磁共振评价Dega截骨术治疗小儿发育性髋关节脱位的短期疗效
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摘要
目的:通过测量评估患有发育性髋脱位的婴幼儿在行Dega截骨术前术后X线平片和MRI的影像学指标,观察患儿髋臼形态在术后短期内的变化,并分析术后短期疗效与影像学指标和手术年龄的关系。方法:收集38例46髋发育性髋关节脱位,在Dega截骨术前及术后3～6月分别行髋关节MRI扫描和X线骨盆正位片。男5例,女33例;左侧19例,右侧11例,双侧8例,年龄13～72月,平均术前年龄为25.2月,全部脱位髋按术前年龄分为两组,A组:年龄<2岁,B组:年龄≥2岁。结果:脱位髋及正常髋术前术后各指标差值比较均具有统计学意义(P<0.01)。脱位髋术前术后髋臼指数(AI)、MRI上的骨性髋臼指数(BAI)的差值分别与软骨性髋臼指数(CAI)的差值比较均具有显著的统计学意义(P<0.01),AI与BAI差值比较无统计学意义(P<0.01)。年龄组A、B两组术前比较AI、BAI、CAI均具有统计学意义(P<0.01),A、B两组术后比较AI、BAI无统计学意义(P<0.01)、CAI有统计学意义(P<0.01)。术前术后AI、BAI、CAI差值与年龄呈负相关。结论:复位后观察CAI的变化情况相对于BAI的变化更能敏感的反映术后短期内髋臼的形态变化,其中CAI变化能够最佳反映髋臼改善程度,特别是年龄较小患儿行Dega截骨术的髋臼改善程度。
Objective: A follow-up was performed to make the radiological evaluation after Dega osteotomy in developmental dysplasia of the hip(DDH) in children. The postoperative developmental characteristics of the hip were observed and the relationship of short-term efficacy, radiographic indicators and operative age was analyzed. Methods: Thirty-eight untreated patients included 46 dislocation hips(5 boys and 33 girls; age range from 13 months to 72 months; mean age 25.2 months)were diagnosed with DDH. Those patients include 19 in left, 11 in right and 8 bilateral; in total was 38. All the dislocation hips were divided into A and B groups, the age of group A was less than two years old, the age of group B was equal or greater than two years old. Results: The difference of all the parameters preoperative and postoperative between the dislocation hip and the normal side had statistical significance(P<0.01). The difference of acetabular index(AI) and bone acetabular index(BAI) respectively compared with that of cartilage acetabular index(CAI) had significant statistical significance(P<0.01), but the difference between AI and BAI had no statistical significance(P>0.05). The data was divided into 2 groups(group A and group B), comparison of group A and group B before operation, the parameters of AI, BAI and CAI had statistical significance(P<0.01). Comparison of group A and group B after operation, the parameters of AI and BAI had no statistical significance(P>0.05), the parameter of CAI had statistical significance(P<0.01). The differences between preoperative parameters and the postoperative parameters were negatively correlated with age. Conclusions: The change of CAI could reflect the change of acetabulum more sensitively compared with that of BAI in the short term after Dega osteotomy operation, which suggests the change of CAI could reveal the improvement of acetabulum most, especially for the younger children.
Objective: A follow-up was performed to make the radiological evaluation after Dega osteotomy in developmental dysplasia of the hip(DDH) in children. The postoperative developmental characteristics of the hip were observed and the relationship of short-term efficacy, radiographic indicators and operative age was analyzed. Methods: Thirty-eight untreated patients included 46 dislocation hips(5 boys and 33 girls; age range from 13 months to 72 months; mean age 25.2 months)were diagnosed with DDH. Those patients include 19 in left, 11 in right and 8 bilateral; in total was 38. All the dislocation hips were divided into A and B groups, the age of group A was less than two years old, the age of group B was equal or greater than two years old. Results: The difference of all the parameters preoperative and postoperative between the dislocation hip and the normal side had statistical significance(P<0.01). The difference of acetabular index(AI) and bone acetabular index(BAI) respectively compared with that of cartilage acetabular index(CAI) had significant statistical significance(P<0.01), but the difference between AI and BAI had no statistical significance(P>0.05). The data was divided into 2 groups(group A and group B), comparison of group A and group B before operation, the parameters of AI, BAI and CAI had statistical significance(P<0.01). Comparison of group A and group B after operation, the parameters of AI and BAI had no statistical significance(P>0.05), the parameter of CAI had statistical significance(P<0.01). The differences between preoperative parameters and the postoperative parameters were negatively correlated with age. Conclusions: The change of CAI could reflect the change of acetabulum more sensitively compared with that of BAI in the short term after Dega osteotomy operation, which suggests the change of CAI could reveal the improvement of acetabulum most, especially for the younger children.
