CAJ | 학술논문

目的探讨成人髋关节发育不良(developmental dysplasia of the hip,DDH)患者股骨近端解剖形态的CT三维重建特征及其临床意义.方法通过CT三维重建测量70例(76髋)DDH患者与54例(54髋)健康志愿者股骨近端的解剖学参数,包括股骨头直径、股骨头高度、颈干角、头心-千轴距、股骨颈前倾角、股骨髓腔冠状径、股骨髓腔矢状径、股骨髓腔最长径、股骨各断面髓腔扭转角、股骨峡部距小转子距离及髓腔开口指数.比较DDH患者与健康志愿者股骨近端的解剖学参数有无差异,分析DDH患者各解剖参数的相关性,并与国外研究中DDH患者的相关数据进行比较.结果 DDH组与健康志愿者相比,股骨头高度[(4.82±0.95)cm与(5.18±0.57) cm]、头心-千轴距[(2.66±0.74) cm与(3.16±0.51) cm]、髓腔开口指数(4.12±1.05与4.53±0.65)及小转子远端40 mm处(LT-40水平)的股骨髓腔扭转角(46.86°±49.53°与66.38°±28.75°)均较小,差异有统计学意义.DDH组股骨头高度与头心-干轴距呈正相关(r=0.491,P=0.000),股骨头直径与股骨颈前倾角呈负相关(r=-0.443,P=O.001).散点图显示DDH组峡部以上不同股骨冠状面的扭转角差异较大且无规律.与国外同类研究比较,股骨头直径的差异无统计学意义,其他参数的差异有统计学意义.结论 DDH患者股骨的解剖形态与正常股骨存在差异.对DDH患者施行全髋关节置换术前必须进行CT扫描及三维重建评估股骨近端解剖形态,对股骨畸形严重者应使用个体化定制假体.
목적 탐토성인관관절발육불량(developmental dysplasia of the hip,DDH)환자고골근단해부형태적CT삼유중건특정급기림상의의.방법 통과CT삼유중건측량70례(76관)DDH환자여54례(54관)건강지원자고골근단적해부학삼수,포괄고골두직경、고골두고도、경간각、두심-천축거、고골경전경각、고골수강관상경、고골수강시상경、고골수강최장경、고골각단면수강뉴전각、고골협부거소전자거리급수강개구지수.비교DDH환자여건강지원자고골근단적해부학삼수유무차이,분석DDH환자각해부삼수적상관성,병여국외연구중DDH환자적상관수거진행비교.결과 DDH조여건강지원자상비,고골두고도[(4.82±0.95)cm여(5.18±0.57) cm]、두심-천축거[(2.66±0.74) cm여(3.16±0.51) cm]、수강개구지수(4.12±1.05여4.53±0.65)급소전자원단40 mm처(LT-40수평)적고골수강뉴전각(46.86°±49.53°여66.38°±28.75°)균교소,차이유통계학의의.DDH조고골두고도여두심-간축거정정상관(r=0.491,P=0.000),고골두직경여고골경전경각정부상관(r=-0.443,P=O.001).산점도현시DDH조협부이상불동고골관상면적뉴전각차이교대차무규률.여국외동류연구비교,고골두직경적차이무통계학의의,기타삼수적차이유통계학의의.결론 DDH환자고골적해부형태여정상고골존재차이.대DDH환자시행전관관절치환술전필수진행CT소묘급삼유중건평고고골근단해부형태,대고골기형엄중자응사용개체화정제가체.
Objective To investigate the morphological characteristics of the proximal femurs in adults with developmental dysplasia of the hip (DDH) by CT three-dimensional reconstruction.Methods CT scans were obtained from 70 adults with DDH (76 hips) and 54 healthy controls (54 hips).Morphometric parameters of the femurs,including femoral head diameter,femoral head height,neck-shaft angle,femoral offset,femoral neck anteversion angle,coronal femoral canal diameter,sagittal femoral canal diameter,the longest femoral canal diameter,torsion angle of femur,the distance from the lesser trochanter to the isthmus and the canal flare index (CFI),were derived from CT reconstructions.These anatomical parameters were compared between the DDH hips and healthy hips to show the difference and correlation.Results The femoral head height,femoral offset,CFI and torsion angle of femur in DDH group and control group were 4.82±0.95 cm and 5.18±0.57 cm,2.66±0.74 cm and 3.16±0.51 cm,4.12±1.05 and 4.53±0.65,46.86°±49.53° and 66.38°±28.75°,respectively.There were statistical differences for parameters above.In DDH group,there was a positive correlation between femoral head height and femoral offset (r=0.491,P=0.000),while a negative correlation between femoral head diameter and femoral neck anteversion angle (r=-0.443,P=0.001).The scatter plots showed that the DDH patients had a large irregular variance in coronal torsion angle of femur.Conclusion The shape of the dysplastic femur is abnormal,and the preoperative CT evaluation of the proximal femur in DDH patients is necessary,which can provide valuable information for THA.Custom prostheses are recommended to fit the abnormal morphologic characteristics of the severely dysplastic femurs.