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[目的]使用3D-CT技术对单髋脱位DDH患儿的骨盆形态学畸形进行分析,按照脱位程度分型分层后对骨盆内旋畸形进行观察测量,并探讨其临床意义。[方法]回顾性收集单髋脱位DDH患儿72例,其中男12例,女60例;年龄7~60个月,平均18个月。左髋38例,右髋34例。脱位程度:Ⅰ度18例,Ⅱ度38例,Ⅲ度16例。28例正常对照组。所有患儿均行双侧髋关节CT扫描,扫描图像行三维图像重建,测量髋臼前倾角(AA)、上骨盆旋转角(URA)、下骨盆旋转角(LRA)。[结果]28例正常对照组左侧髋和右侧髋的URA、LRA和AA差异均无统计学意义(P>0.05)。72例单髋脱位DDH患儿脱位侧髋的URA、LRA和AA均大于未受累侧髋,差异有统计学意义(P<0.05)。Ⅰ度和Ⅲ度脱位组,脱位侧髋的LRA均大于未受累侧髋,且差异有统计学意义(P<0.05),但脱位侧髋的URA与未受累侧髋的URA差异并无统计学意义(P>0.05)。在Ⅱ度脱位组,脱位侧髋的URA和LRA均大于未受累侧髋,差异有统计学意义(P<0.05)。Ⅰ度、Ⅱ度和Ⅲ度脱位组,脱位侧髋的AA均与LRA成正相关。[结论]DDH患儿在矫正髋臼过度前倾时,要同时测量髋臼前倾角和下骨盆旋转角,并观察髋臼前后壁的发育情况。明确髋臼在水平面出现过度前倾的原因后再给予适当矫正,这对于预防术后髋臼后倾的发生十分重要。
[Objective] To analyze the pelvic morphological deformity in children with DDH with single hip dislocation by 3D-CT technique, observe and measure pelvic rotation deformity according to the degree of dislocation, and discuss its clinical significance. [Methods] A total of 72 DDH children with single hip dislocation were retrospectively collected, including 12 males and 60 females, aged from 7 to 60 months with an average of 18 months. Left hip in 38 cases, right hip in 34 cases. Degree of dislocation: Ⅰ degree 18 cases, Ⅱ degree 38 cases, Ⅲ degree 16 cases. 28 cases of normal control group. All children underwent bilateral hip CT scans. Scanned images were reconstructed by three-dimensional images. The acetabular anteversion (AA), upper pelvic rotation (URA) and lower pelvic rotation (LRA) were measured. [Results] There were no significant differences in URA, LRA and AA between the left hip and the right hip in 28 normal controls (P> 0.05). URA, LRA and AA in the dislocated hip of 72 children with DDH were significantly higher than those of the uninvolved side (P <0.05). There was no significant difference in LRA between the URA and the unaffected hip in the group of degree Ⅰ and Ⅲ degree dislocation and the number of dislocation hip in the unaffected side (P <0.05) Significance (P> 0.05). In the group of degree Ⅱ dislocation, the URA and LRA of the dislocated hip were greater than those of the uninvolved side, with significant difference (P <0.05). AA in degrees Ⅰ, Ⅱ and Ⅲ, and AA in dislocation hip were positively correlated with LRA. [Conclusions] Acetabular anteversion and lower pelvis rotation angle are measured simultaneously in DDH children with correction of excessive acetabular anteversion, and the development of anterior and posterior acetabular wall is observed. It is very important to correct the cause of acetabular anterior tilt in the horizontal plane and then to correct it properly.