摘要目的 应用CT三维重建坐标系构建发育性髋关节发育不良(DDH)患儿髋关节的三维重建数字化模型,精确量化评价DDH患儿髋关节骨量化发育,探讨髋关节脱位过程中髋关节组成骨骼的发育转变.方法 收集2010年12月至2014年12月在华中科技大学附属同济医院行CT检查的单侧DDH患儿,其中CT影像学资料可获取者16例,其中男4例,女12例;年龄1岁8个月至9岁9个月,平均(4.42±2.59)岁;左侧DDH共10例,右侧DDH共6例;所有CT资料经过三维重建分析处理构建三维数字化模型,采用逆向工程软件建立三维重建坐标系,并在三维坐标系中采用球体拟合工程逆向求解方法构建髋关节各组成骨骼的三维模型,准确测量髂骨体积、坐骨体积、耻骨体积、股骨头和股骨上段的骨质体积,采用配对自身对照比较健侧髋关节与患侧髋关节的骨质发育有无差异.结果 健侧髋臼的髂骨骨化体积为(31.14±16.25) cm3,患侧髋臼的髂骨骨化体积为(32.84±17.36) cm3,差异有统计学意义(t髂骨=2.660,P髂骨=0.018),健侧髋臼的坐骨骨化体积为(11.61 ±5.63) cm3,患侧髋臼的坐骨骨化体积为(8.62 ±4.09) cm3,差异有统计学意义(t坐骨=3.041,P坐骨=0.008),健侧髋臼的耻骨骨化体积为(4.93±2.73) cm3,患侧髋臼的耻骨骨化体积为(3.93±1.94) cm3,差异有统计学意义(t耻骨=3.776,P耻骨=0.002),健侧髋臼的股骨头及股骨上段骨化体积为(23.42 ±12.48) cm3,患侧髋关节的股骨头及股骨上段骨化体积为(20.21±8.93) cm3,差异有统计学意义(t股骨=3.158,P股骨=0.006).其中,除髂骨外,坐骨、耻骨及股骨上端均与年龄相关,高年龄组较低年龄组骨化体积小;与脱位程度无关.结论 应用CT三维重建可以构建DDH髋关节的三维数字化模型,并可以据此准确构建髋关节各个构成骨骼的三维模型,进而能够准确地测量髋关节各个构成骨骼的骨性体积,脱位侧髋关节的骨性体积显著小于未脱位侧,骨化发育与年龄相关,高年龄组较低年龄组骨化发育差,但与脱位程度无关,这也充分证实了髋臼同心圆匹配是髋关节骨化发育的重要前提,非同心圆匹配将延缓髋关节的骨性发育,且发育落后是随着年龄增加逐渐加重的.

abstractsObjective To Evaluate the bone development of the hip in developmental dysplasia of the hip (DDH) by three-dimensional (3D) CT.Methods Preoperative 3D CT was performed for 16 unilateral DDH from Dec,2010 to Dec,2014 in Tongji Hospital,with 4 males and 12 females,age rank from 20 months to 9 years.When assessing the CT images,the three dimensional coordinate system were established to analysis the development of hips by a paired self-control study.Additionally,the ossific radius,the dislocation length,and the relationships of those variables with the age,the dislocation length were analyzed.Results The ossific volume of the ilium were (31.14 ± 16.25) cm3 and (32.84± 17.36) cm3 for the normal side and dislocation side,respectively (t =2.660,P =0.018).The ossific volume of the ischium were (11.61 ±5.63) cm3 and (8.62 ±4.09) cm3 for the normal side and dislocation side,respectively (t =3.041,P =0.008).The ossific volume of the pubis were (4.93 ±2.73) cm3 and (3.93 ± 1.94) cm3 for the normal side and dislocation side,respectively (t =3.776,P =0.002).The ossific volume of the head and superior part of femur were (23.42 ± 12.48) cm3 and (20.21 ± 8.93) cm3 for the normal side and dislocation side,respectively (t =3.158,P =0.006).It is related to the age but not the dislocation length that the ossific volume of the pubis,the ischium and the superior part of femur.Conclusion Preoperative 3D-CT in cases of DDH revealed the bone development of the hip in DDH.Digital model is thought to help discover the bone characteristics of DDH hips.Older age,less ossific volume of bones.