拍摄体位对发育性髋关节发育不良X线评估指标的影响  

Effects of shooting position on X-ray evaluation index of developmental hip dysplasia

作　　者：杨国跃[1] 李雅玥[2] 罗殿中[3] 程徽 肖凯 张洪[3] Yang Guoyue;Li Yayue;Luo Dianzhong;Cheng Hui;Xiao Kai;Zhang Hong(Department of Orthopaedics,the Third Central Hospital of Tianjin,Tianjin 300170,China;Tianjin Key Laboratory of Artificial Cell,the Third Central Hospital of Tianjin,Tianjin 300170,China;Department of Orthopaedics,the Fourth Medical Center of the Chinese People's Liberation Army General Hospital,Beijing 300048,China)

机构地区：[1]天津市第三中心医院骨科,300170 [2]天津市第三中心医院天津市人工细胞重点实验室 [3]解放军总医院第四医学中心骨科,北京100048

出　　处：《中华骨科杂志》2019年第15期954-960,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨拍摄体位对发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者骨盆矢状面倾斜及髋关节发育X线参数的影响。方法2015年12月2016年10月收集接受伯尔尼髋关节周围截骨术的女性DDH患者78例(DDH组),年龄(28.41±9.91)岁(范围18~49岁);共135髋,单侧21例、双侧57例。另招募26名(52髋)无脊柱及髋关节疾病的女性志愿者(对照组),年龄(23.54±5.58)岁(范围18~49岁)。两组均拍摄仰卧位和站立位骨盆前后位X线片。通过测量骶尾关节至耻骨联合的距离(pubic symphysis to sacrococcygeal distance,PSSC)评估骨盆矢状面倾斜程度,以外侧中央边缘角、臼顶倾斜角、Sharp角评估髋关节发育不良程度,以泪滴距评估股骨头与髋臼的水平位置关系。数据均由两名测量者分别测量2次,分析骨盆及髋关节参数与拍摄体位的相关性。结果对照组仰卧位和站立位PSSC分别为(53.73±16.22)mm、(36.45±14.21)mm,差值为(-17.28±8.07)mm,两组差异有统计学意义(t=-10.913,P=0.000);DDH组仰卧位和站立位PSSC分别为(56.76±13.54)mm、(48.62±15.44)mm,差值为(-8.13±13.02)mm,两组差异有统计学意义(t=-5.516,P=0.000);站立位时DDH组PSSC大于对照组,仰卧位时两组差异无统计学意义。单侧、双侧DDH患者两种体位PSSC的差异均无统计学意义(P>0.05)。对照组仰卧位和站立位外侧中央边缘角分别为30.33°±4.69°和29.70°±3.83°、臼顶倾斜角分别为4.05°±3.51°和4.36°±3.07°、Sharp角分别为40.53°±4.34°和41.79°±3.16°、泪滴距分别为(6.80±0.98)mm和(6.65±1.30)mm,差异均无统计学意义(P>0.05);DDH组仰卧位和站立位外侧中央边缘角分别为3.07°±12.07°和1.69°±12.11°、臼顶倾斜角分别为22.62°±9.31°和23.82°±9.45°、Sharp角分别为48.01°±4.68°和48.49°±4.74°、泪滴距分别为(10.51±3.51)mm和(10.93±4.23)mm,差异均有统计学意义(P<0.05)。结论从仰卧位到站立位骨盆矢状面以后倾为主要趋势,与Objective To explore the impacts of the imaging positions on the sagittal tilt of the pelvis and the imaging parameters of the hip joint. Methods From December 2015 to October 2016, a total of 78 female DDH patients (DDH group) who received Bernese periarticular osteotomy were enrolled, aged 28.41±9.91 years (range 18-49 years) with 135 hips. There were 21 cases on one side and 57 cases on both sides. Another 26 female volunteers without spinal and hip disease were enrolled as the control group, aged 23.54±5.58 years (range 18-49 years) with 52 hips. X-ray films of the anterior and posterior pelvis were performed in both groups. The pelvic sagittal tilt was evaluated by measurement (pubic symphysis to sacrococcygeal distance, PSSC), with lateral center-edge angle of Wiberg (LCEA), T?nnis angle (TA), and Sharp angle (angle of Sharp, SA) assessed the degree of hip dysplasia and assessed the horizontal positional relationship between the femoral head and the acetabulum using tear drop distance (TD). All data were measured twice by two measurers independently. The correlation between hip parameters and X-ray position was analyzed. Results The average PSSC in the supine and standing positions of the control group were 53.73±16.22 mm and 36.45±14.21 mm, respectively with significant difference-17.28±8.07 mm (t=-10.913, P=0.000). The PSSC of the supine and standing positions of the DDH group were 56.76±13.54 mm and 48.62±15.44 mm, respectively with significant difference-8.13±13.02 mm (t=-5.516, P=0.000). The PSSC of the standing DDH group was larger than that in the control group. There was no significant difference in the PSSC between the two groups in the supine position. Furthermore, there were no significant difference in the supine and standing PSSC between the unilateral and bilateral DDH patients (P>0.05). In the control group, the hip in supine and standing position, LCEA averaged 30.33°±4.69° and 29.70°±3.83°(P>0.05), and TA averaged 4.05°±3.51° and 4.36°±3.07°(P>0.05), respectively. SA ave

关 键 词：髋脱位 先天性 骨盆 摄影测量法 截骨术 

分 类 号：R681.1[医药卫生—骨科学]