婴儿发育性髋关节脱位的髋关节超声定量分析

doi:10.3877/cma.j.issn.1672-6448.2017.03.010

目的

超声评价发育性髋关节脱位婴儿的髋关节生物学特征。

方法

对2013年1月至2016年6月深圳市儿童医院出生1~8个月诊断发育性髋关节脱位的30例患儿进行超声检查，女性25例，男性5例。关节总数60个，脱位关节34个，单侧脱位26例，双侧脱位4例；其中手术治疗20例，非手术治疗10例。全部患儿均经X线、磁共振成像（MRI）检查或手术证实。采用髋关节冠状切面、横切面等进行关节定量超声检测，并行双髋关节X平片测量，比较脱位关节与健侧关节的差异。

结果

脱位关节组患儿α角减小，小于对照关节组患儿[（50.5±3.75）^° vs （64.8±3.38）^°]，且差异有统计学意义（t=-15.181，P<0.001）。脱位关节组患儿骨性髋臼覆盖率减低，股骨头长径减小，股骨头宽径减小，均小于对照关节组患儿[（23.4 ±17.63）% vs （64.3 ±6.45）%，（0.98±0.15）cm vs （1.19±0.11）cm，（1.38 ±0.21）cm vs （1.61 ±0.16）cm]，且差异均有统计学意义（t=-12.469、-6.034、-4.568，P均<0.001）。脱位关节组患儿耻头距、坐头距均增大，均大于对照关节组患儿[（0.97±0.45）cm vs （0.27±0.05）cm，（0.75±0.30）cm vs （0.17±0.05）cm]，且差异均有统计学意义（t=8.805、10.696，P均<0.001）。双侧脱位关节组患儿α角、股骨头长径、股骨头宽径均略小于单侧脱位关节组患儿 [（50.3±2.75）^° vs （51.3±4.77）^°，（0.90 ±0.15）cm vs （0.97 ±0.12）cm，（1.25 ±0.20）cm vs （1.37 ±0.17）cm]，但差异均无统计学意义；而耻头距及坐头距均略大于单侧脱位关节组患儿 [（0.97±0.49）cm vs （0.80±0.31）cm，（0.92±0.26）cm vs （0.68±0.18）cm]，但差异均无统计学意义。超声测量的髋臼指数测值略大于X线片测量的髋臼指数 [（33.13±7.82）° vs （31.20±8.31）°]，但差异无统计学意义。

结论

发育性髋关节脱位患儿髋关节特征包括，骨性髋臼及股骨头发育不良、股骨头与髋臼位置关系异常。对髋关节进行多方位定量超声检测，可定量评估发育性髋关节发育不良（DDH）的结构特征，有助于DDH的早期诊断和随访复查。

关键词: 超声检查, 发育性髋关节发育不良, 脱位, 婴儿

Objective

To evaluate the biological characteristics of hip joint in infants with developmental dislocation of the hip (DDH).

Methods

From January 2013 to June 2016, 30 patients (age from 1 to 8 months, 25 females and 5 males) who were diagnosed as DDH, underwent ultrasound examination in Shenzhen Children′s Hospital, in these patients 20 cases were treated surgically, and 10 cases were treated with non-surgical treatment. There were 34 hips (26 unilateral dislocation and 4 bilateral dislocation) dislocation in 60 hips. All the patients were confirmed by X-ray, magnetic resonance imaging (MRI) examination or operation. All the patients were examined by ultrasound through the coronal and transverse plane of the hip joint. The α angle, femoral head coverage ratio by acetabulum (FHC), femoral head length and width, distance from pubis to femoral head (P-H) and distance from ischium to femoral head (I-H) were measured. The dislocation joints were compared with contralateral joints.

Results

The α angle in the hip dislocation group was smaller than the contralateral group [(50.5±3.75)^° vs (64.8±3.38) ^°], and there was significant difference between the two groups (t=-15.181, P<0.001). The FHC, femoral head length and width in the hip dislocation group were all smaller than the contralateral group [(23.4±17.63)% vs (64.3±6.45)%, (0.98 ±0.15) cm vs (1.19 ±0.11) cm, (1.38±0.21) cm vs (1.61±0.16) cm ], and there were significant differences between the two groups (t= -12.469, -6.034, -4.568, all P<0.001). The P-H and I-H in the hip dislocation group were larger than the contralateral group [(0.97±0.45) cm vs (0.27±0.05) cm, (0.75±0.30) cm vs (0.17±0.05) cm], and there were significant differences between the two groups (t= 8.805, 10.696, both P<0.001). The α angle, femoral head length and width in bilateral dislocation of hip group were slightly smaller than the unilateral dislocation of hip group [(50.3±2.75)^° vs (51.3±4.77)^°, (0.90 ±0.15) cm vs (0.97 ±0.12) cm, (1.25±0.20) cm vs (1.37 ±0.17) cm], but there were no significant differences between the two groups. The P-H and I-H in bilateral dislocation of hip group were slightly larger than the unilateral dislocation of hip group [(0.97±0.49) cm vs (0.80±0.31) cm, (0.92±0.26) cm vs (0.68±0.18) cm], but there were no significant differences between the two groups. The value of acetabular index in the ultrasound group was slightly larger than the X-ray group [(33.13±7.82)^° vs (31.20±8.31)^°], and there were no significant differences between the two groups.

