Albiñana J, Morcuende J A, Weinstein S L
Department of Orthopaedic surgery, The University of Iowa Hospitals and Clinics, Iowa City, 52242-1088, USA.
J Bone Joint Surg Am. 1996 Jul;78(7):1048-55. doi: 10.2106/00004623-199607000-00009.
We retrospectively reviewed the radiographs of the pelvis and hips of forty-five patients who had unilateral congenital dislocation of the hip treated with closed reduction and application of a cast without subsequent operations. The radiographs were made at the time of the initial diagnosis, two years after the reduction, when the child was ten years old, and at skeletal maturity. The width, shape, and type of the teardrop; the thickness of the acetabular floor; the acetabular index; the center-edge angle; the articulotrochanteric distance; and the Severin class at maturity were measured in the dislocated and contralateral, normal hips. At the time of the initial diagnosis, a well defined teardrop was seen in thirty-six (80 per cent) of the normal hips and in seven (16 per cent) of the dislocated hips. There was no difference in the width of the teardrop in the seven dislocated hips compared with that in the normal hips, although the v-shaped and crossed types of teardrops were more frequent in the dislocated hips. The v shape was not observed in the normal hips but was seen in sixteen dislocated hips two years after the reduction and in twelve dislocated hips when the children were ten years old. The superior and inferior widths of the teardrop of the dislocated hips were significantly greater than those of the normal hips (p < 0.001 and p < 0.05, respectively) when the children were ten years old. The hips with residual acetabular dysplasia had a v-shaped teardrop, widening of the superior width of the teardrop, and thickening of the acetabular floor. These hips, which were usually Severin class IV at the time of skeletal maturity, had a poor prognosis in adult life.
我们回顾性分析了45例单侧先天性髋关节脱位患者的骨盆和髋部X线片，这些患者均接受了闭合复位及石膏固定治疗，未进行后续手术。X线片拍摄时间分别为初始诊断时、复位后两年、患儿10岁时以及骨骼成熟时。测量了脱位髋和对侧正常髋的泪滴宽度、形状和类型、髋臼底厚度、髋臼指数、中心边缘角、关节转子间距以及成熟时的Severin分级。初始诊断时，36例（80%）正常髋和7例（16%）脱位髋可见清晰的泪滴。7例脱位髋的泪滴宽度与正常髋相比无差异，尽管脱位髋中v形和交叉形泪滴更为常见。正常髋未观察到v形，但复位后两年16例脱位髋以及患儿10岁时12例脱位髋可见v形。患儿10岁时，脱位髋泪滴的上下宽度显著大于正常髋（分别为p < 0.001和p < 0.05）。残留髋臼发育不良的髋部有v形泪滴、泪滴上缘增宽以及髋臼底增厚。这些髋部在骨骼成熟时通常为Severin IV级，成年后预后较差。
