成人髋臼发育不良性骨关节病的影像学表现(1)
摘要：目的 探讨成人髋臼发育不良性骨关节病的影像学表现。方法 对51例成人发育不良的影像资料进行回顾性分析。患者除男4例外均为女性，年龄22～78 岁，平均42岁。所有患者均摄有标准的骨盆前后位X线片，18例行CT扫描。结果 51例发育不良髋臼的主要 X线改变为髋臼浅小，倾斜度增加和对股骨头覆盖不全。测量中心边缘角(CE)为-10°～30°，平均13°。测量髋臼指数为35～67°，平均 45°。其中40例有继发性骨关节炎，30例出现髋臼或股骨头负重区软骨下囊性变，19例伴有髋关节半脱位。CT和MRI发现平片不能显示的小囊变和股骨头向前移位者分别为13例和10例。结论 髋臼浅小和股骨头囊样病变是髋臼发育不良性骨关节病的常见表现，CT或MRI能显示其早期征象。
关键词：髋关节脱位；骨关节炎，髋关节；影像诊断
【Abstract】Objective To investigate the imaging diagnosis of acetabular dysplastic coxarthrosis. Method The imaging of the acetabular dysplasia was analyzed in 51 patients. All but four patients were female. The age ranged from 22 to 78 years，and the mean age was 42 years. Pelvis radiographs were studied in all cases，and CT scan was performed in 18 cases. Results The fundamental signs on the plain film included shallow acetabulum，increased obliquity and insufficient coverage of the femoral head by the acetabulum. The CE angles were determined in all the cases，ranging from - 10° to 30°，mean 13° . The charp angles ranged from 35° to 67°，mean 45° . The secondary osteoarthritis were revealed in 40 cases. 30 cases .had cyst-like lesions in weight-bear area of the acetabulum or femoral head. 19 cases had subluxation of femoral head. CT and MRI displayed small cystlike lesions and forward shift of the femoral head，which could not be shown on plain film，respectivly in 13 and 10 cases. Conclusion The cyst-like lesion of subarticular region and shallow acetabulum is a common sign in acetabular dysplastic coxarthrosis. CT or MRI can show the early osteolytic lesion and forward subluxations.
【Key words】Hip dislocation；Osteoarthritis，hip；Imaging diagnostic
成人髋臼发育不良性骨关节病是因髋臼先天发育缺陷导致长期生物力学异常而于成年发病的髋关节病，主要病变包括在髋臼发育不良基础上继发的骨性关节炎、软骨下假囊肿、慢性关节脱位等。髋臼发育不良可在幼儿时引发髋关节脱位，也可隐匿十几年或数十年方始发病，它是引起成人髋关节骨性关节炎的重要原因[1]。本病并非少见，笔者搜集51例成人髋臼发育不良的临床及影像学资料进行分析以期提高对本病的认识和诊断水平。
材料与方法
一、临床资料
本组中男4例，女47例，年龄22～70 岁，平均42岁。临床症状为反复发作的髋关节疼痛，劳累后加重，休息后缓解，患者常自述不能久站或走远路。症状随年龄增加而逐渐加重，部分患者有跛行，病史1～20年不等。
47例女性除1例外均有生育史，其中10例从事售货员、教师、舞蹈演员等站立性工作。骨科体检有髖关节内收，外展受限，腹股沟中点压痛及“4”字试验阳性。2例经关节镜检查，显示骨性关节炎改变，其中1例有盂唇撕裂。5例分别实施骨盆截骨术、髋关节置换术及髋臼囊肿刮除植骨术。
二、设备和测量方法
采用 DR成像系统对51例双髋关节行X线前后位摄片，全部测量中心边缘角[center-edge angle，CE 角；自股骨头中心(C)至髋臼缘(E)划一线，另通过股骨头中心作一垂线，两线的夹角为 CE角]和髋臼指数。首先确定是否存在髋臼发育不良，并按 Perner 法进行分度(Ⅰ度：CE角11°～30°；Ⅱ度：CE角0°～10°；Ⅲ度：CE角呈负角；IV度：完全性髋关节脱位)，然后对继发病变进行分析。其中18例行 CT检查，扫描层厚2 mm，螺距0.625，3例行三维重建，重建间隔 1.6 mm。
