应用最大内切球法分析单侧髋臼周围截骨术对骨产道的影响  

The influence of unilateral periacetabular osteotomy on bony birth canal in female patients with DDH using maximum⁃inscribed⁃sphere method

作　　者：王彦军 程徽[3] 张利强 杨健 刘新新[4] 邵龙[4] 张洪[3] Wang Yanjun;Cheng Hui;Zhang Liqiang;Yang Jian;Liu Xinxin;Shao Long;Zhang Hong(Postgraduate Institute,Tianjin Medical University,Tianjin 300070,China;Department of Orthopaedics,the Second Hospital of Tangshan City,Tangshan 063500,China;Department of Orthopaedics,Fourth Medical Center of PLA General Hospital,Beijing 100048,China;School of Optics and Photonics,Beijing Institute of Technology,Beijing 100081,China)

机构地区：[1]天津医科大学研究生院,300070 [2]唐山市第二医院骨科,063500 [3]解放军总医院第四医疗中心骨科,北京100048 [4]北京理工大学光电学院,100081

出　　处：《中华骨科杂志》2021年第4期233-241,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨采用三维CT最大内切球法分析单侧髋臼周围截骨术(periacetabular osteotomy,PAO)对女性髋关节发育不良(developmental dysplasia of the hip,DDH)患者骨产道影响的可行性。方法选取62例行单侧PAO手术的育龄女性DDH患者,采集手术前后骨盆CT的"DICOM"数据,用最大内切球法在医学影像交互软件(the medical imaging interaction toolkit,MITK)上测量25层骨产道的大小(即最大内切球直径)。于手术前后骨盆站立正位X线片上测量外侧中心边缘(lateral center edge,LCE)角、髋臼倾斜角(T?nnis角)和髂坐线与股骨头内缘的距离。根据LCE角大小将患者分为严重组(LCE≤0°)和非严重组(0°0.05)。其中髋臼截骨块前上缘(1~13层)变窄明显(手术前后差值的均值范围为4.23~5.95 mm);髋臼截骨块前缘耻骨支下缘与闭孔后缘上部之间的区域(5~10层)变窄最多(5.62~5.95 mm)。手术前后骨产道最窄位置均在坐骨棘平面(20层),术前最大内切球直径为(105.34±7.16)mm,术后为(104.47±7.06)mm,差异有统计学意义(t=2.198,P=0.032)。髋关节旋转中心内移与1~20层骨产道变窄呈正相关,T?nnis角变小与1~10层骨产道变窄呈正相关,LCE增大与2~5层骨产道变窄呈负相关(P<0.05)。髂坐线与股骨头内缘的距离对1~20层骨产道大小的影响有统计学意义(β=0.27~0.50,P<0.05)。身高与术前、术后骨产道最窄部位的大小呈正相关(r=0.565,r=0.586,P<0.001)。严重组与非严重组手术前后骨产道及骨产道变窄程度的差异无统计学意义(t=-0.685~0.655,P>0.05)。结论单侧PAO引起坐骨棘以上骨产道变窄,轻度影响骨产道最窄位置(坐骨棘水平)。单侧PAO不会影响骨产道正常的DDH育龄女性患者正常胎儿的正常分娩。Objective To investigate the influence of unilateral periacetabular osteotomy(PAO)on the bony birth canal(BBC)in female patients with developmental dysplasia of the hip(DDH)by using pelvic 3D⁃CT maximum⁃inscribed⁃sphere(MIS)method.Methods A total of 62 female DDH patients of childbearing age were included in the present study.The DICOM data of their pre⁃and post⁃operative pelvic CT was collected.The diameters of the MIS in 25 layers of the BBC were measured on the Med⁃ical Imaging Interaction Toolkit(MITK)platform.Lateral center edge angle(LCE),Tönnis angle and the distance between the me⁃dial margin of the femoral head and Kohler's line were measured on standing anteroposterior pelvic radiographs before and after unilateral PAO.Patients were divided into severe(LCE≤0°)and non⁃severe group(0°<LCE<20°)according to their LCE values.Results After unilateral PAO,the BBC above the sciatic spine(1-20th layer)narrowed(0.86-5.95 mm,P<0.05).However,there was no change in levels below the sciatic spine(21-25th layer,P>0.05).The anterior margin of acetabular fragment(1-13th layer)narrowed significantly(4.23-5.95 mm)after unilateral PAO with the narrowest part(5.62-5.95 mm)locating at the inferior margin of pubic ramus and the region superior to the lateral margin of obturator foramen(5-10th layer).The narrowest part of BBC before and after the surgery occurred at the level of bilateral sciatic spines(20th layer).The diameter of MIS changed significantly from 105.34±7.16 mm pre⁃operatively to 104.47±7.06 mm post⁃operatively(t=2.198,P=0.032).There was a positive correlation be⁃tween the inward displacement of the hip center and the narrowing of the 1-20th layer of the BBC.The decrease of Tönnis angle was positively correlated with the narrowing of the 1-10th layer of the BBC.The increase of LCE was negatively correlated with the narrowing of 2-5th layer of the BBC(P<0.05).The standardized coefficients were with statistical significance when comparing the distance between the Kohler's line and th

关 键 词：髋脱位 先天性 截骨术 分娩 产道 体层摄影术 X线计算机 

分 类 号：R687.4[医药卫生—骨科学]