CAJ | 학술논문

目的利用快速磁共振来评价发育性髋关节异常闭合复位后的复位质量,并随访保守治疗的结果,评估复位质量对于预后的影响.方法 2010年9月至2013年12月29例(43髋)发育性髋关节异常(DDH)患儿在常规保守治疗中接受了快速磁共振检查,该组患儿平均年龄9个月(4～16个月),男4例,女25例,共43髋,左侧22髋,右侧21髋,平均随访时间18个月.依照复位后MRI图像上所显示的头臼距离和盂唇形态对复位质量进行评价,将全部髋关节分为同心圆复位和非同心圆复位两组,在PACS系统中搜集所有髋关节的X线片和MRI图像,在MRI图像上测量闭合复位后双髋外展角度,在骨盆平片上测量治疗前和最近一次随访时的髋臼指数,记录治疗前股骨头骨化中心是否出现,应用Tonnis分级对治疗前畸形程度及残余畸形程度进行评价,记录股骨头缺血坏死情况及分型(Bucholz and Ogden分型).利用SPSS软件分析,比较治疗前,治疗后,以及最终随访的各项参数在两组髋关节之间差异是否有统计学意义.结果 43髋中25髋为同心圆复位,18髋为非同心圆复位,经过统计分析,我们发现两组髋关节在年龄、性别、侧别、治疗时股骨头出现与否、复位前髋臼指数、髋臼指数下降值及术后双髋外展角等方面差异无统计学意义,在术前Tonnis分级、复位后头臼间距离、最终随访时髋臼指数、严重残余畸形发生率及严重股骨头缺血坏死发生率方面差异有统计学意义(P＜0.05).在治愈率方面差异有出现统计学意义的趋势(P=0.052).同心圆复位组的预后明显要优于非同心圆复位组.结论快速磁共振检查能够有效确定闭合复位后的复位质量,复位前畸形程度越高,术后越难以达到同心圆复位,预后越差,对于这部分病例,保守治疗虽然对于髋臼的发育有一定的促进作用,但最终的治愈率低,发生严重残余畸形和股骨头缺血坏死的概率明显增加,应考虑更改治疗策略来改善这部分患儿的预后. 目的利用快速磁共振來評價髮育性髖關節異常閉閤複位後的複位質量,併隨訪保守治療的結果,評估複位質量對于預後的影響.方法 2010年9月至2013年12月29例(43髖)髮育性髖關節異常(DDH)患兒在常規保守治療中接受瞭快速磁共振檢查,該組患兒平均年齡9箇月(4～16箇月),男4例,女25例,共43髖,左側22髖,右側21髖,平均隨訪時間18箇月.依照複位後MRI圖像上所顯示的頭臼距離和盂脣形態對複位質量進行評價,將全部髖關節分為同心圓複位和非同心圓複位兩組,在PACS繫統中搜集所有髖關節的X線片和MRI圖像,在MRI圖像上測量閉閤複位後雙髖外展角度,在骨盆平片上測量治療前和最近一次隨訪時的髖臼指數,記錄治療前股骨頭骨化中心是否齣現,應用Tonnis分級對治療前畸形程度及殘餘畸形程度進行評價,記錄股骨頭缺血壞死情況及分型(Bucholz and Ogden分型).利用SPSS軟件分析,比較治療前,治療後,以及最終隨訪的各項參數在兩組髖關節之間差異是否有統計學意義.結果 43髖中25髖為同心圓複位,18髖為非同心圓複位,經過統計分析,我們髮現兩組髖關節在年齡、性彆、側彆、治療時股骨頭齣現與否、複位前髖臼指數、髖臼指數下降值及術後雙髖外展角等方麵差異無統計學意義,在術前Tonnis分級、複位後頭臼間距離、最終隨訪時髖臼指數、嚴重殘餘畸形髮生率及嚴重股骨頭缺血壞死髮生率方麵差異有統計學意義(P＜0.05).在治愈率方麵差異有齣現統計學意義的趨勢(P=0.052).同心圓複位組的預後明顯要優于非同心圓複位組.結論快速磁共振檢查能夠有效確定閉閤複位後的複位質量,複位前畸形程度越高,術後越難以達到同心圓複位,預後越差,對于這部分病例,保守治療雖然對于髖臼的髮育有一定的促進作用,但最終的治愈率低,髮生嚴重殘餘畸形和股骨頭缺血壞死的概率明顯增加,應攷慮更改治療策略來改善這部分患兒的預後.
