股骨头偏移度的测量在诊断成人髋臼发育不良中的应用研究

发布时间：2018-06-09 14:18

本文选题：髋臼发育不良 + 成人　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:髋臼发育不良是一种发育性畸形,1939年,Wiberg首先提出髋臼发育不良(Acetabular Dysplasia,AD)的概念[1],并用CE角(centre edge angle)CE角≤20°来诊断成人髋臼发育不良。由于髋臼发育不良股骨头覆盖不全,导致髋关节负重状态发生改变,关节软骨退变加重,最终导致发生髋关节骨性关节炎[2.3]。有报道[4]称髋关节骨性关节炎患者中20%~50%有髋臼发育不良,髋臼发育不良在髋关节骨性关节炎的发病中起到了重要作用。髋臼发育不良患者早期无明显症状,多在20-40岁逐渐出现症状,发现时多数病人已经有了比较严重的髋关节骨性关节炎,应用4种不同方法对成人的髋臼进行X线测量,主要包括:CE角(centre edge angle)、Sharp角[5](acetabular angle of Sharp)、头臼指数[6](acetabular head index AHI)及髋臼指数(acetabular index AI)为了能够对髋臼发育不良早期做出诊断,进行有效的干预,目前对髋臼发育不良的研究越来越受到重视。目前对成人髋臼发育不良的影像学诊断方法多种多样,标准不统一,各种测量方法都有一定的局限性,且同一病人,应用不同测量方法得出的诊断结论可能不同。为此提出一种新的测量指标:股骨头偏移度即以“泪滴”点为参照,通过测量股骨头的横向偏移度及纵向偏移度,观察股骨头向外、向上偏移的程度来诊断髋臼发育不良。通过对比临床常用测量方法分析不同方法的优劣,从而得出诊断成人髋臼发育不良更可靠地指标。方法:本文通过筛选出河北医科大学第三医院2014年7月至2014年12月骨科门诊就诊者402例,进行骨盆正位X线片检查。X线片检查由同一组人进行。摄片方法统一标准:检查者平卧位,双下肢伸直,第一趾趾尖端并拢垂直检查床面,保持骨盆无旋转及倾斜,管球与底片间距离是100厘米。纳入标准:由两位放射学专家及骨病科专家鉴定为正常髋关节或髋臼发育不良。排除标准:已知有神经肌肉性疾病,合并其他畸形,严重的髋关节骨性关节炎合并髋臼外缘增生明显者,严重骨盆倾斜、骨盆骨折及重度股骨头坏死创伤性关节炎者。其中男性199例,女性203例,年龄为18-91岁,平均年龄51.1岁,体重为42.5-98公斤,平均体重65.1公斤,身高为150-185厘米,平均身高167厘米。三次取平均值测量每个人双侧髋臼共804例髋关节的CE角、Sharp角、头臼指数AHI、髋臼指数AI及股骨头纵向偏移度及横向偏移度。股骨头横向偏移度:股骨头中心点到经同侧泪滴中点垂线的垂直距离a与髋臼外上缘到同侧泪滴垂线的垂直距离b的百分比,即:(a/b)%。股骨头纵向偏移度:股骨头中心点到双侧泪滴最低点连线的垂直距离c与髋臼外上缘到双侧泪滴最低点连线的垂直距离d的百分比,即:(c/d)%。以CE角和Sharp角均在正常范围内判定为正常髋关节,正常髋关节496例,髋臼发育不良308例。通过统计分析得出正常髋关节股骨头偏移度正常参考值范围。通过一致性检验(Kappa检验)将股骨头偏移度测量法与CE角、Sharp角进行对比,Sharp角与CE角对比、头臼指数AHI及髋臼指数AI分别与CE角进行对比,分析各种方法之间诊断的一致性是否有差别。以CE角为标准,观察股骨头偏移度诊断髋臼发育不良的敏感度及特异度,并分析股骨头偏移度方法的诊断髋臼发育不良的效力。结果:CE角20°且Sharp角45°的正常髋关节496例,经统计学检验,样本数据不符合正态分布,应用百分位数法制定95%的正常参考值范围分别是:股骨头横向偏移度:80.08%,股骨头纵向偏移度:45.15%。根据股骨头横向偏移度和纵向偏移度均在正常值范围内来确定正常髋关节,股骨头横向偏移度或纵向偏移度异常时诊断髋臼发育不良。一致性检验结果:股骨头偏移度测量法和CE角测量法及Sharp角测量法阳性率无统计学差异,新测量方法与CE角、Sharp角的诊断一致性较好,新方法与CE角测量法比较的Kappa值=0.565,P=0.353,新方法与Sharp角测量法比较的Kappa值=0.401,P=0.125。与CE角测量法比较,新方法的灵敏度为66.67%,特异度为88.89%,Sharp角测量法的灵敏度为68.86%,86.11%。头臼指数法及髋臼指数法分别与CE角进行对比,两者与CE角的诊断一致性均较差。头臼指数测量法与CE角测量法比较P=0.000,kappa值=0.470,敏感度90.7%,特异度66.84%,髋臼指数测量法与CE角测量法比较P=0.000,kappa值=0.090,敏感度95.17%,特异度19.27%。结论:1.股骨头偏移度的测量可以作为诊断髋臼发育不良的一个较好的指标,股骨头横向偏移度正常值为80.08%,股骨头纵向偏移度正常值为45.15%。当成人髋臼股骨头偏移度有一项超过上述正常值时即可以诊断为髋臼发育不良。2.股骨头偏移度的测量诊断髋臼发育不良,方法简单,测量误差相对较小,为诊断成人髋臼发育不良提供了一个新的可靠的诊断标准。3.成人髋臼发育不良的诊断中,与其他几个指标对比,髋臼指数的测量误差最大,诊断效力最低。CE角及头臼指数均是反应股骨头向外脱位的程度,而股骨头纵向及横向偏移度的测量能够全面的评价股骨头向外及向上脱位的趋势,测量时受髋臼外缘骨赘增生等因素影响较小,有显著的优势。
[Abstract]:Objective: acetabular dysplasia is a developmental malformation. In 1939, Wiberg first proposed the concept [1] of Acetabular Dysplasia (AD), and used CE angle (centre edge angle) CE angle less than 20 degrees to diagnose adult acetabular dysplasia. The aggravation of cartilage degeneration, which eventually leads to the occurrence of osteoarthritis of the hip joint [2.3]., has reported that [4] said that 20%~50% has acetabular dysplasia in the patients with hip osteoarthritis, and acetabular dysplasia plays an important role in the pathogenesis of hip osteoarthritis. Most patients have severe hip osteoarthritis at the time of discovery. 