Department of Orthopedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.
Bone Joint J. 2020 Oct;102-B(10):1311-1318. doi: 10.1302/0301-620X.102B10.BJJ-2020-0317.R1.
Morphological abnormalities are present in patients with developmental dysplasia of the hip (DDH). We studied and compared the pelvic anatomy and morphology between the affected hemipelvis with the unaffected side in patients with unilateral Crowe type IV DDH using 3D imaging and analysis.
A total of 20 patients with unilateral Crowe-IV DDH were included in the study. The contralateral side was considered normal in all patients. A coordinate system based on the sacral base (SB) in a reconstructed pelvic model was established. The pelvic orientations (tilt, rotation, and obliquity) of the affected side were assessed by establishing a virtual anterior pelvic plane (APP). The bilateral coordinates of the anterior superior iliac spine (ASIS) and the centres of hip rotation were established, and parameters concerning size and volume were compared for both sides of the pelvis.
The ASIS on the dislocated side was located inferiorly and anteriorly compared to the healthy side (coordinates on the y-axis and z-axis; p = 0.001; p = 0.031). The centre of hip rotation on the dislocated side was located inferiorly and medially compared to the healthy side (coordinates on the x-axis and the y-axis; p < 0.001; p = 0.003). The affected hemipelvis tilted anteriorly in the sagittal plane (mean 8.05° (SD 3.57°)), anteriorly rotated in the transverse plane (mean 3.31° (SD 1.41°)), and tilted obliquely and caudally in the coronal plane (mean 2.04° (SD 0.81°)) relative to the healthy hemipelvis. The affected hemipelvis was significantly smaller in the length, width, height, and volume than the healthy counterpart. (p = 0.014; p = 0.009; p = 0.035; p = 0.002).
Asymmetric abnormalities were identified on the affected hemipelvis in patients with the unilateral Crowe-IV DDH using 3D imaging techniques. Improved understanding of the morphological changes may influence the positioning of the acetabular component at THA. Acetabular component malpositioning errors caused by anterior tilt of the affected hemi pelvis and the abnormal position of the affected side centre of rotation should be considered by orthopaedic surgeons when undertaking THA in patients with Crowe-IV DDH. Cite this article: 2020;102-B(10):1311-1318.
发育性髋关节发育不良（DDH）患者存在形态学异常。我们通过三维成像和分析，研究并比较了单侧 Crowe Ⅳ型 DDH 患者患侧半骨盆与健侧半骨盆的骨盆解剖结构和形态。
共纳入 20 例单侧 Crowe-IV DDH 患者。所有患者对侧均视为正常。在重建骨盆模型中，基于骶骨底（SB）建立坐标系。通过建立虚拟骨盆前平面（APP）来评估患侧骨盆的倾斜度、旋转度和倾斜度。建立髂前上棘（ASIS）的双侧坐标和髋关节旋转中心坐标，并比较骨盆两侧的大小和体积参数。
脱位侧的 ASIS 低于健侧，位于前侧（y 轴和 z 轴坐标；p = 0.001；p = 0.031）。脱位侧髋关节旋转中心低于健侧，位于内侧（x 轴和 y 轴坐标；p < 0.001；p = 0.003）。患侧半骨盆在矢状面上前倾（平均 8.05°（SD 3.57°）），在横断面上前倾（平均 3.31°（SD 1.41°）），在冠状面上斜向和向后倾斜（平均 2.04°（SD 0.81°））相对于健侧半骨盆。患侧半骨盆在长度、宽度、高度和体积上均明显小于健侧（p = 0.014；p = 0.009；p = 0.035；p = 0.002）。
使用三维成像技术，在单侧 Crowe-IV DDH 患者的患侧半骨盆上发现了不对称的异常。对形态变化的深入了解可能会影响 THA 中髋臼组件的定位。在行 THA 时，矫形外科医生应考虑因患侧半骨盆前倾和患侧旋转中心位置异常引起的髋臼组件位置不良的误差。应考虑因患侧半骨盆前倾和患侧旋转中心位置异常引起的髋臼组件位置不良的误差。
2020；102-B（10）：1311-1318。
