Department of Othopaedic and Spine Surgery, Fukuoka Children's Hospital, 5-1-1 Kashii Teriha, Higashi-ku, Fukuoka 812-0017, Japan.
Department of Othopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
J Orthop Sci. 2021 Jul;26(4):644-649. doi: 10.1016/j.jos.2020.05.002. Epub 2020 Jun 24.
Although acetabular dysplasia is a common etiology of osteoarthritis of the hip regardless of the history of developmental dysplasia of the hip (DDH), whether or not corrective surgeries are beneficial for the childhood asymptomatic acetabular dysplasia remains controversial due to a lack of evidence. We conducted a longitudinal study to compare the cartilaginous morphology on childhood magnetic resonance imaging (MRI) and the mature hip morphology of the same patient and to assess the predictive indicators for future acetabular dysplasia.
A total of 92 unaffected hips (47 unilateral DDH and 45 unilateral Legg-Calvé-Perthes disease) were reviewed for X-ray and MRI findings on childhood (mean age: 6.0 years) and X-ray findings from a skeletally mature age with a mean follow-up period of 15.1 years. The following parameters were measured and compared: the immature-acetabular index (AI) and center edge angle (CE) on immature X-ray; the cartilage- and bone- AI, CE, Sharp and acetabular head index (AHI) on childhood MRI; and the mature-acetabular roof obliquity (ARO), CE, Sharp and AHI on skeletally mature X-ray. The prognostic factors on childhood MRI for acetabular dysplasia, defined by a CE of <20° on skeletally mature X-ray were also assessed.
Positive correlations were shown between the cartilage-AI and mature-ARO (7.6°/6.3°; r = 0.44), the cartilage-CE and mature-CE (27.8°/28.0°; r = 0.62), the cartilage-Sharp and mature-Sharp (44.4°/41.8°; r = 0.52) and the cartilage-AHI and mature-AHI (78.7%/80.3%; r = 0.46). A multivariate analysis indicated cartilage-CE to be an independent predictor for acetabular dysplasia with a cut-off value of 22°. Children with a cartilage-CE <22° developed more frequently acetabular dysplasia compared to the others (52.4% vs. 1.4%).
Childhood MRI findings are useful for the prediction of acetabular dysplasia without a DDH history. Children with a cartilage-CE ≥23° are likely to achieve a non-dysplastic hip without the need for surgical intervention.
尽管髋臼发育不良是髋关节骨关节炎的常见病因，与发育性髋关节发育不良（DDH）无关，但由于缺乏证据，对于儿童无症状髋臼发育不良是否需要进行矫正手术仍存在争议。我们进行了一项纵向研究，比较了同一位患者儿童期磁共振成像（MRI）的软骨形态和成熟髋关节形态，并评估了未来髋臼发育不良的预测指标。
共回顾了 92 个未受影响的髋关节（47 个单侧 DDH 和 45 个单侧 Legg-Calvé-Perthes 病）的 X 射线和 MRI 检查结果，包括儿童期（平均年龄：6.0 岁）和骨骼成熟时的 X 射线检查结果，平均随访时间为 15.1 年。测量和比较了以下参数：儿童期 X 射线的不成熟髋臼指数（AI）和中心边缘角（CE）；儿童期 MRI 的软骨和骨 AI、CE、Sharp 和髋臼头指数（AHI）；骨骼成熟 X 射线的成熟髋臼顶倾斜角（ARO）、CE、Sharp 和 AHI。还评估了儿童期 MRI 对髋臼发育不良的预测因素，定义为骨骼成熟 X 射线的 CE<20°。
软骨 AI 与成熟 ARO 呈正相关（7.6°/6.3°；r=0.44），软骨 CE 与成熟 CE 呈正相关（27.8°/28.0°；r=0.62），软骨 Sharp 与成熟 Sharp 呈正相关（44.4°/41.8°；r=0.52），软骨 AHI 与成熟 AHI 呈正相关（78.7%/80.3%；r=0.46）。多变量分析表明，软骨 CE 是髋臼发育不良的独立预测因素，截断值为 22°。软骨 CE<22°的儿童更常发生髋臼发育不良（52.4% vs. 1.4%）。
儿童期 MRI 检查结果有助于预测无 DDH 病史的髋臼发育不良。软骨 CE≥23°的儿童很可能髋关节发育正常，无需手术干预。
