Pei Yinzhi,Huang Peng,Wu Chunxing,et al.Application of MRI-Bony teardrop and sourcil line in predicting residual acetabular dysplasia after closed reduction of developmental dysplasia of the hip[J].Journal of Clinical Pediatric Surgery,2024,(10):940-945.[doi:10.3760/cma.j.cn101785-202403002-008]
MRI-骨性泪滴眉弓线预测发育性髋关节发育不良闭合复位后残余髋臼发育不良的研究
- Title:
- Application of MRI-Bony teardrop and sourcil line in predicting residual acetabular dysplasia after closed reduction of developmental dysplasia of the hip
- 关键词:
- 发育性髋关节发育不良; 残余髋臼发育不良; 外科手术; 儿童
- Keywords:
- Developmental Hip Dysplasia; Residual Acetabular Dysplasia; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨MRI-泪滴眉弓线(teardrop and sourcil line, TSL)预测发育性髋关节发育不良(developmental dysplasia of the hip, DDH)患儿闭合复位后残余髋臼发育不良(residual acetabular dysplasia, RAD)的可行性。方法 本研究为回顾性研究, 研究对象为2011年10月至2019年12月复旦大学附属儿科医院儿童骨科54例(68髋)临床诊断为DDH且接受闭合复位的患儿(单侧发病40例, 双侧发病14例)。采用MRI测量并记录骨性TSL连续性以及髋臼开口最大连线(acetabular distance, AD);采用X线片观察并记录DDH患儿闭合复位时髋臼指数(acetabular index, AI)、国际髋关节发育不良协会(International Hip Dysplasia Institute, IHDI)分型。根据改良Severin分型将患髋分为RAD组和非RAD组, 根据MRI-骨性TSL的连续性将患儿分为MRI-骨性TSL连续组和非连续组, 比较上述各组间临床指标差异;运用受试者操作特征 (receiver operating characteristic curve, ROC) 曲线评估AD差值预测RAD发生的效能。结果 68髋中, Severin分型Ⅰ型2髋、Ⅱ型15髋、Ⅲ型46髋、Ⅳ型5髋;RAD组51髋, 非RAD组17髋。单因素分析发现, IHDI分型、MRI-骨性TSL连续性以及正常侧和患侧AD的差值是DDH患儿闭合复位后RAD发生的相关因素(P＜0.05);多因素Logistic回归分析发现, IHDI分型(OR=0.090, 95%CI:0.010~0.794), MRI-骨性TSL连续性(OR=0.015, 95%CI:0.002~0.128) 以及正常侧与患侧AD的差值(OR=7.1×108, 95%CI:370.6~1.4×1015) 是DDH患儿闭合复位后RAD发生的独立影响因素(P<0.05)。ROC曲线分析显示, 正常侧与患侧AD差值预测RAD发生的临界值为0.31 cm, 对应的灵敏度、特异度分别为0.900及0.833, 曲线下面积为0.917。结论 IHDI分型、MRI-骨性TSL连续性以及正常侧和患侧AD的差值可作为预测DDH患儿闭合复位后发生RAD的指标。与X线-TSL相比, MRI-骨性TSL可以更早、更准确地预测RAD的发生。
- Abstract:
- Objective To explore the feasibility of using magnetic resonance imaging (MRI) to measure the teardrop and sourcil line (TSL) for predicting the occurrence of residual acetabular dysplasia (RAD) after closed reduction (CR) in children with developmental dysplasia of the hip (DDH). Methods This study measured and recorded the continuity of the bony TSL and the maximum acetabular distance (AD) on MRI in 54 children, totaling 68 hips (40 unilateral cases and 14 bilateral cases) clinically diagnosed with DHH and who underwent CR.X-ray images were used to observe and record the acetabular index (AI) at the time of CR, as well as the International Hip Dysplasia Institute (IHDI) classification.According to the modified Severin classification, the affected hips were divided into RAD and non-RAD groups, and differences between the two groups were compared.Additionally, patients were categorized into MRI-bony TSL continuous and non-continuous groups to compare differences in indicators between these groups.The receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of the AD difference in predicting the occurrence of RAD. Results Among the 68 hips, 2 were classified as Severin type Ⅰ, 15 as type Ⅱ, 46 as type Ⅲ, and 5 as type Ⅳ;51 hips in the RAD group, and 17 in the non-RAD group.Univariate analysis showed that IHDI classification, the continuity of the bony TSL, and the AD difference between the normal and affected sides were related factors for the occurrence of RAD after CR in DHH children.Multivariate logistic regression analysis revealed that IHDI classification (OR=0.090, 95%CI:0.010-0.794), MRI-bony TSL continuity (OR=0.015, 95%CI:0.002-0.128), and AD difference between the normal and affected sides (OR=7.1×108, 95%CI:370.6-1.4×1015) were independent factors influencing the occurrence of RAD after CR in DHH children (P<0.05).ROC curve analysis showed that the difference between normal side and affected side AD predicted the onset of RAD by 0.31cm, corresponding sensitivity and specificity were 0.900 and 0.833, respectively, and AUC was 0.917. Conclusions IHDI classification, MRI-bony TSL continuity, and the AD difference between the normal and affected sides can serve as indicators for predicting RAD occurrence after CR in DDH children.Compared to X-ray TSL, MRI-bony TSL can predict the occurrence of RAD earlier and more accurately.
