧的高度差异均有统计学意义(P均<0.05),而CroweⅠ型病人健侧与患侧各部分的差异均无统计学意义。对照组与CroweⅠ~Ⅳ型DDH病人间α角的差异不大,但β、γ和δ角的角度差异均有统计学意义(P均<0.05)。结论DDH影响整个骨盆解剖结构的发育,发育不良程度越大,骨盆的不对称性和各部位的变化越明显。在单侧CroweⅢ、Ⅳ型DDH病人THA术中,推荐在泪滴上方5~9 mm置入髋臼假体和使用骶髂远侧关节连线作为平衡下肢长度的参考。Objective To investigate how pelvic asymmetry presents in patients with unilateral developmental dysplasia of the hip （DDH）, whether the ‘acetabular teardrop’ is appropriate for determination of placement of acetabular components, and leg length balancing in total hip arthroplasty （THA） for those patients. Methods We separated the pelvis into three parts by joining lines through teardrops and distal sacroiliac joints, measured the heights of the pelvis and each part in 165 patients with unilateral Crowe Ⅰ-Ⅳ DDH and 40 normal controls on anteroposterior radiographs of the pelvis. We measured and compared the angles between the line drawn from the inferior sacroiliac joints and lines through the bottom of the fourth lumbar body, apices of the crista iliaca, acetabular teardrops and ischium inferiors, respectively. Results In patients with unilateral DDH, differences in pelvic height in type Ⅲ and Ⅳ were significant but not in type Ⅰ and Ⅱ. In each part, significant differences were observed between the DDH side and healthy side in types Ⅱ, Ⅲ and Ⅳ, but not in type Ⅰ. There were no significant differences in angle α in the control group and types Ⅰ-Ⅳ DDH, but significant differences were noted in angles β, γ, and δ between the control group and the four types. Conclusion DDH affects development of the entire pelvis. The greater degree of hip dysplasia, the more amplified is the change of pelvic asymmetry and each part. Given the distal teardrop in unilateral DDH, placement of the acetabular component 5-9 mm superior in type Ⅲ and Ⅳ dysplastic hips and using the line connecting the distal sacroiliac joints as the maker to balance leg length are recommended.

关 键 词：髋脱位 先天性 关节成形术 置换 髋 骨盆不对称 放射学解剖 

分 类 号：R684[医药卫生—骨科学]