摘要
目的 研究发育性髋脱位髋臼方向的三维改变,为术前计划提供依据。方法 选择30例单侧发育性髋脱位(DDH)进行髋臼方向的对比性研究。男8例,女22例,年龄2～9岁,平均4.5岁。其中21例行Salter术。采用多层螺旋CT扫描,然后进行髋臼三维重建,并通过旋转进行多方向观察。X线平片测量髋臼指数(AI)。结果 髋关节脱位时,髋臼指数(AI)增大(16.22±6.07)°;前外侧臼唇角(ALAL)增大(7.65±4.63)°、后外侧臼唇角(PLAL)增大(10.49±4.94)°,髋臼在冠状面上呈外展改变;髋臼横向旋转(TR)增大(5.78±3.88)°,髋臼在横断面上前倾增加;髋臼外侧倾斜度(LAI)增大(7.11±3.85)°,髋臼在矢状面上呈后伸改变。术后AI下降(16.45±5.55)°、ALAL下降(14.76±3.95)°、PLAL下降(15.49±4.94)°、TR下降(6.57±3.60)°、LAI下降(9.53±4.66)°。结论 发育性髋关节脱位时髋臼方向呈现显著的三维改变,表现为外展、屈曲、前倾;Salter术能够通过纠正髋臼方向的变化使头臼恢复正常解剖关系,其选择原则:①单纯髋臼指数(AI)增大而前倾和屈曲不明显时,截骨远端单纯向外、向后旋转即可,不必向前旋转,以免引起截骨间隙增加导致骨不连和降低后覆盖;②根据髋臼方向的变化确定髋臼旋转程度,避免矫枉过正或不足;③Sater术可使后覆盖减少,髋臼后缺损?
Objective To study three-dimensional changes of acetabular direction of developmental
dysplasia of hip (DDH) and its value for operative plan. Methods Thirty cases of DDH (male 8, female
22) were studied by three-dimensional computed tomography (3DCT). Their age ranged from 2 to 9 years
(mean 4.5 years). By watching the 3 DCT images from different direction, anterior lateral acetabular lip
angle (ALAL), posterior lateral acetabular lip angle (PLAL), transversal rotation (TR) and lateral acetab-
ular incline (LAI) of hip were measured before and after operation. Acetabular index(AI) of each hip was
measured with X-ray film at the same time. Of them, 21 cases were treated with innominate osteotomy
(Salter procedure). Results As compared to the normal hip, AI, ALAL, PLAL, TR, and LA in DDH
were increased (16.22 ± 6.07)°, (7.65 ± 4.63)°, (10.49 ± 4.94)°, (5.78 ± 3.88)°and (7.11 ± 3.85)°
respectively. After operation, AI ALAL, PLAL, TR, and LA in DDH were decreased (16.45 ± 5.55)°,
(14.76 ± 3.95)°, (15.49 ± 4.94)°,(6.57 ± 3.60)°and (9.53 ± 4.66)° respectively. Conclusions Ac-
etabulum tends to be abduct, flex and anteverse in DDH. Usually, these variations could be effectively cor-
rected by Salter procedure.
出处
《中华小儿外科杂志》
CSCD
北大核心
2003年第5期446-449,共4页
Chinese Journal of Pediatric Surgery
