造影与磁共振成像在儿童发育性髋关节发育不良评估中的一致性分析  

Consistency analysis of hip arthrography and magnetic resonance imaging in assessing developmental dysplasia of the hip in children

作　　者：杨帅[1] 颉强 苏菲 王欢[1] 吴永涛[1] 陆清达 王晓威[1] 杨亚婷 刘趁心 Yang Shuai;Jie Qiang;Su Fei;Wang Huan;Wu Yongtao;Lu Qingda;Wang Xiaowei;Yang Yating;Liu Chenxin(Department of Pediatric Orthopedic,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院儿童骨病医院,西安710054

出　　处：《中华小儿外科杂志》2023年第2期154-159,共6页Chinese Journal of Pediatric Surgery

基　　金：陕西省重点研发计划(2021ZDLSF02-11);陕西省创新能力支撑计划(2020TD-036);陕西省临床医学研究中心(2020LCZX-03)。

摘　　要：目的验证髋关节造影与磁共振成像对儿童髋臼的骨性与软骨性覆盖评估的一致性,发掘两者之间优势交叉点或互补之处。方法收集2020年11月至2021年11月在西安交通大学附属红会医院儿童骨病医院经历过至少一次闭合复位石膏固定的16例发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患儿(行3次石膏固定的有2例,2次4例,1次10例)的临床资料。其中男3例,女13例;双侧为8例,单侧为8例(左侧为6例,右侧为2例),共测量了32个髋关节(24个患侧髋关节和8个正常髋关节),患儿初次手术年龄为(11.88±5.29)个月,年龄范围4~22个月。选取同体位的术中造影片与术后2 d内MRI片,分别测量骨性髋臼指数(acetabular index,AI)与盂唇AI,按照排除标准,最终纳入40组数据。先分为MRI组与造影组并采用组内相关系数(intra-class correlation coefficient,ICC)评估两者对同一指标的测量是否有一致性;再分为AI组与盂唇AI组进行Pearson相关性分析以明确骨性覆盖与软骨性覆盖之间的关系。结果MRI组与造影组AI的ICC值较高,为0.775(95%可信区间:0.609~0.872),盂唇AI的ICC值中等,为0.621(95%可信区间:0.398~0.784)。AI组与盂唇AI组的Pearson相关分析显示:MRI中AI与盂唇AI存在正相关关系(r=0.591;P<0.001),造影片中AI与盂唇AI存在正相关关系(r=0.428;P<0.05)。结论在对骨性覆盖指标AI与软骨性覆盖指标盂唇AI的观察上,MRI总是比造影X线测量平均值略高,但两者具有良好的一致性,提示两者在观测同一指标时具有一定替代性。Objective To verify the consistency of hip arthrography and magnetic resonance imaging(MRI)for evaluating acetabular bone and cartilage covering in children and to explore the advantages of intersection or complementarity between the two.Methods Clinical data were retrospectively reviewed for 16 children with developmental dysplasia of the hip(DDH)undergoing at least one closed reduction and plaster fixation from November 2020 to November 2021(2 cases underwent plaster fixation thrice,4 cases twice,10 cases once).There were 3 boys and 13 girls(8 bilateral,8 unilateral;6 left and 2 right).A total of 32 hip joints(24 affected,8 normal)were measured.The average age of initial operation was(11.88±5.29)(4-22)months.Acetabular index(AI)and labrum AI were measured by intraoperative arthrography film and MRI within 2 days post-operation.According to the exclusion criteria,40 data sets were finally acquired.They were divided into two groups of MRI and arthrography.Intra-class correlation coefficient(ICC)was utilized for evaluating the consistency of the same parameter.Pearson's correlation analysis was performed between AI and labral AI groups for clarifying the relationship between bony coverage and cartilage coverage.Results ICC value of AI in MRI group and arthrography group was higher:0.775(95%CI:0.609-0.872);ICC value of labrum AI was moderate:0.621(95%CI:0.398-0.784).Pearson's correlation analysis revealed a positive correlation between AI and labrum AI on MRI(r=0.591,P<0.001).Also a positive correlation existed between AI and labrum AI on arthrography film(r=0.428,P<0.05).Conclusions Regarding bone coverage index-AI and cartilage coverage index-labrum AI,average value of MRI is always slightly higher than that on arthrography film.However,the two have excellent consistency.It hints that hip arthrography and MRI have certain substitutability in measuring the same parameter.

关 键 词：髋关节 磁共振成像 关节造影术 一致性 

分 类 号：R726.8[医药卫生—儿科]