CAJ | 학술논문

目的介绍一个反映儿童髋关节MRI图像上盂唇软骨复合体形态改变的量化指标:盂唇角(LA),探讨该指标的可靠性和对临床的指导意义.方法回顾2011年6月至2012年6月的影像资料库,选取正常组(22例,35髋)、Tonnis 1级髋关节发育异常组(23例,34髋)、Tonnis 2级髋关节发育异常组(15例,20髋)的髋关节MRI图像进行测量研究.利用PACS系统自带测量工具,按照选定的解剖标志测量所有髋关节的盂唇角,由1位放射科(sJ)和1位骨科医生(GYH)分别独立测量3组髋关节的髋臼指数和盂唇角各两次(间隔15 d).利用SPSS软件中的一致性检验比较盂唇角测量者间差异以及同一测量者2次测量间的差异,并与经典的测量指标髋臼指数做对比,验证该方法的可靠性,利用T检验比较3组髋关节盂唇角的差异.结果盂唇角的一致性检验结果,测量者间(GYH-SJ)的组间相关系数为0.832,同一测量者两次测量间的组间相关系数分别为0.979(GYH)和0.932 (SJ).髋臼指数的一致性检验结果,测量者间(GYH-SJ)的组间相关系数为0.914,同一测量者两次测量间的组间相关系数分别为0.985(GYH)和0.956(SJ).综合两位研究者的测量结果,正常组中盂唇角56.0°±4.3°；Tonnis 1级髋关节发育异常组盂唇角46.7°±3.1°；Tonnis 2级髋关节发育异常组盂唇角39.4°±4.1°.3组结果间差异有统计学意义(P均＜0.001).结论盂唇角的测量方法简单,可重复性高,可靠性接近目前使用的经典测量指标髋臼指数.同时,由于该指标能够定量化地反映髋关节外侧盂唇软骨复合体的形态改变,填补了普通X片的盲区,可以为临床诊断和治疗DDH提供更多依据.本次研究还发现,与正常组儿童相比,Tonnis 1、2级髋关节发育异常患儿的盂唇角存在着明显的、与病变严重程度相关的量化改变,进一步验证了该指标对于判断DDH疾病的严重程度具有指导意义.
목적 개소일개반영인동관관절MRI도상상우진연골복합체형태개변적양화지표:우진각(LA),탐토해지표적가고성화대림상적지도의의.방법 회고2011년6월지2012년6월적영상자료고,선취정상조(22례,35관)、Tonnis 1급관관절발육이상조(23례,34관)、Tonnis 2급관관절발육이상조(15례,20관)적관관절MRI도상진행측량연구.이용PACS계통자대측량공구,안조선정적해부표지측량소유관관절적우진각,유1위방사과(sJ)화1위골과의생(GYH)분별독립측량3조관관절적관구지수화우진각각량차(간격15 d).이용SPSS연건중적일치성검험비교우진각측량자간차이이급동일측량자2차측량간적차이,병여경전적측량지표관구지수주대비,험증해방법적가고성,이용T검험비교3조관관절우진각적차이.결과 우진각적일치성검험결과,측량자간(GYH-SJ)적조간상관계수위0.832,동일측량자량차측량간적조간상관계수분별위0.979(GYH)화0.932 (SJ).관구지수적일치성검험결과,측량자간(GYH-SJ)적조간상관계수위0.914,동일측량자량차측량간적조간상관계수분별위0.985(GYH)화0.956(SJ).종합량위연구자적측량결과,정상조중우진각56.0°±4.3°；Tonnis 1급관관절발육이상조우진각46.7°±3.1°；Tonnis 2급관관절발육이상조우진각39.4°±4.1°.3조결과간차이유통계학의의(P균＜0.001).결론 우진각적측량방법간단,가중복성고,가고성접근목전사용적경전측량지표관구지수.동시,유우해지표능구정양화지반영관관절외측우진연골복합체적형태개변,전보료보통X편적맹구,가이위림상진단화치료DDH제공경다의거.본차연구환발현,여정상조인동상비,Tonnis 1、2급관관절발육이상환인적우진각존재착명현적、여병변엄중정도상관적양화개변,진일보험증료해지표대우판단DDH질병적엄중정도구유지도의의.
Objective To introduce a quantifiable labrum angle (LA) indicating the morphological changes of the Labrum-cartilage complex in the children's hip,and to investigate the reliability and clinical significance of LA in the diagnosis and treatment of developmental dislocation of the hip (DDH).Methods The hip MRI images in the PACS database were reviewed from June 2011 to June 2012.MRI images of the hip were chosen and measured including the normal group (22 children with 35 hips),Tonnis-classification grade-1 group (23 DDH patients with 34 hips) and Tonnis-classification grade-2 group (15 DDH patients with 20 hips).Coronal T1-weighted images through the centre of the tri-radiate cartilage were selected to measure the LA.A radiologist (SJ) and an orthopedic surgeon (GYH) independently measured the LA with selected anatomical landmarks twice with the intermission of 15 days.The consistency was tested and the results were compared using the acetabular index to verify the reliability of the method.T test was used to compare the differences of LA among the 3 groups.Results The analysis of intra-and inter-observer agreement of the labrum angle showed that the intraclass correlation coefficiency of the inter-observer group (GYH-SJ) was 0.832.The intraclass correlation coefficiency of the two measurements of the same observer was 0.979 (GYH) and 0.932 (SJ) respectively.The analysis of the intra-and inter-observer agreement of the acetabular index showed that the intra-class correlation coefficiency between the inter-observer group (GYH-SJ) was 0.914.And the analysis of the intra-class correlation coefficiency between the two measurements of the same observer was 0.985 (GYH)and 0.956(SJ) respectively.The LA of the normal group was 56.0°± 4.3°,the LA of the Tonnis-classification grade-1 group was 46.7° ± 3.1°,and the LA of the Tonnisclassification grade-2 group was 39.4° ± 4.1°,with significant difference between each group (P＜0.001).Conclusions The method of measuring LA is simple and has a high repeatability.LA is closely related to the classic measurement parameter-acetabular index.The LA is a quantifiable indicator to indicate the morphological changes of hip labra by MRI.LA can provide strong evidence for clinical diagnosis and treatment for patients with DDH,and may also be used as a prognostic indicator for DDH patients.