Conclusions

The characteristics of DDH includes acetabulum and femoral head dysplasia, and femoral head and acetabulum position relationship abnormalities. Quantitative ultrasonography of the hip can be used to quantitatively evaluate the structural features of DDH, and it is helpful to the early diagnosis and follow-up of DDH.

Key words: Ultrasonography, Developmental dysplasia of the hip, Dislocation, Infant

图7，8 经外侧横切图测量耻头距（黄色箭头所示）、坐头距（红色箭头所示）。图7为脱位关节；图8为正常关节

图9~14 患儿女性，4.5个月，右侧髋关节脱位，可复位。采用蛙式石膏固定术。图9 为右髋关节中立位冠状切面图，示髋臼指数较对侧增大；图10 为左髋关节中立位冠状切面图，示与X线平片对应的髋臼指数测量方法；图11 为右侧屈髋关节后外侧横切图，显示股骨头向外侧移位；图12 为左侧屈髋关节后外侧横切图，显示股骨头位于髋臼内；图13 为初次X线片，示右侧髋臼指数增大，股骨头向外侧移位，位于Perkin方格外下象限；图14 为出生12个月，患儿蛙式石膏固定7个月X线片，左右髋臼角分别约14^°和16^°，双侧股骨头骨化中心基本被髋臼所包容，右侧股骨头骨化中心较左侧小，双侧沈通线连续正常

表1 脱位关节组与对照关节组患儿髋关节各项结构测量结果及其比较（±s）

分组	例数	α角（^°）	骨性髋臼覆盖率（%）	股骨头长径（cm）	股骨头宽径（cm）	耻头距（cm）	坐头距（cm）
对照关节组	26例	64.8±3.38	64.3 ±6.45	1.19 ±0.11	1.61 ±0.16	0.27±0.05	0.17±0.05
脱位关节组	34例	50.5±3.75	23.4 ±17.63	0.98 ±0.15	1.38 ±0.21	0.97±0.45	0.75±0.30
t值	?	-15.181	-12.469	-6.034	-4.568	8.805	10.696
P值	?	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表1 脱位关节组与对照关节组患儿髋关节各项结构测量结果及其比较（±s）

分组	例数	α角（^°）	骨性髋臼覆盖率（%）	股骨头长径（cm）	股骨头宽径（cm）	耻头距（cm）	坐头距（cm）
对照关节组	26例	64.8±3.38	64.3 ±6.45	1.19 ±0.11	1.61 ±0.16	0.27±0.05	0.17±0.05
脱位关节组	34例	50.5±3.75	23.4 ±17.63	0.98 ±0.15	1.38 ±0.21	0.97±0.45	0.75±0.30
t值	?	-15.181	-12.469	-6.034	-4.568	8.805	10.696
P值	?	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

图15~20 患儿女性，3个月，顺产出生。左侧髋关节脱位，可复位。行左侧内收肌、髂腰肌切断、髋关节切开复位、髋臼清扫、圆韧带切除，双髋蛙式石膏外固定术。图15 为右髋关节中立位冠状切面图，显示股骨头位于髋臼内；图16 为左髋关节中立位冠状切面图，示股骨头向上方移位，髋臼指数增大；图17为右髋关节中立位外侧横切图，示股骨头与耻骨和坐骨的位置关系正常；图18 为左髋关节中立位外侧横切图，示股骨头向后外侧移位，远离耻骨与坐骨；图19 为X线片示左侧髋臼指数较对侧增大；图20 为出生7个月时，患儿双髋关节蛙式石膏外固定术后4个月，X线片显示双侧髋臼发育尚可，左右髋臼角分别约19^°和14^°，左侧股骨头骨化中心尚未出现，左侧股骨近端对向髋臼外缘，略偏外侧

表2 双侧脱位关节组与单侧脱位关节组各项结构测量结果及其比较（±s）

分组	脱位关节数	α角（^°）	股骨头长径（cm）	股骨头宽径（cm）	耻头距（cm）	坐头距（cm）
双侧脱位关节组	8个	50.3±2.75	0.90 ±0.15	1.25 ±0.20	0.97±0.49	0.92±0.26
单侧脱位关节组	8个	51.3±4.77	0.97 ±0.12	1.37 ±0.17	0.80±0.31	0.68±0.18
t值	?	-0.486	-0.989	-1.264	0.793	2.049
P值	?	0.636	0.340	0.227	0.442	0.061

表2 双侧脱位关节组与单侧脱位关节组各项结构测量结果及其比较（±s）

分组	脱位关节数	α角（^°）	股骨头长径（cm）	股骨头宽径（cm）	耻头距（cm）	坐头距（cm）
双侧脱位关节组	8个	50.3±2.75	0.90 ±0.15	1.25 ±0.20	0.97±0.49	0.92±0.26
单侧脱位关节组	8个	51.3±4.77	0.97 ±0.12	1.37 ±0.17	0.80±0.31	0.68±0.18
t值	?	-0.486	-0.989	-1.264	0.793	2.049
P值	?	0.636	0.340	0.227	0.442	0.061

图21 α角在观察者组间（上图）与组内（下图）的重复性检测结果

图22 耻头距在观察者组间（上图）与组内（下图）的重复性检测结果

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Developmental dislocation of the hip in infants: the hip′s ultrasound quantitative analysis

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Developmental dislocation of the hip in infants: the hip′s ultrasound quantitative analysis