引文
[1]Nemeth BA, Narotam V. Developmental dysplasia of the hip[J].Pediatr Rev, 2012, 33(12):553-561.
[2]Musielak B, Idzior M, Jówiak M. Evolution of the term and definition of dysplasia of the hip—a review of the literature[J]. Arch Med Sci:AMS, 2015, 11(5):1052-1057.
[3]de Hundt M, Vlemmix F, Bais JM, et al. Risk factors for developmental dysplasia of the hip:a meta-analysis[J]. Eur J Obstet Gynecol Reprod Biol, 2012, 165(1):8-17.
[4]葛微,李琦,李连永,等.小儿发育性髋关节脱位:MRI增强观察股骨头血运已成研究热点[J].中国组织工程研究,2015,19(4):623-628.
[5]刘玲玲,高月,李琦,等.发育性髋关节发育不良磁共振检查的研究进展[J].中国临床医学影像杂志,2017,28(12):893-896.
[6]Dega W. Selection of surgical methods in the treatment of congenital dislocation of the hip in children[J]. Chirurgia Narzadów Ruchu I Ortopedia Polska, 1969, 34(3):357-366.
[7]Phillips L, Hesketh K, Schaeffer EK, et al. A vascular necrosis in children with cerebral palsy after reconstructive hip surgery[J].J Child Orthop, 2017, 11(5):326-333.
[8]Grudziak JS, Ward WT. Dega osteotomy for the treatment of congenital dysplasia of the hip[J]. J Bone Joint Surg, 2001, 83A(6):845-854.
[9]Maheshwari R, Madan S. Pelvic osteotomy techniques and comparative effects on biomechanics of the hip[J]. J Bone Joint Surg,2010, 92-B(SupplⅡ):305.
[10]Gulati V, Eseonu K, Sayani J, et al. Developmental dysplasia of the hip in the newborn:A systematic review[J]. World J Orthop,2013, 4(2):32-41.
[11]Beltran LS, Rosenberg ZS, Mayo JD, et al. Imaging evaluation of developmental hip dysplasia in the young adult[J]. AJR,2013, 200(5):1077-1088.
[12]Bracken J, Tran T, Ditchfield M. Developmental dysplasia of the hip:controversies and current concepts[J]. J Pediatr Child Health, 2012, 48(11):963-973.
[13]Servaes R, Jaramillo B, Mint Z. MR imaging in postreduction assessment of developmental dysplasia of the hip:goals and obstacles[J]. Radiographics, 2016, 36(3):840-854.
[14]Lee CB, Kim YJ. Imaging hip dysplasia in the skeletally mature[J]. Orthop Clin North Am, 2012, 43(3):329-342.
[15]Shirai Y, Wakabayashi K, Wada I, et al. Magnetic resonance imaging evaluation of the labrum to predict acetabular development in developmental dysplasia of the hip:A STROBE compliant study[J]. Medicine, 2017, 96(21):1-6.
[16]Fukiage K, Yamasaki N, Suzuki S. Visualization of developmental dysplasia of the hip in infants by using three-dimensional magnetic resonance imaging[J]. J Pediatr Orthop B, 2014, 23(2):107-111.
[17]Takeuchi R, Kamada H, Mishima H, et al. Evaluation of the cartilaginous acetabulum by magnetic resonance imaging in developmental dysplasia of the hip[J]. J Pediatr Orthop B, 2014,23(3):237-243.
[18]Demb J, Chu P, Nelson T, et al. Optimizing radiation doses for computed tomography across in stitutions:dose auditing and best practices[J]. JAMA Intern Med, 2017, 177(6):810-817.
[19]Grissom L, Harcke HT, Thacker M. Imaging in the surgical management of developmental dislocation of the hip[J]. Clin Orthop Relat Res, 2008, 466(4):791-801.
[20]Collins-Sawaragi. How to use hip examination and ultrasound in newborns[J]. Arch Dis Child Edu Pract Ed, 2018, 103(1):34-40.
[21]Roovers EA, Boere-Boonekamp MM, Castelein RM, et al. Effectiveness of ultrasound screening for developmental dysplasia of the hip[J]. Arch Dis Child Fetal Neonatal Ed, 2005, 90(1):F25-F30.
[22]Fisher R, O’Brien TS, Davis KM. Magnetic resonance imaging in congenital dysplasia of the hip[J]. J Pediatr Orthop, 1991, 11(5):617-622.
