髋臼周围截骨术治疗 13 岁以上发育性髋关节发育不良患者的侧位中心边缘角的影像学选择标准。
The lateral center-edge angle as radiographic selection criteria for periacetabular osteotomy for developmental dysplasia of the hip in patients aged above 13 years.
机构信息
Department of Orthopedics, the First Hospital of Jilin University, No.71, Xinmin Street, Changchun, 130021, China.
Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, 130041, China.
出版信息
BMC Musculoskelet Disord. 2020 Jul 25;21(1):493. doi: 10.1186/s12891-020-03515-8.
BACKGROUND
This retrospective study sought to delineate the radiographic characteristics of DDH patients over 13 years of age and investigate whether the lateral center-edge angle (LCEA) could serve as radiographic selection criteria for periacetabular osteotomy.
METHODS
We enrolled patients with Hartofilakidis type I DDH without dislocation who underwent periacetabular osteotomy between August 2009 and August 2012. LCEA, anterior central edge angle (ACEA), femoral neck-shaft angle (FNSA), Shenton line and Tönnis acetabular index (AI) were evaluated by anteroposterior and 65° false⁃profile pelvic X-ray radiographs in the standing position. Femoral neck anteversion angle (FNA), labral lesion, labral inversion and cartilage lesion were evaluated by direct magnetic resonance arthrography. DDH was categorized by LCEA into four grades (grade I: 10° ≤ LCEA< 20°, grade II: 0° ≤ LCEA< 10°, grade III: -10° ≤ LCEA< 0°, grade IV: LCEA<-10) and osteoarthritis (OA) severity was assessed using Tönnis OA classification. Pearson correlation analysis was done between LCEA and other variables.
RESULTS
Totally patients (274 hips) with a mean age of 27.3 years (range 13-47 years) were included. The mean LCEA was 3.5° (range: - 30° to 20°). Based on LCEA grades, grade I DDH was present in 104 hips, grade II in 40 hips, grade III in 76 hips, and grade IV in 54 hips. Based on Tönnis OA classification, 54.5% hips (150/274) were grade 0, 33.1% hips (91/274) grade 1, 8.4% hips (23/274) grade 2 and 4% hips (11/274) grade 3. Pearson correlation analysis showed a negative correlation between LCEA grade and Tönnis OA grades (r = 0.3987; P < 0.001). Cochran-Armitage trend test further showed a positive correlation between LCEA grades and labral lesion (P < 0.001) and interrupted Shenton line (P < 0.001).
CONCLUSION
The LCEA classification scheme offers a simple and practical approach to categorize the level of acetabulum coverage on the femoral head, hip deformity and characteristics of DDH. Our findings could provide clinically useful guidance for orthopedic surgeons in preparation for periacetabular osteotomy in DDH patients aged above 13 years.
背景
本回顾性研究旨在描述 13 岁以上发育性髋关节脱位（DDH）患者的影像学特征，并探讨外侧中心边缘角（LCEA）是否可作为髋臼周围截骨术的影像学选择标准。
方法
我们纳入了 2009 年 8 月至 2012 年 8 月期间接受髋臼周围截骨术的 Hartofilakidis Ⅰ型 DDH 且无脱位患者。通过站立位前后位和 65°假性骨盆 X 线片评估 LCEA、前中央边缘角（ACEA）、股骨颈干角（FNSA）、Shenton 线和 Tönnis 髋臼指数（AI）。通过直接磁共振关节造影术评估股骨颈前倾角（FNA）、盂唇病变、盂唇反转和软骨病变。根据 LCEA 将 DDH 分为四级（Ⅰ级：10°≤LCEA<20°，Ⅱ级：0°≤LCEA<10°，Ⅲ级：-10°≤LCEA<0°，Ⅳ级：LCEA<-10°）和骨关节炎（OA）严重程度采用 Tönnis OA 分类。对 LCEA 与其他变量进行 Pearson 相关性分析。
结果
共纳入 274 髋（274 髋，平均年龄 27.3 岁[范围 13-47 岁]）。平均 LCEA 为 3.5°（范围：-30°至 20°）。根据 LCEA 分级，Ⅰ级 DDH 为 104 髋，Ⅱ级为 40 髋，Ⅲ级为 76 髋，Ⅳ级为 54 髋。根据 Tönnis OA 分类，54.5%（150/274）髋为 0 级，33.1%（91/274）髋为 1 级，8.4%（23/274）髋为 2 级，4%（11/274）髋为 3 级。Pearson 相关性分析显示 LCEA 分级与 Tönnis OA 分级呈负相关（r=0.3987；P<0.001）。Cochran-Armitage 趋势检验进一步显示 LCEA 分级与盂唇病变（P<0.001）和中断的 Shenton 线（P<0.001）呈正相关。
结论
LCEA 分级方案为评估股骨头髋臼覆盖水平、髋关节畸形和 DDH 特征提供了一种简单实用的方法。我们的发现可为 13 岁以上 DDH 患者髋臼周围截骨术提供有临床意义的指导。
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