4 different methods are used to measure the adult's acetabulum by 4 different methods, including centre edge angle, Sharp [5] (acetabular angle of Sharp), the [6] index of the head molars and the acetabular index. It is possible to make an early diagnosis of acetabular dysplasia and intervene effectively. The current research on acetabular dysplasia is becoming more and more important. There are various imaging diagnosis methods for adult acetabular dysplasia, the standard is not uniform, and various measurement methods have some limitations, and the same patient is used for different measurement methods. The results of the diagnosis may be different. A new measurement index is put forward: the deviation of the femoral head is based on the "tear drop" point. By measuring the lateral deviation and the longitudinal migration of the femoral head, the degree of the femoral head outward and upward is observed to diagnose the dysplasia of the acetabulum. The different methods are analyzed by comparing the common clinical measurement methods. The advantages and disadvantages of the method, so as to get a more reliable indicator of the diagnosis of adult acetabular dysplasia. Methods: in this paper, 402 cases in the Department of orthopedics of the Third Hospital of Hebei Medical University from July 2014 to December 2014 were selected and the X-ray examination of the pelvis was performed. The X-ray examination was carried out by the same group. Double lower extremity straightening, the first toe and toe point close together to check the surface of the bed vertically, keep the pelvis without rotation and tilt, the distance between the tube and the bottom is 100 centimeters. The inclusion criteria: two radiologists and orthopedics experts identified as normal hip joint or acetabular dysplasia. Exclusion criteria: known neuromuscular diseases, other malformations, serious The patients with hip osteoarthritis complicated with acetabular hyperplasia, severe pelvic tilt, pelvic fracture and severe traumatic arthritis of the femoral head, including 199 males and 203 women, age 18-91 years, average age 51.1 years, weight of 42.5-98 kg, average weight 65.1 kg, height of 150-185 cm, and average height of 167 centimeters. The CE angle, Sharp angle, the head index AHI, the acetabular index AI and the femoral head longitudinal deviation and lateral deviation were measured at the three times of each hip joint. The transverse deviation of the femoral head, the vertical distance from the center of the femoral head to the midpoint of the middle point of the teardrop, and the vertical distance from the upper margin of the acetabulum to the same side of the tear drop. The percentage of the B is: (a/b). The longitudinal deviation of the femoral head: the vertical distance of the vertical distance between the central point of the femoral head to the lowest point of the tear drop and the percentage of the vertical distance D of the lowest line between the upper margin of the acetabulum and the lower tear drop of the bilateral teardrop, that is, (c/d). The normal hip joint, 496 normal hip joints, and the acetabulum in 496 cases of normal hip joint, are determined in the normal range with the CE angle and Sharp angle. 