MRI-骨性泪滴眉弓线预测发育性髋关节发育不良闭合复位后残余髋臼发育不良的研究  

Application of MRI-Bony teardrop and sourcil line in predicting residual acetabular dysplasia after closed reduction of developmental dysplasia of the hip

作　　者：裴胤志 黄鹏 吴春星[1] 宁波[1] Pei Yinzhi;Huang Peng;Wu Chunxing;Ning Bo(Department of Pediatric Orthopedics,Pediatric Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院儿童骨科,上海201102

出　　处：《临床小儿外科杂志》2024年第10期940-945,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(82272441);上海市科学技术委员会科技创新行动计划(22Y11912200)。

摘　　要：目的探讨MRI-泪滴眉弓线(teardrop and sourcil line,TSL)预测发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患儿闭合复位后残余髋臼发育不良(residual acetabular dysplasia,RAD)的可行性。方法本研究为回顾性研究,研究对象为2011年10月至2019年12月复旦大学附属儿科医院儿童骨科54例(68髋)临床诊断为DDH且接受闭合复位的患儿(单侧发病40例,双侧发病14例)。采用MRI测量并记录骨性TSL连续性以及髋臼开口最大连线(acetabular distance,AD);采用X线片观察并记录DDH患儿闭合复位时髋臼指数(acetabular index,AI)、国际髋关节发育不良协会(International Hip Dysplasia Institute,IHDI)分型。根据改良Severin分型将患髋分为RAD组和非RAD组,根据MRI-骨性TSL的连续性将患儿分为MRI-骨性TSL连续组和非连续组,比较上述各组间临床指标差异;运用受试者操作特征(receiver operating characteristic curve,ROC)曲线评估AD差值预测RAD发生的效能。结果68髋中,Severin分型Ⅰ型2髋、Ⅱ型15髋、Ⅲ型46髋、Ⅳ型5髋;RAD组51髋,非RAD组17髋。单因素分析发现,IHDI分型、MRI-骨性TSL连续性以及正常侧和患侧AD的差值是DDH患儿闭合复位后RAD发生的相关因素(P<0.05);多因素Logistic回归分析发现,IHDI分型(OR=0.090,95%CI:0.010~0.794),MRI-骨性TSL连续性(OR=0.015,95%CI:0.002~0.128)以及正常侧与患侧AD的差值(OR=7.1×108,95%CI:370.6~1.4×1015)是DDH患儿闭合复位后RAD发生的独立影响因素(P<0.05)。ROC曲线分析显示,正常侧与患侧AD差值预测RAD发生的临界值为0.31 cm,对应的灵敏度、特异度分别为0.900及0.833,曲线下面积为0.917。结论IHDI分型、MRI-骨性TSL连续性以及正常侧和患侧AD的差值可作为预测DDH患儿闭合复位后发生RAD的指标。与X线-TSL相比,MRI-骨性TSL可以更早、更准确地预测RAD的发生。Objective To explore the feasibility of using magnetic resonance imaging(MRI)to measure the teardrop and sourcil line(TSL)for predicting the occurrence of residual acetabular dysplasia(RAD)after closed reduction(CR)in children with developmental dysplasia of the hip(DDH).Methods This study measured and recorded the continuity of the bony TSL and the maximum acetabular distance(AD)on MRI in 54 children,totaling 68 hips(40 unilateral cases and 14 bilateral cases)clinically diagnosed with DHH and who underwent CR.X-ray images were used to observe and record the acetabular index(AI)at the time of CR,as well as the International Hip Dysplasia Institute(IHDI)classification.According to the modified Severin classification,the affected hips were divided into RAD and non-RAD groups,and differences between the two groups were compared.Additionally,patients were categorized into MRI-bony TSL continuous and non-continu-ous groups to compare differences in indicators between these groups.The receiver operating characteristic curve(ROC)was used to evaluate the effectiveness of the AD difference in predicting the occurrence of RAD.Re-sults Among the 68 hips,2 were classified as Severin type I,15 as type II,46 as type II,and 5 as type IV;51 hips in the RAD group,and 17 in the non-RAD group.Univariate analysis showed that IHDI classification,the continuity of the bony TSL,and the AD difference between the normal and affected sides were related factors for the occurrence of RAD after CR in DHH children,Multivariate logistic regression analysis revealed that IH-DI classification(OR=0.090,95%CI:0.010-0.794),MRI-bony TSL continuity(OR=0.015,95%CI:0.002-0.128),and AD difference between the normal and affected sides(0R=7.1×10°,95%CI:370.6-1.4×1o'5)were independent factors influencing the occurrence of RAD after CR in DHH children(P<0.05).ROC curve analysis showed that the difference between normal side and affected side AD predicted the onset of RAD by 0.31cm,corresponding sensitivity and specificity were 0.900 and 0.833,respectivel

关 键 词：发育性髋关节发育不良 残余髋臼发育不良 外科手术 儿童 

分 类 号：R72[医药卫生—儿科]