成人非创伤性股骨头坏死与髋关节发育不良相关性的影像学研究
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摘要
目的探讨成人非创伤性股骨头坏死(osteonecrosis of the femoral head,ONFH)与髋关节发育不良(developmental dysplasia of the hip,DDH)的相关性。方法收集2014年6~9月本院ONFH患者骨盆正位X线片,测量其中心边缘角(centre-edge angle,CE角)、Sharp角、髋臼指数(acetabular index,AI)、股骨头覆盖率、股骨头颈直径比、髋臼深宽指数、髋臼顶切线角7项指标。收集来院就诊无髋关节疾患并且年龄、性别与ONFH组相配伍的患者作为对照组进行比较。结果 ONFH组患者CE角平均值为(32.14±6.27)°,小于对照组(35.09±4.93)°(F=4.608,P=0.035);Sharp角平均值(38.34±3.77)°,大于对照组(35.88±2.39)°(F=10.855,P=0.001);髋臼指数平均值(9.19±4.78)°,大于对照组(5.69±6.31)°(F=9.196,P=0.003);股骨头覆盖率平均值(79.81±13.95)%,小于对照组(85.84±5.27)%(F=5.071,P=0.028);股骨头颈直径比平均值1.45±0.09,小于对照组1.53±0.09(F=11.775,P=0.001)。而髋臼深宽比和髋臼顶切线角两组之间差异无统计学意义(F=0.042,P=0.837;χ2=0.104,P=0.748)。结论 ONFH组患者的髋关节发育情况较非创伤性ONFH组的差,提示DDH有可能是ONFH发生发展的原因之一。
objective To analyze the correlation between non-traumatic occlusion femoral head necrosis( ONFH) and developmental dysplasia of the hip( DDH) in adult patients. Methods AP pelvic radiographs from adult patients with ONFH seen from June 2014 to September 2014 in Department of Orthopedics of West China Hospital of Sichuan University were collected. Centre-edge angle, femoral head coverage ratio, head-neck ratio, sharp angle, acetabular index, tangent angle of acetabulum and depth to width of acetabulum were measured. Then AP pelvic radiographs from patients who seek medical advice from West China Hospital without hip diseases and whose age and gender matched with treatment group were collected as control to make a comparison. Results The mean value of CE angle in patients with ONFH was( 32.14 ± 6.27) °, less than that of the control group( 35.09 ± 4.93) °( F = 4.608, P = 0.035). The mean value of Sharp angle was( 38.34 ± 3.77) °, more than the control group( 35.88 ± 2.39) °( F = 10.855, P = 0.001); The mean value of AI was( 9.19 ± 4.78) °, higher than that of the control group( 5.69 ± 6.31) °( F = 9.196, P = 0.003); the mean value of femoral head coverage ratio was( 79.81 ± 13.95) %, lower than that of the control group( 85.84 ± 5.27) %( F = 5.071, P = 0.028); the mean value of head-neck ratio was 1.45 ± 0.09, lower than that of the control group 1.53 ± 0.09( F = 11.775, P = 0.001). No signifi cant differences in tangent angle of acetabulum and depth to width of acetabulum were found between the two groups( F = 0.042, P = 0.837; χ~2 = 0.104, P = 0.748). Conclusions The developmental state of the hip in patients with ONFH was worse than that in patients without ONFH, so there is a possibility that DDH is one of risk factors that makes ONFH occur.