308 cases of dysplasia. Through statistical analysis, the normal range of reference value of the femoral head offset of normal hip is obtained. Through the consistency test (Kappa test), the measurement of femoral head offset is compared with CE angle and Sharp angle, Sharp angle and CE angle are compared, the head index AHI and the acetabular index AI are compared with CE angle respectively, and the various methods are analyzed. Whether there was a difference in diagnostic consistency. Using CE angle as a criterion, the sensitivity and specificity of the femoral head offset in the diagnosis of acetabular dysplasia were observed, and the effectiveness of the femoral head offset method for the diagnosis of acetabular dysplasia was analyzed. Results: 496 cases of normal hip joint with CE angle 20 degrees and Sharp angle 45 degrees were statistically tested, the sample data did not conform to normal state. Distribution, the range of 95% normal reference values by the percentile method is the lateral deviation of the femoral head: 80.08%, the longitudinal deviation of the femoral head: 45.15%. determines the normal hip joint in the normal range according to the lateral migration degree and the longitudinal offset of the femoral head, and the diagnosis of the acetabular hair when the lateral displacement of the femoral head or the longitudinal deviation is abnormal. Poor fertility. Results of consistency test: there is no statistical difference between the measurement of femoral head deviation and the positive rates of CE angle measurement and Sharp angle measurement. The new method is in good agreement with the diagnosis of CE angle and Sharp angle. The Kappa value of the new method and CE angle measurement is =0.565, P=0.353, the Kappa value =0.401 of the new method and Sharp angle measurement, P=0.125, and P=0.125. Compared with the CE angle measurement, the sensitivity of the new method is 66.67%, the specificity is 88.89%, the sensitivity of the Sharp angle measurement is 68.86%. The 86.11%. head mortar index method and the acetabular index method are compared with the CE angle respectively. The diagnostic consistency between the two methods is poor with the CE angle. The head index measurement and CE angle measurement are P=0.000, kappa value =0.470, sensitivity. 90.7%, the specificity was 66.84%, the acetabular index measurement was compared with the CE angle measurement P=0.000, kappa value =0.090, the sensitivity 95.17%, and the specificity 19.27%. conclusion: the 1. femoral head offset can be used as a better indicator for the diagnosis of acetabular dysplasia, the normal value of the lateral displacement of the femoral head is 80.08%, and the normal value of the femoral head longitudinal deviation is 45. .15%. when an adult acetabular femoral head offset is more than the above normal value, it is possible to diagnose acetabular dysplasia.2. femoral head deviation in the diagnosis of acetabular dysplasia. The method is simple and the measurement error is relatively small, which provides a new and reliable diagnostic standard for the diagnosis of adult acetabular dysplasia,.3. adult acetabular development. In the good diagnosis, the measurement error of the acetabular index is the largest, the lowest.CE angle and the head index of the diagnostic effectiveness are the extent to the dislocation of the femoral head, while the longitudinal and lateral migration of the femoral head can evaluate the outward and upward dislocation of the femoral head and be increased by the external osteophyte of the acetabulum. The factors such as birth and other factors have little influence, and have significant advantages.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R681.1

【参考文献】