[23]Feeley IH, Green CJ, Rowan FE, et al. International variance in the treatment of developmental dysplasia of the hip[J]. J Child Orthop, 2014, 8(5):381-386.
[2]Musielak B, Idzior M, Jówiak M. Evolution of the term and definition of dysplasia of the hip—a review of the literature[J]. Arch Med Sci:AMS, 2015, 11(5):1052-1057.
[3]de Hundt M, Vlemmix F, Bais JM, et al. Risk factors for developmental dysplasia of the hip:a meta-analysis[J]. Eur J Obstet Gynecol Reprod Biol, 2012, 165(1):8-17.
[4]葛微,李琦,李连永,等.小儿发育性髋关节脱位:MRI增强观察股骨头血运已成研究热点[J].中国组织工程研究,2015,19(4):623-628.
[5]刘玲玲,高月,李琦,等.发育性髋关节发育不良磁共振检查的研究进展[J].中国临床医学影像杂志,2017,28(12):893-896.
[6]Dega W. Selection of surgical methods in the treatment of congenital dislocation of the hip in children[J]. Chirurgia Narzadów Ruchu I Ortopedia Polska, 1969, 34(3):357-366.
[7]Phillips L, Hesketh K, Schaeffer EK, et al. A vascular necrosis in children with cerebral palsy after reconstructive hip surgery[J].J Child Orthop, 2017, 11(5):326-333.
[8]Grudziak JS, Ward WT. Dega osteotomy for the treatment of congenital dysplasia of the hip[J]. J Bone Joint Surg, 2001, 83A(6):845-854.
[9]Maheshwari R, Madan S. Pelvic osteotomy techniques and comparative effects on biomechanics of the hip[J]. J Bone Joint Surg,2010, 92-B(SupplⅡ):305.
[10]Gulati V, Eseonu K, Sayani J, et al. Developmental dysplasia of the hip in the newborn:A systematic review[J]. World J Orthop,2013, 4(2):32-41.
[11]Beltran LS, Rosenberg ZS, Mayo JD, et al. Imaging evaluation of developmental hip dysplasia in the young adult[J]. AJR,2013, 200(5):1077-1088.
[12]Bracken J, Tran T, Ditchfield M. Developmental dysplasia of the hip:controversies and current concepts[J]. J Pediatr Child Health, 2012, 48(11):963-973.
[13]Servaes R, Jaramillo B, Mint Z. MR imaging in postreduction assessment of developmental dysplasia of the hip:goals and obstacles[J]. Radiographics, 2016, 36(3):840-854.
[14]Lee CB, Kim YJ. Imaging hip dysplasia in the skeletally mature[J]. Orthop Clin North Am, 2012, 43(3):329-342.
[15]Shirai Y, Wakabayashi K, Wada I, et al. Magnetic resonance imaging evaluation of the labrum to predict acetabular development in developmental dysplasia of the hip:A STROBE compliant study[J]. Medicine, 2017, 96(21):1-6.
[16]Fukiage K, Yamasaki N, Suzuki S. Visualization of developmental dysplasia of the hip in infants by using three-dimensional magnetic resonance imaging[J]. J Pediatr Orthop B, 2014, 23(2):107-111.
[17]Takeuchi R, Kamada H, Mishima H, et al. Evaluation of the cartilaginous acetabulum by magnetic resonance imaging in developmental dysplasia of the hip[J]. J Pediatr Orthop B, 2014,23(3):237-243.
[18]Demb J, Chu P, Nelson T, et al. Optimizing radiation doses for computed tomography across in stitutions:dose auditing and best practices[J]. JAMA Intern Med, 2017, 177(6):810-817.
[19]Grissom L, Harcke HT, Thacker M. Imaging in the surgical management of developmental dislocation of the hip[J]. Clin Orthop Relat Res, 2008, 466(4):791-801.
[20]Collins-Sawaragi. How to use hip examination and ultrasound in newborns[J]. Arch Dis Child Edu Pract Ed, 2018, 103(1):34-40.
[21]Roovers EA, Boere-Boonekamp MM, Castelein RM, et al. Effectiveness of ultrasound screening for developmental dysplasia of the hip[J]. Arch Dis Child Fetal Neonatal Ed, 2005, 90(1):F25-F30.
[22]Fisher R, O’Brien TS, Davis KM. Magnetic resonance imaging in congenital dysplasia of the hip[J]. J Pediatr Orthop, 1991, 11(5):617-622.
[23]Feeley IH, Green CJ, Rowan FE, et al. International variance in the treatment of developmental dysplasia of the hip[J]. J Child Orthop, 2014, 8(5):381-386.