CAJ | 학술논문

目的通过三维CT重建分析成人髋关节发育不良不同Crowe分型之间髋臼形态的演变规律.方法 2010年6月至2013年1月收治成人髋关节发育不良患者62例68髋,男6例8髋,女56例60髋；年龄47～59岁,平均(53.7±5.8)岁.Crowe Ⅰ型14例17髋,Ⅱ型17例17髋,Ⅲ型15例17髋,Ⅳ型16例17髋.行标准髋关节CT扫描及三维重建.在侧位三维图像上标记Harris窝,确定髋臼旋转中心,利用十字坐标轴确定髋臼旋转中心的冠状面和横断面位置；在正位三维图像上利用Ranwant三角确定髋臼旋转中心的矢状面位置；在髋臼水平重建图像上确定髋臼旋转中心.观察髋臼前后缘增生及髋臼前后柱发育不良程度,测量并比较不同Crowe分型患者的髋臼前倾角、前覆盖角、后覆盖角和内壁宽度.结果随Crowe分型增加,髋臼前倾角逐渐加大,两者呈正相关,除Crowe Ⅰ型和Ⅱ型组间外,其余组间差异有统计学意义；髋臼前覆盖角逐渐减小,两者呈负相关,各组间差异均有统计学意义,CroweⅢ、Ⅳ型组平均值小于50°；髋臼后覆盖角逐渐减小,两者呈负相关,各组间差异均有统计学意义,CroweⅢ、Ⅳ型组平均值小于90°；髋臼内壁宽度逐渐增加,两者呈正相关,各组间差异均有统计学意义.结论不同Crowe分型成人髋关节发育不良的髋臼形态变化存在一定的演变规律.对Crowe Ⅰ型和Ⅱ型髋臼的重建可充分利用髋臼前后柱骨量,对CroweⅢ、Ⅳ型髋臼的重建可适度上移和(或)内移髋臼中心.
목적 통과삼유CT중건분석성인관관절발육불량불동Crowe분형지간관구형태적연변규률.방법 2010년6월지2013년1월수치성인관관절발육불량환자62례68관,남6례8관,녀56례60관；년령47～59세,평균(53.7±5.8)세.Crowe Ⅰ형14례17관,Ⅱ형17례17관,Ⅲ형15례17관,Ⅳ형16례17관.행표준관관절CT소묘급삼유중건.재측위삼유도상상표기Harris와,학정관구선전중심,이용십자좌표축학정관구선전중심적관상면화횡단면위치；재정위삼유도상상이용Ranwant삼각학정관구선전중심적시상면위치；재관구수평중건도상상학정관구선전중심.관찰관구전후연증생급관구전후주발육불량정도,측량병비교불동Crowe분형환자적관구전경각、전복개각、후복개각화내벽관도.결과 수Crowe분형증가,관구전경각축점가대,량자정정상관,제Crowe Ⅰ형화Ⅱ형조간외,기여조간차이유통계학의의；관구전복개각축점감소,량자정부상관,각조간차이균유통계학의의,CroweⅢ、Ⅳ형조평균치소우50°；관구후복개각축점감소,량자정부상관,각조간차이균유통계학의의,CroweⅢ、Ⅳ형조평균치소우90°；관구내벽관도축점증가,량자정정상관,각조간차이균유통계학의의.결론 불동Crowe분형성인관관절발육불량적관구형태변화존재일정적연변규률.대Crowe Ⅰ형화Ⅱ형관구적중건가충분이용관구전후주골량,대CroweⅢ、Ⅳ형관구적중건가괄도상이화(혹)내이관구중심.
Objective To analyze the evolution of acetabular morphology changes of different Crowe types among adults with developmental dysplasia of the hip through standard hip 3D CT reconstruction.Methods From June 2010 to January 2013,there were 62 patients with 68 hips (8 hips of 6 male cases,56 female cases of 60 hips) diagnosed as acetabular dysplasia in our hospital,with an average age of 53.7±5.8 years old (range,47-59 years).According to Crowe classification,there were 14 cases (17 hips) of Crowe type Ⅰ,17 cases (17 hips) of Crowe type Ⅱ,15 cases (17 hips) of Crowe type Ⅲ,and 16 cases (17 hips) of Crowe type Ⅳ.Through standard hip 3D CT reconstruction,Harris nest in the pelvic side 3D image was marked,and the coronal and horizontal position of acetabular rotation center was determined by using the cross axis; secondly,in the anteroposterior 3D image (by gray level adjustment to the shape of X ray perspective effect) through Ranwant triangulation,sagittal position of the center of rotation of the hip joint was determined; finally,the acetabular rotation center in the acetabular horizontal reconstruction plane.The bone stock of anterior and posterior columns of acetabular was observed and acetabular anteversion,front cover angle,rear cover angle and medial wall thickness were measured.Results 1) With Crowe type increased,acetabular anteversion angle gradually increased as well,and there was a positive correlation between them with statistically significant (P＜0.05) except in Crowe Ⅰ and Ⅱ group.2) With Crowe type increased,anterior acetabular coverage angle was significantly decreased; the mean anterior acetabular coverage angle of Crowe Ⅲ and Ⅳ groups was less than 50°.3) With Crowe type increased,posterior acetabular coverage angle was decreased significantly as well the mean posterior acetabular coverage angle of Crowe Ⅲ and Ⅳ groups was less than 90°.4) With Crowe type increased,acetabular medial wall thickness was increased significantly.Conclusion Adult acetabular morphology changes between different Crowe types in patients with developmental dysplasia of the hip.For acetabular reconstruction of Crowe Ⅰ and Ⅱ,we could make full use of the acetabular bone stock of anterior and posterior column; for acetabular reconstruction of Crowe Ⅲ and Ⅳ,we could moderately shift the acetabular center superiorly and (or) medially.