2019 年第 12 期 第 14 卷

先天性髋关节发育不良患者股骨近端解剖形态学测量分析

Measurement and analysis of anatomical morphology of proximal femur in patients with developmental dysplasia of the hip

作者：郑文宾齐岩松吴海贺刘张章包呼日查王永祥徐永胜

英文作者：

单位：100029首都医科大学附属北京安贞医院骨科（郑文宾、刘张章）；010017呼和浩特，内蒙古自治区人民医院骨关节科（齐岩松、吴海贺、包呼日查、王永祥、徐永胜）

英文单位：

关键词：先天性髋关节发育不良；三维；股骨近端

英文关键词：

• 摘要：

• 【摘要】目的    探讨成人先天性髋关节发育不良（DDH）患者股骨髓腔的解剖参数和形态差异。方法    收集2013年1月至2018年4月首都医科大学附属北京安贞医院和内蒙古自治区人民医院收治的首次行全髋关节置换术DDH患者的病历资料，将55例DDH患者（男15例、女40例）中的65髋，根据Crowe分型分为4组，Ⅰ型（DDH Ⅰ组）23髋、Ⅱ型（DDH Ⅱ组）22 髋、Ⅲ型（DDH Ⅲ组）10髋、Ⅳ型（DDH Ⅳ组）10髋，随机筛选60例健康志愿者为对照组。为全部55例患者拍摄双下肢全长等比例X线片及髋关节CT，并与对照组相关影像资料进行比较。结果    DDHⅠ、Ⅱ、Ⅲ、Ⅳ组患者股骨近端形态异常，股骨头旋转中心高度明显小于对照组［（54±13）、（52±10）、（50±5）、（48±7）mm比（61±3）mm,  F=7.896, P＜0.001］；前倾角明显大于对照组［ (37.2±2.9）°、（44.5±4.1）°、（39.1±4.4）°、（41.6±4.7）°比（20.1±3.7）°, F=4.691, P＜0.001］;峡部内径明显小于对照组［ (12.5±4.4）、（11.9±3.8）、（11.7±2.9）、（10.3±3.4）mm比（12.6±3.7）mm, F=5.516,P=0.005］。结论    DDH患者股骨髓腔发生较大程度变异，特别是Crowe Ⅳ型更为明显。

• 【Abstract】Objective    To analyze the anatomical measurements and morphological changes of femoral medullary cavity in adults with congenital developmental dysplasia of the hip(DDH). Methods    Clinical data of adult patients with DDH admitted to Beijing Anzhen Hospital, Capital Medical University and Inner Mongolia People′s Hospital from January 2013 to April 2018 were reviewed. According to the Crowe classification criteria, 65 hips of 55 cases(15 males and 40 females) were divided into type Ⅰ(DDH Ⅰ group, 23 hips), type Ⅱ(DDH Ⅱ group, 22 hips), type Ⅲ(DDH Ⅲ group, 10 hips) and type Ⅳ(DDH Ⅳ group, 10 hips). Sixty healthy volunteers were collected as control group. Imaging data of full-length X-ray of both lower extremities and CT of hip joints were analyzed. Results    DDH Ⅰ, Ⅱ, Ⅲ, Ⅳ groups showed morphological abnormalities of proximal femur. The height of femoral head in DDH Ⅰ, Ⅱ, Ⅲ, Ⅳ groups was significantly less［(54±13),(52±10),(50±5),(48±7)mm vs (61±3)mm, F=7.896, P<0.001］, the angle of femoral anteversion was significantly larger［(37.2±2.9)°,(44.5±4.1)°,(39.1±4.4)°,(41.6±4.7)° vs (20.1±3.7)°, F=4.691, P<0.001］, and the isthmus diameter was significantly less［(12.5±4.4),(11.9±3.8),(11.7±2.9),(10.3±3.4)mm vs (12.6±3.7)mm, F=5.516, P=0.005］ than those in control group. Conclusion    DDH leads to significant anatomical morphological abnormalities of femoral medullary cavity, especially Crowe type Ⅳ DDH.