参考文献/References:
[1] Shipman SA, Helfand M, Moyer VA, et al.Screening for developmental dysplasia of the hip:a systematic literature review for the US Preventive Services Task Force[J].Pediatrics, 2006, 117(3):e557-e576.DOI:10.1542/peds.2005-1597.
[2] Kuitunen I, Uimonen MM, Haapanen M, et al.Incidence of neonatal developmental dysplasia of the hip and late detection rates based on screening strategy:a systematic review and meta-analysis[J].JAMA Netw Open, 2022, 5(8):e2227638.DOI:10.1001/jamanetworkopen.2022.27638.
[3] Ortiz-Neira CL, Paolucci EO, Donnon T.A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns[J].Eur J Radiol, 2012, 81(3):e344-e351.DOI:10.1016/j.ejrad.2011.11.003.
[4] Sharrock MN, Whelton CR, Paton RW.Selective sonographic scree-ning for developmental dysplasia of the hip-increasing trends in late diagnosis[J].Acta Orthop Belg, 2023, 89(1):15-19.DOI:10.52628/89.1.8636.
[5] Morris WZ, Hinds S, Worrall H, et al.Secondary surgery and residual dysplasia following late closed or open reduction of developmental dysplasia of the hip[J].J Bone Joint Surg Am, 2021, 103(3):235-242.DOI:10.2106/JBJS.20.00562.
[6] Albinana J, Dolan LA, Spratt KF, et al.Acetabular dysplasia after treatment for developmental dysplasia of the hip.Implications for secondary procedures[J].J Bone Joint Surg Br, 2004, 86(6):876-886.DOI:10.1302/0301-620x.86b6.14441.
[7] Farsetti P, Caterini R, De Maio F, et al.T nnis triple pelvic osteotomy for the management of late residual acetabular dysplasia:mid-term to long-term follow-up study of 54 patients[J].J Pediatr Orthop B, 2019, 28(3):202-206.DOI:10.1097/BPB.0000000000000575.
[8] Grissom L, Harcke HT, Thacker M.Imaging in the surgical management of developmental dislocation of the hip[J].Clin Orthop Relat Res, 2008, 466(4):791-801.DOI:10.1007/s11999-008-0161-3.
[9] Li YQ, Guo YM, Li M, et al.Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip[J].Int Orthop, 2018, 42(3):631-640.DOI:10.1007/s00264-017-3726-5.
[10] Zhang ZL, Fu Z, Yang JP, et al.Intraoperative arthrogram predicts residual dysplasia after successful closed reduction of DDH[J].Orthop Surg, 2016, 8(3):338-344.DOI:10.1111/os.12273.
[11] Takeuchi R, Kamada H, Mishima H, et al.Evaluation of the cartilaginous acetabulum by magnetic resonance imaging in developmental dysplasia of the hip[J].J Pediatr Orthop B, 2014, 23(3):237-243.DOI:10.1097/BPB.0000000000000032.
