发育性髋关节脱位闭式复位术MRI术前预测因素分析

Q4 Medicine

中华小儿外科杂志 Pub Date : 2020-01-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2020.01.017

Guoqiang Jia, E. Wang, Jun Sun, Tianjing Liu, Li-jun Zhang, Jihong Fang, Ran Gu

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On standard MRI, the preoperative measurement of MRI in joint sacs were anterior access angle, inferior access angle, maximal coronal entrance diameter, maximal axial entrance diameter, axial diameter of femoral head, coronal diameter of femoral head, coronal diameter ratio (CMAD/AFHD) and axial diameter ratio (AMAD/CFHD). And the significant differences of data were compared among three groups. Logistic regression analysis was performed for the correlations of gender, age, degree of dislocation, weight bearing time and final treatment. And receiver operating characteristic (ROC) curve was used for assessing the sensitivity and specificity of closed reduction group and determine the cutoff point. \n \n \nResults \nNo significant difference existed in AAA/CFHD/AFHD among 3 groups (P>0.05). IAA angle (108.2±9.8)° was significantly higher in group A than that in group B (98.8±11.2)° and group C (91.7±6.9)°(P 0.05). 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引用次数: 0

摘要

目的探讨术前磁共振成像(MRI)对2岁以下儿童发育性髋关节脱位手术方式选择的影响。方法回顾性分析2013年7月至2017年2月收治的儿童发育性髋关节脱位。按照Bowen放射学标准将患者分为闭合复位组(A组，n=26)、闭合复位失败组(B组，n=24)、无法复位组(C组，n=7) 3组。在标准MRI上，术前关节囊MRI测量为前通路角、下通路角、最大冠状口直径、最大轴向口直径、股骨头轴向直径、股骨头冠状面直径、冠状面直径比(CMAD/AFHD)、轴向直径比(AMAD/CFHD)。比较三组间数据的显著性差异。对性别、年龄、脱位程度、负重时间和最终治疗的相关性进行Logistic回归分析。采用受试者工作特征(ROC)曲线评估闭合复位组的敏感性和特异性，确定截断点。结果AAA/CFHD/AFHD 3组间比较差异无统计学意义(P>0.05)。A组IAA角(108.2±9.8)°显著高于B组(98.8±11.2)°和C组(91.7±6.9)°(P < 0.05)。Logistic回归分析显示，除年龄外，性别、测量方法、脱位程度、负重时间及最终治疗均不存在相关性(P>0.05)。ROC曲线的最大面积为0.515 (AMAD/CFHD)，其特异性为92.3%，拐点为0.515。结论术前测量IAA、CMAD、AMAD、CMAD/AFHD、AMAD/CFHD的MRI对治疗有一定的指导价值。当AMAD/CFHD比值>0.515时，建议闭合减持。关键词:磁共振成像;发育性髋关节脱位;封闭的减少;关节囊

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Analysis of preoperative predictive factors of MRI for closed reduction of developmental dislocation of the hip

Objective To explore the influence of preoperative magnetic resonance imaging (MRI) on the choice of operative methods in children aged under 2 years with developmental dislocation of hip. Methods Retrospective analysis was performed for children with developmental dislocation of hip from July 2013 to February 2017. According to the Bowen's radiographic standards, they were divided into 3 groups of closed reduction (A, n=26), failure of closed reduction (B, n=24) and impossibility of reduction (C, n=7). On standard MRI, the preoperative measurement of MRI in joint sacs were anterior access angle, inferior access angle, maximal coronal entrance diameter, maximal axial entrance diameter, axial diameter of femoral head, coronal diameter of femoral head, coronal diameter ratio (CMAD/AFHD) and axial diameter ratio (AMAD/CFHD). And the significant differences of data were compared among three groups. Logistic regression analysis was performed for the correlations of gender, age, degree of dislocation, weight bearing time and final treatment. And receiver operating characteristic (ROC) curve was used for assessing the sensitivity and specificity of closed reduction group and determine the cutoff point. Results No significant difference existed in AAA/CFHD/AFHD among 3 groups (P>0.05). IAA angle (108.2±9.8)° was significantly higher in group A than that in group B (98.8±11.2)° and group C (91.7±6.9)°(P 0.05). Logistic regression analysis revealed that, except for age, no correlation existed in gender, measurement, degree of dislocation, weight bearing time or final treatment (P>0.05). The maximal area of ROC curve was 0.515 (AMAD/CFHD), its specificity (92.3%) and inflection point (0.515). Conclusions Preoperative measurements of MRI of IAA, CMAD, AMAD, CMAD/AFHD, AMAD/CFHD offer certain guiding values for treatment. When AMAD/CFHD ratio is >0.515, closed reduction is recommended. Key words: Magnetic resonance imaging; Developmental dislocation of the hip; Closed reduction; Articular sacs

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来源期刊

中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.40

自引率

0.00%

发文量

8707

期刊介绍： Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.