系列MRI观察发育性髋脱位闭合复位后"靠港"现象的研究  

A pilot study of observing“docking”in patients with developmental dislocation of the hip after closed reduction by seri⁃al MRI

作　　者：孟祥虹[1] 杨建平[2] 王植[1] 付喆[2] 张中礼[2] Meng Xianghong;Yang Jianping;Wang Zhi;Fu Zhe;Zhang Zhongli(Department of Radiology,Tianjin Hospital,Tianjin,Tianjin 300211,China;Department of Orthopedic Pediatrics,Tianjin Hospi-tal,Tianjin 300211,China)

机构地区：[1]天津市天津医院放射科,300211 [2]天津市天津医院小儿骨科,300211

出　　处：《中华骨科杂志》2021年第4期219-226,共8页Chinese Journal of Orthopaedics

摘　　要：目的应用MRI及平片连续观察发育性髋脱位(developmental dislocation of the hip,DDH)闭合复位后髋关节软组织结构的变化,探讨复位后股骨头是否获得同心圆复位、实现"靠港"以及股骨头坏死。方法回顾性分析2012年10月至2018年7月间年龄在6~24个月、单侧完全脱位、在我院接受闭合复位石膏裤外固定的DDH患儿,在闭合复位术后当天及术后每2~3个月更换石膏裤前进行MRI复查,术前及术后随访均行骨盆正位X线片检查。在MRI图像上将患髋盂唇软骨复合体(labro-chondral complex,LCC)分为4型,应用组内相关系数评价LCC分型的可靠性和可重复性。应用趋势卡方检验或Fisher精确概率法分析患侧股骨头圆韧带、髋臼横韧带、髋臼脂肪垫增厚率在MRI随访时有无区别;应用重复测量资料的方差分析或Mann-Whitney U检验评价患侧软骨性臼头指数在随访时有无区别;统计闭合复位当天股骨头同心圆复位率、最后一次更换石膏时患侧股骨头的"靠港"率和复位后随访18个月及以上者患侧股骨头坏死率。结果共纳入闭合复位石膏裤外固定DDH患儿63例(63髋),LCC分型一致性在观察者间为0.84(95%CI:0.74~0.91),观察者内为0.94(95%CI:0.90~0.97)。LCC在复位当天多为4型(93.7%,59/63),在第二次复查时多为1型(50.9%,28/55),即恢复正常形态。股骨头圆韧带、髋臼横韧带、髋臼脂肪垫在复位后肥厚率为94.5%~100%,在第二次复查时肥厚率降为10.9%~12.7%,差异有统计学意义(χ^(2)=88.6;χ^(2)=86.4;χ^(2)=97.9,均P<0.05)。软骨性臼头指数在复位当天为68.1±12.1,在第二次复查时增加至84.4±7.0,差异有统计学意义(Z=-3.15,P=0.002)。58.7%的股骨头实现"靠港",8.6%出现股骨头坏死。结论闭合复位石膏裤外固定的DDH患儿髋关节软组织异常结构在复位后大多逐渐恢复,60%的股骨头可实现"靠港",短期随访股骨头坏死的风险较低。Objective To utilize MRI and plain films to observe the changes of soft tissue structures in patients with de⁃velopmental dysplasia of the hip(DDH)after closed reduction,and explore the concentric reduction rate,the"docking"rate and the femoral head necrosis rate after reduction.Methods Retrospective analysis of unilateral completely dislocated DDH patients with closed reduction and spica casting in our hospital from October 2012 to July 2018.MRI was performed on the day of closed re⁃duction and every 2-3 months after operation.Pelvic plain films were performed before operation and follow⁃up.The labro⁃chon⁃dral complex(LCC)of the hip was divided into 4 types on MRI images,and the reliability and repeatability of LCC classification were evaluated by intra⁃class correlation coefficient.Trend chi⁃square test or Fisher exact probability method was used to analyze the variation of thickening rate of ligamentum teres,transverse ligaments and pulvinar during MRI follow⁃up,and the difference of cartilaginous acetabular head index was evaluated by analysis of variance of repeated measurements or Mann⁃Whitney U test.The concentric reduction rate of the femoral head after performing closed reduction,the"docking"rate of the femoral headwhen the cast was changed for the last time were analyzed,and the necrosis rate of the femoral head were followed up for 18 months or more after reduction.Results A total of 63 DDH patients(63 hips)with closed reduction were included.Intra⁃class correlation coeffi⁃cient of LCC classification was 0.84 between observers(95%CI:0.74-0.91)and 0.94 within observers(95%CI:0.90-0.97).Most LCC classifications were type 4 on the day of CR(93.7%,59/63),and return to normal(type 1 classifications)at the second follow⁃up(50.9%,28/55).ligamentum teres,transverse ligaments and pulvinar were hypertrophic(94.5%-100%)on the day of CR,and decreased to 10.9%-12.7%at the second follow⁃up,which had statistically differences(χ^(2)=88.6;χ^(2)=86.4;χ^(2)=97.9,P<0.05).The cartilaginous acet

关 键 词：髋脱位 先天性 外固定器 磁共振成像 股骨头坏死 治疗结果 

分 类 号：R726.8[医药卫生—儿科]