목적 이용쾌속자공진래평개발육성관관절이상폐합복위후적복위질량,병수방보수치료적결과,평고복위질량대우예후적영향.방법 2010년9월지2013년12월29례(43관)발육성관관절이상(DDH)환인재상규보수치료중접수료쾌속자공진검사,해조환인평균년령9개월(4～16개월),남4례,녀25례,공43관,좌측22관,우측21관,평균수방시간18개월.의조복위후MRI도상상소현시적두구거리화우진형태대복위질량진행평개,장전부관관절분위동심원복위화비동심원복위량조,재PACS계통중수집소유관관절적X선편화MRI도상,재MRI도상상측량폐합복위후쌍관외전각도,재골분평편상측량치료전화최근일차수방시적관구지수,기록치료전고골두골화중심시부출현,응용Tonnis분급대치료전기형정도급잔여기형정도진행평개,기록고골두결혈배사정황급분형(Bucholz and Ogden분형).이용SPSS연건분석,비교치료전,치료후,이급최종수방적각항삼수재량조관관절지간차이시부유통계학의의.결과 43관중25관위동심원복위,18관위비동심원복위,경과통계분석,아문발현량조관관절재년령、성별、측별、치료시고골두출현여부、복위전관구지수、관구지수하강치급술후쌍관외전각등방면차이무통계학의의,재술전Tonnis분급、복위후두구간거리、최종수방시관구지수、엄중잔여기형발생솔급엄중고골두결혈배사발생솔방면차이유통계학의의(P＜0.05).재치유솔방면차이유출현통계학의의적추세(P=0.052).동심원복위조적예후명현요우우비동심원복위조.결론 쾌속자공진검사능구유효학정폐합복위후적복위질량,복위전기형정도월고,술후월난이체도동심원복위,예후월차,대우저부분병례,보수치료수연대우관구적발육유일정적촉진작용,단최종적치유솔저,발생엄중잔여기형화고골두결혈배사적개솔명현증가,응고필경개치료책략래개선저부분환인적예후.
Objective To employ fast MRI (magnetic resonance imaging) for evaluating the effect of reduction quality on prognosis of DDH (developmental dysplasia of the hip) patients.Methods From September 2010 to December 2013,29 DDH patients (43 hips) underwent fast MRI immediately after close reduction.Complete imaging data were collected and the quality of reduction was evaluated according to femoral head-acetabular distance (FAD) and the shape of labrum on fast MRI images.All hips were divided into deep and incomplete concentric reduction groups.Radiological and MRI images of hips were retrieved from the PACS database.The abduction angle of hip after close reduction on MRI images and initial and last follow-up acetabular indices on radiological images were measured.We recorded whether the ossification center of femoral head was present before treatment.And Tonnis classification was used to evaluate deformity before treatment.The hips with avascular necrosis of femoral head and their types (Bucholz and Ogden type) were recorded.We analyzed whether there were statistically significant inter-group differences in preoperative,postoperative and follow-up parameters with SPSS software.Results There were 4 males and 25 females with an average age of 9 (4-16) months.And 21 left and 22 right hips were examined.The average follow-up period was 18 months.And 25 hips achieved a deep concentric reduction and another 18 hips had an incomplete concentric reduction.Statistical analyses revealed no significant differences in age,gender,sideness,preoperative presence of ossification center in femoral head,preoperative acetabular index,decreased degree of acetabular index and abduction angles of hips postoperatively.Significant statistical differences existed in preoperative Tonnis grade,head-acetabular distance (FAD) after reduction,acetabular index at the final follow-up,serious residual deformity and severe avascular necrosis of femoral head (P＜0.05).There was a trend of statistical difference in curative rate (P =0.052).The prognosis of deep concentric reduction group was obviously better than that of incomplete concentric reduction group.Conclusions Fast MRI may effectively determine the reduction quality immediately after close reduction.The more severe initial deformity,the more difficult obtaining deep concentric reduction after close reduction and the worse the prognosis.For incompletely concentrically reduced hips,conservative treatment has some stimulatory effect on the development of acetabulum,the final curative rate remains low.The probability of severe residual deformity and avascular necrosis of femoral head becomes obviously enhanced.Treatment strategies may be modified for improved patient prognosis.