三、诊断标准
参考文献并结合笔者的经验，本组成人髋臼发育不良的诊断标准为髋臼浅小，CE角 < 30°，股骨头顶部裸露 25 %以上，伴或不伴有髋臼指数增大。X线测量：(1)CE角(又称臼缘角)：正常应 > 30°；(2)成人髋臼指数：正常成人为39.86±4.3。, 百拇医药(沈智蓉 李杰)
关键词：髋关节脱位；骨关节炎，髋关节；影像诊断
【Abstract】Objective To investigate the imaging diagnosis of acetabular dysplastic coxarthrosis. Method The imaging of the acetabular dysplasia was analyzed in 51 patients. All but four patients were female. The age ranged from 22 to 78 years，and the mean age was 42 years. Pelvis radiographs were studied in all cases，and CT scan was performed in 18 cases. Results The fundamental signs on the plain film included shallow acetabulum，increased obliquity and insufficient coverage of the femoral head by the acetabulum. The CE angles were determined in all the cases，ranging from - 10° to 30°，mean 13° . The charp angles ranged from 35° to 67°，mean 45° . The secondary osteoarthritis were revealed in 40 cases. 30 cases .had cyst-like lesions in weight-bear area of the acetabulum or femoral head. 19 cases had subluxation of femoral head. CT and MRI displayed small cystlike lesions and forward shift of the femoral head，which could not be shown on plain film，respectivly in 13 and 10 cases. Conclusion The cyst-like lesion of subarticular region and shallow acetabulum is a common sign in acetabular dysplastic coxarthrosis. CT or MRI can show the early osteolytic lesion and forward subluxations.
【Key words】Hip dislocation；Osteoarthritis，hip；Imaging diagnostic
成人髋臼发育不良性骨关节病是因髋臼先天发育缺陷导致长期生物力学异常而于成年发病的髋关节病，主要病变包括在髋臼发育不良基础上继发的骨性关节炎、软骨下假囊肿、慢性关节脱位等。髋臼发育不良可在幼儿时引发髋关节脱位，也可隐匿十几年或数十年方始发病，它是引起成人髋关节骨性关节炎的重要原因[1]。本病并非少见，笔者搜集51例成人髋臼发育不良的临床及影像学资料进行分析以期提高对本病的认识和诊断水平。
材料与方法
一、临床资料
本组中男4例，女47例，年龄22～70 岁，平均42岁。临床症状为反复发作的髋关节疼痛，劳累后加重，休息后缓解，患者常自述不能久站或走远路。症状随年龄增加而逐渐加重，部分患者有跛行，病史1～20年不等。
47例女性除1例外均有生育史，其中10例从事售货员、教师、舞蹈演员等站立性工作。骨科体检有髖关节内收，外展受限，腹股沟中点压痛及“4”字试验阳性。2例经关节镜检查，显示骨性关节炎改变，其中1例有盂唇撕裂。5例分别实施骨盆截骨术、髋关节置换术及髋臼囊肿刮除植骨术。
二、设备和测量方法
采用 DR成像系统对51例双髋关节行X线前后位摄片，全部测量中心边缘角[center-edge angle，CE 角；自股骨头中心(C)至髋臼缘(E)划一线，另通过股骨头中心作一垂线，两线的夹角为 CE角]和髋臼指数。首先确定是否存在髋臼发育不良，并按 Perner 法进行分度(Ⅰ度：CE角11°～30°；Ⅱ度：CE角0°～10°；Ⅲ度：CE角呈负角；IV度：完全性髋关节脱位)，然后对继发病变进行分析。其中18例行 CT检查，扫描层厚2 mm，螺距0.625，3例行三维重建，重建间隔 1.6 mm。
三、诊断标准
参考文献并结合笔者的经验，本组成人髋臼发育不良的诊断标准为髋臼浅小，CE角 < 30°，股骨头顶部裸露 25 %以上，伴或不伴有髋臼指数增大。X线测量：(1)CE角(又称臼缘角)：正常应 > 30°；(2)成人髋臼指数：正常成人为39.86±4.3。, 百拇医药(沈智蓉 李杰)
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