基于3D重建技术探讨发育性髋关节发育不良患者膝关节形态差异

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摘要目的本研究通过3D重建技术探讨发育性髋关节发育不良(developmental dysplasia of the hip，DDH)患者膝关节参数的差异，为DDH患者行髋膝手术提供数据参考。方法 2019年1月至2022年12月前瞻性招募127例DDH患者，其中单侧DDH组98例，双侧DDH组29例(58膝)，对照组(健康体检者)110例。单侧DDH组男28例，女70例；平均年龄(35.40±11.62)岁。双侧DDH组男7例，女22例；平均年龄(36.17±12.58)岁。对照组男32例，女78例；平均年龄(35.82±11.49)岁。收集三组患者CT数据进行三维重建，基于三维重建模型下测量膝关节相关参数，股骨内侧髁宽度(width of medial femoral condyle，WMFC)、股骨外侧髁宽度(width of lateral femoral condyle，WLFC)股骨内侧髁高度(height of medial femoral condyle，HMFC)、股骨外侧髁高度(height of lateral femoral condyle，HLFC)、胫骨内侧平台宽度(width of medial tibial platform，WMTP)、胫骨外侧平台宽度(width of lateral tibial platform，WLTP)、股骨前关节边缘距离(femoral anterior joint edge distance，FAJED)、股骨后关节边缘距离(femoral posterior joint edge distance，FPJED)、胫骨前关节边缘距离(tibial anterior joint edge distance，TAJED)、胫骨后关节边缘距离(tibial posterior joint edge distance，TPJED)、胫股角(femorotibial angle，FTA)、股骨远端外侧角(lateral distal femoral angle，LDFA)、胫骨近端内侧角(medial proximal tibial angle，MPTA)、胫骨近端后侧角(posterior proximal tibial angle，PPTA)、股骨远端后侧角(posterior distal femoral angle，PDFA)。对比三组膝关节正视位图、侧视位图及角度相关参数。结果对照组WLFC、WLTP、LDFA显著大于单侧DDH组、双侧DDH组(P＜0.05)，单侧DDH组WLFC、WLTP、LDFA显著大于双侧DDH组(P＜0.05)。对照组HMFC显著小于单侧DDH组、双侧DDH组(P＜0.05)，双侧DDH组HMFC大于单侧DDH组(P＜0.05)。对照组WMTP显著小于单侧DDH组(P＜0.05)，单侧DDH组WMTP显著大于双侧DDH组(P＜0.05)，双侧DDH组WMTP与对照组比较差异无统计学意义(P＞0.05)。三组WMFC、HLFC、MPTA比较，差异无统计学意义(P＞0.05)。三组FTA比较差异有统计学意义(P＜0.05)，对照组FTA显著小于单侧DDH组、双侧DDH组(P＜0.05)；此外，三组FAJED、PDFA、PPTA比较差异有统计学意义(P＜0.05)，对照组FAJED、PDFA、PPTA显著大于单侧DDH组、双侧DDH组(P＜0.05)，单侧DDH组FAJED、PDFA显著大于双侧DDH组(P＜0.05)。对照组FPJED显著大于单侧DDH组，双侧DDH组与单侧DDH组FPJED比较差异无统计学意义(P＞0.05)。三组TAJED比较差异有统计学意义(P＜0.05)，单侧DDH组TAJED显著小于对照组及双侧DDH组(P＜0.05)。三组TPJED比较，差异无统计学意义(P＞0.05)。 DDH患者膝关节外翻角增加，其机制与HMFC增加有关。DDH患者膝关节股骨远端后侧角和胫骨近端后侧角均减少。髋臼发育不良严重程度与膝关节外翻、胫骨后倾斜度相关。

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	林天烨
	江禹来
	何晓铭
	何敏聪
	李子祺
	陈镇秋
	张庆文
	何伟
	魏秋实

