儿童发育性髋关节发育不良解剖学改变与影像学

背景：发育性髋关节发育不良是常见的儿童髋关节发育畸形，该病不同时期的治疗效果不同，早期治疗疗效较好，并发症较少，远期的预后更好，可以减少复发率，减轻经济压力，提高生活质量，所以，临床上对发育性髋关节发育不良的早期诊断越来越重要。

目的：对发育性髋关节发育不良的解剖学改变及影像学表现的研究进展进行综述。

方法：以“DDH，Anatomy，X-ray Radiography，CT，MRI，Ultrasound”为英文检索词，“发育性髋关节发育不良，解剖，X 线摄影，CT，MRI，超声”为中文检索词，对PubMed、Springerlink 等英文数据库及万方、CNKI 等中文数据库进行检索，检索时限为1990年1月至2019年12月，排除与文章研究目的无关及重复性研究，纳入符合标准的55 篇文献进行综述。

结果与结论：影像学诊断作为一种无创性的检查手段，已经成为诊断发育性髋关节发育不良首选的检查方法，而明确其解剖学改变更有助于临床影像学诊断，常规X 射线片能够进行发育性髋关节发育不良的快速筛查；MRI 有助于分辨软组织结构以及骨性结构早期信号改变；三维CT 能够多角度评价髋臼骨性结构改变，排除了体位因素造成的遮挡；超声同样能够进行发育性髋关节发育不良筛查，并对关节积液更加敏感。所以，不同的影像学检查各有优势，相辅相成，提高发育性髋关节发育不良的早期诊断率。

BACKGROUND:Developmental dysplasia of the hip is a common hip developmental deformity in treatment of developmental dysplasia of the hip differs in different treatment has better efficacy,fewer complications,and better long-term can reduce the recurrence rate,reduce economic pressure,and improve the quality of ,early diagnosis of developmental dysplasia of the hip is becoming more and more important clinically.

OBJECTIVE:To review the research progress of anatomical changes and imaging manifestations of developmental dysplasia of the hip.

METHODS:“DDH,Anatomy,X-ray Radiography,CT,MRI,Ultrasound” were used as English search terms.“Developmental hip dysplasia;anatomy;X-ray photography;CT;MRI,ultrasound” were used as Chinese search authors searched English databases such as PubMed and Springerlink,and Chinese databases such as Wanfang and CNKI from January 1990 to December and repetitive articles were excluded,and finally 55 articles were included for review.

RESULTS AND CONCLUSION:Imaging diagnosis as a non-invasive examination method has become the preferred examination method for the diagnosis of developmental dysplasia of the hip,and its anatomical changes are more conducive to clinical imaging X-ray examination can be used for rapid screening of developmental dysplasia of the hip.MRI helps to distinguish the early signal changes of soft tissue structure and bony CT can evaluate the acetabular bone structure changes from multiple angles,excluding the obstruction caused by posture is more sensitive to fluid and can also perform early screening of developmental dysplasia of the hip.Thus,different imaging examinations have their advantages and complement each other to improve the early diagnosis rate of developmental dysplasia of the hip.

0 引言 Introduction

髋关节是动态运动的重要焦点，也是骨盆倾斜和平衡的主要支点，由股骨圆形头部和杯状骨盆髋臼组成，其形成的独特球窝形态有助于保持适当的骨盆倾斜，并允许动态范围的旋转运动，包括屈曲、内收、伸展以及外展。由于双足活动时，对髋关节会产生轴向和旋转负荷，因此，支撑韧带、肌腱和肌肉的协调对于维持髋关节的强度和稳定性尤为重要[1]。

发育性髋关节发育不良(developmental dysplasia of the hip，DDH)是常见的儿童髋关节发育畸形。DDH特征是髋臼浅、股骨头覆盖不足和关节内负荷异常，导致关节脱位的风险增加，其病因尚不明确，目前认为与髋关节的骨骼、血管及其软组织结构改变都可能相关[2]。DDH的危险因素有很多，如妊娠周、家族史、臀位、襁褓、先天性膝关节脱位、出生体质量、多胎妊娠、羊水过少及斜颈等，这些危险因素可能因性别而异[3]。髋关节发育不良可能在出生时发生或在出生后早年发生，其临床症状的出现通常在1岁之后，偶尔可见双下肢不等长，发生部位为左髋较右髋更常见，并且能够导致许多并发症，包括关节炎、跛行和腰痛等[4]。由于对不同时期DDH的治疗效果不同，早期疗效较好，并发症较少，远期的预后更好，可以减少复发率，减轻经济压力，提高生活质量。所以，了解DDH的解剖学改变，正确诊断DDH极为重要。

目前，影像学诊断作为一种无创性的检查手段，已经成为诊断DDH首选的检查方法，文章对DDH发生的解剖学改变以及DDH的影像学诊断进行综述。

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