CAJ | 학술논문

目的：观察13岁以上非完全脱位的髋关节发育不良的髋关节畸形特点，探讨影像学测量参数之间及参数与关节损伤的关系。方法回顾性分析2009年8月至2012年8月收治的13岁以上HartofilakidisⅠ、Ⅱ型（非完全脱位）髋关节发育不良患者188例274髋，男28例30髋，女160例244髋，年龄13~47岁，平均27.3岁。所有患者均拍摄标准骨盆正位、双侧65°骨盆斜位X线片，行髋关节核磁造影检查。于术前X线片测量外侧CE角、前侧CE角、臼顶倾斜角、颈干角，观察Shenton线和T?nnis骨关节炎分级情况；于MRI片测量股骨颈前倾角，观察盂唇损伤、盂唇内翻情况；根据外侧CE角大小将髋关节发育不良分为四度：Ⅰ度，外侧CE角11°~20°；Ⅱ度，外侧CE角1°~10°；Ⅲ度，外侧CE角-9°~0°；Ⅳ度，外侧CE角≤-10°。采用Pearson和Spearman相关分析方法分析外侧CE角与患者的就诊年龄、前侧CE角、臼顶倾斜角、颈干角、股骨颈前倾角及盂唇损伤、盂唇内翻、骨关节炎分级的关系，采用卡方检验和秩和检验分析髋关节发育不良分度组间的差异。结果外侧CE角与臼顶倾斜角和骨关节炎分级呈负相关，与患者就诊年龄、前侧CE角呈正相关，与股骨颈前倾角及颈干角不相关。髋关节发育不良不同分度组间Shenton线不连续、盂唇损伤、盂唇内翻、骨关节炎分级的差异有统计学意义。结论对13岁以上非完全脱位髋关节发育不良患者，外侧CE角是有效的临床评价参数，可以反映患者发病年龄、前侧CE角、臼顶倾斜角及髋关节损伤程度。依据外侧CE角对13岁以上髋关节发育不良患者进行分度可以评估病变程度。
목적：관찰13세이상비완전탈위적관관절발육불량적관관절기형특점，탐토영상학측량삼수지간급삼수여관절손상적관계。방법회고성분석2009년8월지2012년8월수치적13세이상HartofilakidisⅠ、Ⅱ형（비완전탈위）관관절발육불량환자188례274관，남28례30관，녀160례244관，년령13~47세，평균27.3세。소유환자균박섭표준골분정위、쌍측65°골분사위X선편，행관관절핵자조영검사。우술전X선편측량외측CE각、전측CE각、구정경사각、경간각，관찰Shenton선화T?nnis골관절염분급정황；우MRI편측량고골경전경각，관찰우진손상、우진내번정황；근거외측CE각대소장관관절발육불량분위사도：Ⅰ도，외측CE각11°~20°；Ⅱ도，외측CE각1°~10°；Ⅲ도，외측CE각-9°~0°；Ⅳ도，외측CE각≤-10°。채용Pearson화Spearman상관분석방법분석외측CE각여환자적취진년령、전측CE각、구정경사각、경간각、고골경전경각급우진손상、우진내번、골관절염분급적관계，채용잡방검험화질화검험분석관관절발육불량분도조간적차이。결과외측CE각여구정경사각화골관절염분급정부상관，여환자취진년령、전측CE각정정상관，여고골경전경각급경간각불상관。관관절발육불량불동분도조간Shenton선불련속、우진손상、우진내번、골관절염분급적차이유통계학의의。결론대13세이상비완전탈위관관절발육불량환자，외측CE각시유효적림상평개삼수，가이반영환자발병년령、전측CE각、구정경사각급관관절손상정도。의거외측CE각대13세이상관관절발육불량환자진행분도가이평고병변정도。
Objective To investigate the radiological characteristics and the relationships between the parameters by X?ray and direct magnetic resonance arthrography (dMRA) in non?completely dislocated dysplasia hips. Methods We retro?spectively reviewed patients (above 13 years old) with dysplasia hips from August 2009 to August 2012. These patients were classi?fied as Hartofilakidis typeⅠand typeⅡ. 188 patients (274 hips) involved 28 males (30 hips) and 160 females (244 hips), average aged 27.3 years (range 13-47 years). Standard pelvic A?P, bilateral 65° oblique X?rays, and dMRA were conducted in each pa?tient. Lateral central?edge angle (LCE), anterior central?edge angle (ACE), femoral neck?shaft angle (FNSA), and tonnis acetabu?lar index (AI) angle were measured based on the X?ray. The dysplasia hips were classified into 4 grades (GradeⅠ:CE 11°-20° , GradeⅡ:CE 1°-10°, GradeⅢ:CE-9°-0°, and GradeⅣ:CE≤-10°). Femoral neck anteversion angle (FNA), labral tear, labral inversion, and labral cyst was observed on dMRA films. Variance analysis and rank correlation were applied to find the relation?ship between CE grades and the relevant parameters by using SPSS 19.0. Results LCE has negative correlation with AI and grade of osteoarthritis, and has positive correlation with age, ACE. However, there was no relationship between FNSA and FNA. There was significantly different in Shenton's line, labral tear, labral inversion, cartilage lesion, among different grade of LCE. Conclusion LCE is an important parameter used in evaluating for dysplasia hips without complete dislocation. LCE can reflect age of onset, ACE, AI angle and degree of joint damages. Evaluation for the severity of non?completely dislocated dysplasia hips can be conducted according to grades of CE.