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目的:研究先天性髋关节脱位骨性髋臼上缘异常形态的形成原因和髋臼软骨形态学变化对其产生的影响。方法:对60例3岁以下先天性髋脱位患儿,70髋分别行骨盆X线片和磁共振表现对比观察。结果:在70髋脱位髋关节中,发现46髋髋臼上缘不同程度的局限性凹痕、陡直及圆钝表现。经磁共振检查发现,有42髋亦有骨性缺陷(χ2=31.39,P<0.01)。有53髋髋臼软骨变形、增厚及移位。其中,相应部位的髂骨骨壁,在绝大多数病例中出现病理形态学改变:髋臼软骨与X线片骨臼上缘异常的统计学检验为,χ2=32.25,P<0.01;髋臼软骨与磁共振髂骨改变的统计学检验为,χ2=30.46,P<0.01。结论:髋臼骨性外缘发育较差的病理基础是,髋臼软骨在髋脱位时产生了一系列继发性病理改变,导致局部骨臼外缘的发育障碍。该类型病例应尽早进行治疗,否则很可能发生继发性髋臼发育不良。
OBJECTIVE: To investigate the causes of the formation of abnormalities in the upper edge of the bony acetabulum and the effects of changes in acetabular cartilage morphology on congenital dislocation of the hip. Methods: A total of 60 children under 3 years of age with congenital hip dislocation, 70 hips were pelvic X-ray and magnetic resonance imaging comparison. RESULTS: In the hip with 70-hips dislocation, localized dents, steepness and dullness were found on the upper edge of the 46-hips. According to MRI, 42 hips also had a bone defect (χ2 = 31.39, P <0.01). There are 53 hip acetabular cartilage deformity, thickening and displacement. Among them, the corresponding parts of the iliac bone wall, pathological changes in the vast majority of cases: statistical analysis of the upper edge of the acetabular cartilage and X-ray osteophyte statistics, χ2 = 32.25, P <0. 01; statistical analysis of acetabular cartilage and magnetic resonance iliac changes, χ2 = 30.46, P <0.01. Conclusion: The pathological basis for the poor development of the acetabulum is that the acetabular cartilage produced a series of secondary pathological changes during the dislocation of the hip, resulting in the development of the local rim of the acetabulum. This type of case should be treated as soon as possible, otherwise it is likely to occur secondary acetabular dysplasia.