[12] Wakabayashi K, Wada I, Horiuchi O, et al.MRI findings in residual hip dysplasia[J].J Pediatr Orthop, 2011, 31(4):381-387.DOI:10.1097/BPO.0b013e31821a556e.
[13] Druschel C, Placzek R, Selka L, et al.MRI evaluation of hip containment and congruency after closed reduction in congenital hip dislocation[J].Hip Int, 2013, 23(6):552-559.DOI:10.5301/hipint.5000070.
[14] Kim HT, Kim JI, Yoo CI.Diagnosing childhood acetabular dysplasia using the lateral margin of the sourcil[J].J Pediatr Orthop, 2000, 20(6):709-717.DOI:10.1097/00004694-200011000-00003.
[15] Erkula G, Celikbas E, Kilic BA, et al.The acetabular teardrop and ultrasonography of the hip[J].J Pediatr Orthop B, 2004, 13(1):15-20.DOI:10.1097/00009957-200401000-00003.
[16] Smith JT, Matan A, Coleman SS, et al.The predictive value of the development of the acetabular teardrop figure in developmental dysplasia of the hip[J].J Pediatr Orthop, 1997, 17(2):165-169.DOI:10.1097/00004694-199703000-00005.
[17] Walter SG, Endler CHJ, Remig AC, et al.Correction to:risk factors for failed closed reduction in dislocated developmental dysplastic hips[J].Int Orthop, 2021, 45(11):3009.DOI:10.1007/s00264-021-05124-z.
[18] Walter SG, Bornemann R, Koob S, et al.Closed reduction as therapeutic gold standard for treatment of congenital hip dislocation[J].Z Orthop Unfall, 2020, 158(5):475-480.DOI:10.1055/a-0979-2346.
[19] Huang P, Wang DH, Mo YQ, et al.Teardrop and sourcil line (TSL):a novel radiographic sign that predicts residual acetabular dysplasia (RAD) in DDH after closed reduction[J].Transl Pediatr, 2022, 11(4):458-465.DOI:10.21037/tp-21-401.
[20] Morbi AHM, Carsi B, Gorianinov V, et al.Adverse outcomes in infantile bilateral developmental dysplasia of the hip[J].J Pediatr Orthop, 2015, 35(5):490-495.DOI:10.1097/BPO.0000000000000310.
[21] Narayanan U, Mulpuri K, Sankar WN, et al.Reliability of a new radiographic classification for developmental dysplasia of the hip[J].J Pediatr Orthop, 2015, 35(5):478-484.DOI:10.1097/BPO.0000000000000318.
[22] Mansour E, Eid R, Romanos E, et al.The management of residual acetabular dysplasia:updates and controversies[J].J Pediatr Orthop B, 2017, 26(4):344-349.DOI:10.1097/BPB.0000000000000358.
[23] Kim HT, Kim JI, Yoo CI.Acetabular development after closed reduction of developmental dislocation of the hip[J].J Pediatr Orthop, 2000, 20(6):701-708.DOI:10.1097/00004694-200011000-00002.
[24] Gotoh E, Tsuji M, Matsuno T, et al.Acetabular development after reduction in developmental dislocation of the hip[J].Clin Orthop Relat Res, 2000, 378:174-182.DOI:10.1097/00003086-200009000-00027.
[25] Zamzam MM, Kremli MK, Khoshhal KI, et al.Acetabular cartilaginous angle:a new method for predicting acetabular development in developmental dysplasia of the hip in children between 2 and 18 months of age[J].J Pediatr Orthop, 2008, 28(5):518-523.DOI:10.1097/BPO.0b013e31817c4e6d.
[26] Miyake T, Tetsunaga T, Endo H, et al.Predicting acetabular gro-wth in developmental dysplasia of the hip following open reduction after walking age[J].J Orthop Sci, 2019, 24(2):326-331.DOI:10.1016/j.jos.2018.09.015.
相似文献/References:
[1]姜海,苗武胜,吴革,等. 发育性髋关节发育不良儿童髋臼形态学病理分型的探讨[J].临床小儿外科杂志,2016,15(02):179.
