儿童骨盆髋臼周围截骨术后的三维计算机断层扫描分析及前倾研究
Three-dimensional computed tomography analysis and anteversion study after periacetabular osteotomy of pelvis in children.
作者信息
Jawish Roger, Khalife Rami, Ghorayeb Jacques
机构信息
Medical School, Sacre Coeur Hospital, St Joseph University, Beirut, Lebanon,
出版信息
J Child Orthop. 2007 Dec;1(6):357-63. doi: 10.1007/s11832-007-0063-z. Epub 2007 Nov 17.
PURPOSE
Three-dimensional computed tomography (CT) is the method of choice in understanding the morphological changes after periacetabular osteotomy in children. We studied different parameters and compared aspects of operated hip (OH) with non-operated hip (NOH) to define the maneuver that promotes normalization of the hip during repositioning of the acetabulum.
METHODS
A total of 22 patients with 25 OHs underwent CT control scans an average of 4 years after surgery. The patients, with a mean age of 6.8 years, had either Legg-Calvé-Perthes disease (12 cases) or dysplasia (10 cases).The measurements included the anterior and posterior coverage angles of the hip and version of the acetabulum on axial CT views. The 3D reconstructed images measured the inclination of the antero- and postero-lateral lips, the external rotation and the anterior inclination of the acetabulum.
RESULTS
The mean anterior coverage angle was 27 degrees for OHs, 31 degrees for NOHs, and 12 degrees versus 10.3 degrees for the posterior coverage angle. Acetabular anteversion was 2 degrees for OHs (6.3 degrees in the dysplastic OHs) and 6 degrees for NOHs. The mean angle of inclination of the antero-lateral lip was 37 degrees for OHs, 47 degrees for NOHs, and the postero-lateral lip inclination was 56 degrees for OHs and 67 degrees for NOHs. Inferior 3D views showed a mean internal acetabular rotation of 1.5 degrees (4.8 degrees in the dysplastic OH), 3 degrees for NOH. The anterior acetabular inclination angle measured with lateral 3D views was 6 degrees for OHs, 11 degrees for NOHs.
CONCLUSION
Our analysis demonstrated a mean anteversion of the acetabulum despite normalization of the anterior coverage of the hip, particularly in the dysplastic group, in which the osteotomized fragments had anteversion superior to NOH. The unexpected external rotation used to improve anterior coverage of a coax magna in Legg-Calvé-Perthes disease was responsible for the retroversion and the decrease of the posterior coverage.
目的
三维计算机断层扫描（CT）是了解儿童髋臼周围截骨术后形态变化的首选方法。我们研究了不同参数，并比较了手术髋关节（OH）和非手术髋关节（NOH）的各方面情况，以确定在髋臼重新定位过程中促进髋关节恢复正常的操作。
方法
共有22例患者的25个手术髋关节在术后平均4年接受了CT对照扫描。这些患者的平均年龄为6.8岁，患有Legg-Calvé-Perthes病（12例）或发育异常（10例）。测量包括髋关节的前后覆盖角以及轴向CT视图上髋臼的旋转角度。三维重建图像测量了髋臼前外侧唇和后外侧唇的倾斜度、髋臼的外旋和前倾。
结果
手术髋关节的平均前覆盖角为27度，非手术髋关节为31度；后覆盖角分别为12度和10.3度。髋臼前倾角度，手术髋关节为2度（发育异常的手术髋关节为6.3度），非手术髋关节为6度。前外侧唇的平均倾斜角度，手术髋关节为37度，非手术髋关节为47度；后外侧唇倾斜角度，手术髋关节为56度，非手术髋关节为67度。三维视图下方显示髋臼平均内旋角度，手术髋关节为1.5度（发育异常的手术髋关节为4.8度），非手术髋关节为3度。通过三维侧视图测量的髋臼前倾角度，手术髋关节为6度，非手术髋关节为11度。
结论
我们的分析表明，尽管髋关节前覆盖恢复正常，但髋臼仍存在平均前倾，尤其是在发育异常组，其中截骨碎片的前倾角度大于非手术髋关节。在Legg-Calvé-Perthes病中，用于改善髋关节前覆盖的意外外旋导致了髋臼后倾和后覆盖减少。
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