无症状人群与发育性髋关节发育不良人群髋臼三维朝向的半自动测量与对比分析  

Semi-automated measurement and analysis of three-dimensional acetabular orientation in asymptomatic population and patients of developmental dysplasia of the hip

作　　者：江旭 张恒辉[1] 胡旭民[2] 谢凯[1] 阚天佑 李波 张弛[2] 艾松涛[3] 高梁斌[2] 严孟宁[1] 王燎[1] JIANG Xu;ZHANG Henghui;HU Xumin;XIE Kai;KAN Tianyou;LI Bo;ZHANG Chi;AI Songtao;GAO Liangbin;YAN Mengning;WANG Liao(Department of Orthopedics,Shanghai Key Laboratory of Orthopaedic Implants,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200011,P.R.China;Department of Orthopedics,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou Guangdong,510120,P.R.China;Department of Radiology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200011,P.R.China)

机构地区：[1]上海交通大学医学院附属第九人民医院骨科上海市骨科内植物重点实验室,上海200011 [2]中山大学孙逸仙纪念医院骨科,广州510120 [3]上海交通大学医学院附属第九人民医院影像科,上海200011

出　　处：《中国修复重建外科杂志》2021年第12期1555-1562,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81772425);上海市科学委员会资助项目(16441908700);上海交通大学医工交叉项目(YG2016MS11);上海交通大学医学院转化医学协同创新中心合作研究项目(TM201814)。

摘　　要：目的比较分析无症状人群与发育性髋关节发育不良(developmental dysplasia of the hip,DDH)人群的髋臼三维朝向,为髋部疾病的鉴别诊断、手术规划、植入器械设计及术后评估等提供数据参考。方法回顾性收集符合选择标准的无症状人群骨盆CT 84例(无症状组)和DDH患者骨盆CT 47例(DDH组)。两组人群性别构成及年龄(包括男女亚组年龄)比较差异均无统计学意义(P>0.05)。使用半自动测量软件MaxTHA测量3种定义下的前倾角和外展角,包括手术学外展角(operative inclination,OI)、影像学外展角(radiographic inclination,RI)、解剖学外展角(anatomic inclination,AI)、手术学前倾角(operative anteversion,OA)、影像学前倾角(radiographic anteversion,RA)和解剖学前倾角(anatomic anteversion,AA),并进行两人群间、不同Crowe分型亚组间、各性别亚组间及左右侧间的比较。结果无症状组与DDH组健、患侧间比较显示,无症状组与DDH组健侧的髋臼朝向各角度参数差异均无统计学意义(P>0.05);DDH组患侧的OI、RI、AI显著大于健侧和无症状组,AA显著小于健侧和无症状组,差异有统计学意义(P<0.05)。正常髋臼与DDH组不同Crowe分型组间比较显示,CroweⅠ型组与正常组髋臼朝向各角度参数比较差异均无统计学意义(P>0.05);CroweⅡ、Ⅲ、Ⅳ型组OI、RI、AI显著大于正常组,CroweⅢ型组的OI、Ⅳ型组的RI和AI显著大于Ⅰ型组,Ⅳ型组的AI显著大于Ⅱ型组(P<0.05);CroweⅢ型组OA、RA、AA显著小于除Ⅰ型组外的各组(P<0.05)。无症状组女性的OA、RA、AA以及DDH组女性的OA、AI显著大于对应组男性,差异有统计学意义(P<0.05)。无症状组男性右侧髋臼的OI、RI、AI、OA以及女性右侧髋臼的RI、AI均显著大于左侧,差异有统计学意义(P<0.05)。结论髋臼朝向在无症状人群和DDH人群间存在人群差异,在不同Crowe分型亚组间存在组间差异,在各人群亚组内存在性别间差异,在无症状人群中Objective To evaluate the three-dimensional acetabular orientation in asymptomatic population and patients of developmental dysplasia of the hip(DDH)using a semi-automated measurement software,which provides data for the differential diagnosis,surgical planning,surgical instrument design,and postoperative evaluation of hip related diseases.Methods Eighty-four cases of CT data in asymptomatic population(asymptomatic group)and 47 cases of CT data in DDH patients(DDH group)were collected.There was no significant difference in gender and age(including age of male and female subgroups)between the two groups(P<0.05).MaxTHA,a semi-automatic measurement software,was used to measure acetabular inclination and anteversion,including operative inclination(OI),radiographic inclination(RI),anatomic inclination(AI),operative anteversion(OA),radiographic anteversion(RA),and anatomic anteversion(AA).Comparisons were made between the two populations,between different Crowe classification subgroups,between different gender subgroups,and between left and right sides of acetabula.Results The comparison between asymptomatic group,healthy side of DDH group,and affected side of DDH group showed that there was no significant difference in acetabular orientation between asymptomatic group and healthy side of DDH group(P>0.05).The OI,RI,and AI of affected side of DDH group were significantly higher than those in healthy side of DDH group and asymptomatic group,and AA was significantly lower than that in healthy side of DDH group and asymptomatic group(P<0.05).The comparison between the normal acetabula and DDH acetabula with different Crowe classifications showed that there was no significant difference in the acetabulum orientation between CroweⅠgroup and the normal group(P>0.05).The OI,RI,and AI of CroweⅡ,Ⅲ,andⅣgroups were significantly higher than those of normal group(P<0.05),the OI of CroweⅢgroup,RI and AI of CroweⅣgroup were significantly higher than those of CroweⅠgroup(P<0.05),the AI of CroweⅣgroup was significantly

关 键 词：发育性髋关节发育不良 髋臼 前倾角 外展角 无症状人群 计算机辅助图像处理 

分 类 号：R687.3[医药卫生—骨科学]