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目的利用3DCT影像,来探讨3岁以下幼儿DDH的骨性髋臼病理形态改变,以指导治疗。方法对44例3岁以下单侧DDH患儿的3DCT影像资料进行分析,测量髋臼前外侧缘倾斜角(ALAL)、侧面髋臼上缘倾斜度(LAI)、髋臼前倾角(AA);分析脱位程度与髋臼上缘形态的关系,年龄与髋臼上缘形态的关系。结果ALAL、LAI、AA在正常侧分别为(20.8±4.7)°、(-2.0±4.9)°、(10.0±4.7)°,在异常侧分别为(33.2±5.2)°、(6.6±5.1)°、(18.1±4.5)°,两侧各指标比较差异均有显著性意义(P<0.01);脱位程度与髋臼形态的关系:重型缺损的髋臼上缘,在Ⅰ°、Ⅱ°脱位组中占62.5%,在其他发育不良组中占16.7%(P<0.01);年龄与髋臼形态的关系:重型缺损髋臼上缘在18个月及以上组中占59.3%,在小于18个月组中占35.3%(P<0.01)。结论3DCT能清晰地显示幼儿DDH骨性髋关节的病理形态;脱位程度与髋臼上缘形态密切相关,Ⅰ°、Ⅱ°脱位时,髋臼外上缘严重受损,当独立行走后,这种破坏更为明显;脱位后,髋臼前倾角明显增加,且脱位时间越长,髋臼前倾越明显。
Objective To explore the pathological changes of DDH in young children under 3 years of age using 3DCT images to guide the treatment. Methods The 3DCT data of 44 children under 3 years of age with unilateral DDH were analyzed. The ALAL, LAI and AA of the acetabulum were measured. The relationship between the degree of dislocation and the shape of the upper edge of the acetabulum and the relationship between the age and the shape of the upper edge of the acetabulum were analyzed. Results The ALAL, LAI and AA were (20.8 ± 4.7) °, (± 2.0 ± 4.9) ° and (10.0 ± 4.7) ° on the normal side and (33.2 ± 5.2) ° and (6.6 ± 5.1) °, (18.1 ± 4.5) °, there was significant difference between each index (P <0.01). The relationship between dislocation and acetabular morphology: 62.5% in the group, and 16.7% in the other dysplasia group (P <0.01). The relationship between age and the shape of the acetabulum: The upper edge of the acetabulum with heavy defect accounted for 59.3% in the group of 18 months and over, The monthly group accounted for 35.3% (P <0.01). Conclusion 3DCT can clearly show the pathological morphology of DDH skeletal hip in children. The degree of dislocation is closely related to the shape of the upper edge of acetabulum. In the case of Ⅰ ° and Ⅱ ° dislocation, the upper edge of acetabulum is severely damaged. When walking independently, Species destruction is more obvious; dislocation, the acetabular anterior descending increased significantly, and the longer the dislocation, acetabular anterior ascend more obvious.