objective To analyze the correlation between non-traumatic occlusion femoral head necrosis( ONFH) and developmental dysplasia of the hip( DDH) in adult patients. Methods AP pelvic radiographs from adult patients with ONFH seen from June 2014 to September 2014 in Department of Orthopedics of West China Hospital of Sichuan University were collected. Centre-edge angle, femoral head coverage ratio, head-neck ratio, sharp angle, acetabular index, tangent angle of acetabulum and depth to width of acetabulum were measured. Then AP pelvic radiographs from patients who seek medical advice from West China Hospital without hip diseases and whose age and gender matched with treatment group were collected as control to make a comparison. Results The mean value of CE angle in patients with ONFH was( 32.14 ± 6.27) °, less than that of the control group( 35.09 ± 4.93) °( F = 4.608, P = 0.035). The mean value of Sharp angle was( 38.34 ± 3.77) °, more than the control group( 35.88 ± 2.39) °( F = 10.855, P = 0.001); The mean value of AI was( 9.19 ± 4.78) °, higher than that of the control group( 5.69 ± 6.31) °( F = 9.196, P = 0.003); the mean value of femoral head coverage ratio was( 79.81 ± 13.95) %, lower than that of the control group( 85.84 ± 5.27) %( F = 5.071, P = 0.028); the mean value of head-neck ratio was 1.45 ± 0.09, lower than that of the control group 1.53 ± 0.09( F = 11.775, P = 0.001). No signifi cant differences in tangent angle of acetabulum and depth to width of acetabulum were found between the two groups( F = 0.042, P = 0.837; χ~2 = 0.104, P = 0.748). Conclusions The developmental state of the hip in patients with ONFH was worse than that in patients without ONFH, so there is a possibility that DDH is one of risk factors that makes ONFH occur.
引文
[1]成人股骨头坏死诊疗标准专家共识(2012年版).中华骨科杂志,2012,32(6):185-192.
[2]Gardeniers JW.ARCO committee on terminology and staging(report on the committee meeting at Santiago De Compostela).ARCO News Lett,1993,5:79-82.
[3]Omeroglu H,Inan U.Inherited thrombophilia may be a causative factor for osteonecrosis of femoral head in male patients with developmental dysplasia of the hip:a case series.Arch Orthop Trauma Surg,2012,132(9):1281-1285.
[4]Connolly P,Weinstein SL.The course and treatment of avascular necrosis of the femoral head in developmental dysplasia of the hip.Acta Orthop Traumatol Turc,2007,41(Suppl 1):S54-59.
[5]Taketa M,Fujii T,Kubota H,et al.Correlation between centeredge angle and acetabulum-head index in developmental dysplasia of the hip with avascular necrosis of the femoral head.J Pediatr Orthop B,2003,12(3):215-218.
[6]Mose K.Methods of measuring in Legg-Calve-Perthes disease with special regard to the prognosis.Clin Orthop Relat Res,1980,(150):103-109.
[7]Troelsen A.Assessment of adult hip dysplasia and the outcome of surgical treatment.Dan Med J,2012,59(6):B4450.
[8]Werner CM,Ramseier LE,Stromberg J,et al.Normal values of Wiberg’s lateral center-edge angle and Lequesne’s acetabular index--a coxometric update.Skeletal Radiol,2012,41(10):1273-1278.
[9]Tannast,M,Hanke MS,Zheng G,et al.What are the radiographic reference values for acetabular under-and overcoverage?Clin Orthop Relat Res,2015,473(4):1234-1246.
[10]Saengnipanthkul S,Techasatien W.Femoral head-neck diameter and ratio in Thais:a cadaveric study.J Med Assoc Thai,2012,95(6):790-794.
[11]Murphy SB,Ganz R,Muller ME.The prognosis in untreated dysplasia of the hip.A study of radiographic factors that predict the outcome.J Bone Joint Surg Am,1995,77(7):985-989.
[12]袁西伟.成人髋臼发育不良的X线分析.中国中西医结合影像学杂志,2012,2(34):355.
[13]Doherty M,Courtney P,Doherty S,et al.Nonspherical femoral head shape(pistol grip deformity),neck shaft angle,and risk of hip osteoarthritis:a case-control study.Arthritis Rheum,2008,58(10):3172-3182.
[14]Russell ME,Shivanna KH,Grosland NM,et al.Cartilage contact pressure elevations in dysplastic hips:a chronic overload model.J Orthop Surg Res,2006,1:6.
[15]Chen GX,Yang L,Li K,et al.A three-dimensional finite element model for biomechanical analysis of the hip.Cell Biochem Biophys,2013,67(2):803-808.