关键词 ：发育性髋关节发育不良, 膝关节, 外翻, 三维, 影像

Abstract：

Objective To explore the differences in knee joint parameters among developmental dysplasia of the hip (DDH) patients through 3D reconstruction technology，providing data reference for hip and knee surgery in DDH patients.Methods From January 2019 to December 2022，127 DDH patients were prospectively recruited，including 98 cases in the unilateral DDH group，29 cases (58 knees) in the bilateral DDH group，and 110 cases in the control group (healthy individuals).28 males and 70 females were included in the unilateral DDH group.The average age was (35.40±11.62) years old.There were 7 males and 22 females in the bilateral DDH group.The average age was (36.17±12.58) years old.32 males and 78 females were included in the control group.The average age is (35.82±11.49) years old.We collected CT data from three groups of patients for 3D reconstruction，and measure knee joint related parameters based on the 3D reconstruction model，including width of medial femoral condyle(WMFC)，width of lateral femoral condyle(WLFC)，height of medial femoral condyle(HMFC)，height of lateral femoral condyle(HLFC)，and width of medial tibial platform(WMTP) Width of lateral tibial platform(WLTP)，femoral anterior joint edge distance(FAJED)，femoral posterior joint edge distance(FPJED)，tibial anterior joint edge distance(TAJED)，and tibial posterior joint edge distance(TPJED)，femorofemoral angle(FTA)，lateral distal femoral angle(LDFA)，medial proximal tibial angle(MPTA)，posterior posterior tibial angle(PPTA)，and posterior posterior femoral angle(PDFA).The knee joint orthographies and angle related parameters were compared.Results The WLFC，WLTP，and LDFA in the control group were significantly higher than those in the unilateral DDH group and bilateral DDH group(P＜0.05)，while the WLFC，WLTP，and LDFA in the unilateral DDH group were significantly higher than those in the bilateral DDH group(P＜0.05).The HMFC of the control group was significantly smaller than that of the unilateral DDH group and bilateral DDH group(P＜0.05)，and the HMFC of the bilateral DDH group was greater than that of the unilateral DDH group(P＜0.05).The WMTP of the control group was significantly lower than that of the unilateral DDH group(P＜0.05)，and the WMTP of the unilateral DDH group was significantly higher than that of the bilateral DDH group(P＜0.05).There was no statistically significant difference in WMTP between the bilateral DDH group and the control group(P＞0.05).There was no statistically significant difference(P＞0.05) in the comparison of three groups of WMFC，HLFC，and MPTA.The difference in FTA among the three groups was statistically significant(P＜0.05)，and the FTA of the control group was significantly smaller than that of the unilateral DDH group and the bilateral DDH group(P＜0.05).In addition，there was a statistically significant difference in FAJED，PDFA，and PPTA among the three groups(P＜0.05).The FAJED，PDFA，and PPTA in the control group were significantly higher than those in the unilateral DDH group and bilateral DDH group(P＜0.05).The FAJED and PDFA in the unilateral DDH group were significantly higher than those in the bilateral DDH group(P＜0.05).The FPJED of the control group was significantly higher than that of the unilateral DDH group，and there was no statistically significant difference in FPJED between the bilateral DDH group and the unilateral DDH group(P＞0.05).Furthermore，there was a statistically significant difference in TAJED among the three groups(P＜0.05).The TAJED of the unilateral DDH group was significantly lower than that of the control group and the bilateral DDH group(P＜0.05).There was no statistically significant difference in TPJED among the three groups(P＞0.05).Conclusion DDH patients have an increase in knee valgus angle，which is related to an increase in HMFC.DDH patients have reduced distal femoral posterior angle and proximal tibial posterior angle in the knee joint.The severity of acetabular dysplasia is related to knee valgus and posterior tibial tilt.

Key words： developmental dysplasia of the hip joint knee joint valgus 3 dimension image

基金资助:广东省中医药管理局项目(20223012)
广州中医药大学第三附属医院科研创新基金课题(Sy2022002)

通讯作者: 魏秋实

作者简介: 林天烨(1992－ )，男，主治医师，广州中医药大学第三附属医院关节中心，1185527583@qq.com

引用本文:

林天烨，江禹来，何晓铭，何敏聪，李子祺，陈镇秋，张庆文，何伟，魏秋实. 基于3D重建技术探讨发育性髋关节发育不良患者膝关节形态差异[J]. 实用骨科杂志, 2024, 30(1): 18-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I1/18

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