[2]刘万林,孙亮,赵振群,等.骨化核与发育性髋关节发育不良闭合复位后股骨头缺血坏死相关性的研究进展[J].临床小儿外科杂志,2023,22(06):584.[doi:10.3760/cma.j.cn101785-202010041-017]
Liu Wanlin,Sun Liang,Zhao Zhenqun,et al.Research advances on the relationship of ossification nucleus with avascular necrosis of developmental hip dysplasia after closed reduction[J].Journal of Clinical Pediatric Surgery,2023,22(10):584.[doi:10.3760/cma.j.cn101785-202010041-017]
[3]李杰,龙江涛,王倩倩,等.发育性髋关节脱位患儿不同股骨颈前倾角对股骨生物力学的影响研究[J].临床小儿外科杂志,2023,22(08):757.[doi:10.3760/cma.j.cn101785-202205019-011]
Li Jie,Long Jiangtao,Wang Qianqian,et al.Effect of different femoral neck anteversion angles on femoral biomechanics in children with developmental dislocation of the hip[J].Journal of Clinical Pediatric Surgery,2023,22(10):757.[doi:10.3760/cma.j.cn101785-202205019-011]
[4]孙强,叶家军,周英.川藏藏族儿童发育性髋关节脱位的影响因素分析[J].临床小儿外科杂志,2023,22(11):1050.[doi:10.3760/cma.j.cn101785-202204079-009]
Sun Qiang,Ye Jiajun,Zhou Ying.Epidemiological survey and influencing factors of developmental dysplasia of the hip in Tibetan children of Sichuan and Tibet[J].Journal of Clinical Pediatric Surgery,2023,22(10):1050.[doi:10.3760/cma.j.cn101785-202204079-009]
[5]赵振辉,熊竹,曾帅丹,等.发育性髋关节发育不良遗传学及分子调控机制的研究进展[J].临床小儿外科杂志,2023,22(11):1095.[doi:10.3760/cma.j.cn101785-202210022-019]
Zhao Zhenhui,Xiong Zhu,Zeng Shuaidan,et al.Research progress on the genetics and molecular regulatory mechanisms of developmental hip dysplasia[J].Journal of Clinical Pediatric Surgery,2023,22(10):1095.[doi:10.3760/cma.j.cn101785-202210022-019]
[6]李大进,张彬,高强,等.股骨截骨联合Salter骨盆截骨治疗残余髋臼发育不良的疗效分析[J].临床小儿外科杂志,2022,21(12):1159.[doi:10.3760/cma.j.cn101785-202112051-011]
Li Dajin,Zhang Bin,Gao Qiang,et al.Efficacy of femoral osteotomy for residual acetabular dysplasia with Salter pelvic osteotomy[J].Journal of Clinical Pediatric Surgery,2022,21(10):1159.[doi:10.3760/cma.j.cn101785-202112051-011]
[7]黎艺强,刘行,郭跃明,等.儿童发育性髋关节发育不良闭合复位术后结局预测模型的构建[J].临床小儿外科杂志,2024,(06):509.[doi:10.3760/cma.j.cn101785-202404061-003]
Li Yiqiang,Liu Hang,Guo Yueming,et al.Prediction model of final outcomes in children with developmental dysplasia of the hip treated by closed reduction[J].Journal of Clinical Pediatric Surgery,2024,(10):509.[doi:10.3760/cma.j.cn101785-202404061-003]
[8]李敬春,刘雁寒,黎艺强,等.发育性髋关节脱位闭合复位后残余髋臼发育不良骨盆截骨时机与指征的多中心前瞻性非随机对照试验研究方案[J].临床小儿外科杂志,2024,(06):527.[doi:10.3760/cma.j.cn101785-202405072-005]
Li Jingchun,Liu Yanhan,Li Yiqiang,et al.A multicenter prospective non-randomized controlled protocol on timing and indications of pelvic osteotomy for residual acetabular dysplasia after closed reduction of developmental dislocation of the hip[J].Journal of Clinical Pediatric Surgery,2024,(10):527.[doi:10.3760/cma.j.cn101785-202405072-005]
备注/Memo
收稿日期:2024-3-2。
基金项目:国家自然科学基金(82272441);上海市科学技术委员会科技创新行动计划(22Y11912200)
通讯作者:宁波,Email:ningbo@fudan.edu.cn