[16]Carter DR,Rapperport DJ,Fyhrie DP,et al.Relation of coxarthrosis to stresses and morphogenesis.A finite element analysis.Acta Orthop Scand,1987,58(6):611-619.
[17]Wingstrand H,Wingstrand A.Biomechanics of the hip joint capsule--a mathematical model and clinical implications.Clin Biomech(Bristol,Avon),1997,12(5):273-280.
[18]张理平,曹跃勇,段宗强.成人股骨头坏死与髋臼结构不良118例临床X线分析.四川医学,2005,26(5):552-553.
[19]陈卫衡,郭效东.非创伤性股骨头坏死的力学因素分析.中国骨伤,2002,15(6):352.
[2]Gardeniers JW.ARCO committee on terminology and staging(report on the committee meeting at Santiago De Compostela).ARCO News Lett,1993,5:79-82.
[3]Omeroglu H,Inan U.Inherited thrombophilia may be a causative factor for osteonecrosis of femoral head in male patients with developmental dysplasia of the hip:a case series.Arch Orthop Trauma Surg,2012,132(9):1281-1285.
[4]Connolly P,Weinstein SL.The course and treatment of avascular necrosis of the femoral head in developmental dysplasia of the hip.Acta Orthop Traumatol Turc,2007,41(Suppl 1):S54-59.
[5]Taketa M,Fujii T,Kubota H,et al.Correlation between centeredge angle and acetabulum-head index in developmental dysplasia of the hip with avascular necrosis of the femoral head.J Pediatr Orthop B,2003,12(3):215-218.
[6]Mose K.Methods of measuring in Legg-Calve-Perthes disease with special regard to the prognosis.Clin Orthop Relat Res,1980,(150):103-109.
[7]Troelsen A.Assessment of adult hip dysplasia and the outcome of surgical treatment.Dan Med J,2012,59(6):B4450.
[8]Werner CM,Ramseier LE,Stromberg J,et al.Normal values of Wiberg’s lateral center-edge angle and Lequesne’s acetabular index--a coxometric update.Skeletal Radiol,2012,41(10):1273-1278.
[9]Tannast,M,Hanke MS,Zheng G,et al.What are the radiographic reference values for acetabular under-and overcoverage?Clin Orthop Relat Res,2015,473(4):1234-1246.
[10]Saengnipanthkul S,Techasatien W.Femoral head-neck diameter and ratio in Thais:a cadaveric study.J Med Assoc Thai,2012,95(6):790-794.
[11]Murphy SB,Ganz R,Muller ME.The prognosis in untreated dysplasia of the hip.A study of radiographic factors that predict the outcome.J Bone Joint Surg Am,1995,77(7):985-989.
[12]袁西伟.成人髋臼发育不良的X线分析.中国中西医结合影像学杂志,2012,2(34):355.
[13]Doherty M,Courtney P,Doherty S,et al.Nonspherical femoral head shape(pistol grip deformity),neck shaft angle,and risk of hip osteoarthritis:a case-control study.Arthritis Rheum,2008,58(10):3172-3182.
[14]Russell ME,Shivanna KH,Grosland NM,et al.Cartilage contact pressure elevations in dysplastic hips:a chronic overload model.J Orthop Surg Res,2006,1:6.
[15]Chen GX,Yang L,Li K,et al.A three-dimensional finite element model for biomechanical analysis of the hip.Cell Biochem Biophys,2013,67(2):803-808.
[16]Carter DR,Rapperport DJ,Fyhrie DP,et al.Relation of coxarthrosis to stresses and morphogenesis.A finite element analysis.Acta Orthop Scand,1987,58(6):611-619.
[17]Wingstrand H,Wingstrand A.Biomechanics of the hip joint capsule--a mathematical model and clinical implications.Clin Biomech(Bristol,Avon),1997,12(5):273-280.
[18]张理平,曹跃勇,段宗强.成人股骨头坏死与髋臼结构不良118例临床X线分析.四川医学,2005,26(5):552-553.
[19]陈卫衡,郭效东.非创伤性股骨头坏死的力学因素分析.中国骨伤,2002,15(6):352.