儿童大转子相对发育过度和转子-骨盆撞击综合征: 畸形病因和放射学特征

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引言:近端股骨多维畸形一直被视为儿童多病因髋关节疾病治疗过程中最常见的问题之一,大多合并大转子肥大[大转子相对发育过度(ROGT)]、大转子高位(相对于股骨头)、骨盆综合征(转子-骨盆撞击)。

目的:本研究的目的是确定ROGT患儿X线解剖学改变的原因和特征。

材料和方法:本研究对350例3至17岁患儿的研究结果进行分析,这些患儿因多种髋关节疾病新发大转子高位。对其中68例患儿(112例关节)放射学指标进行详细研究,这些指标的特征是大转子相对于股骨头和股骨颈出现发育改变。

结果:大转子肥大大多见于有缺血性疾病后遗症的患儿,缺血性疾病在髋关节发育不良和发育性髋关节脱位治疗期间发作,且由既往血源性骨髓炎所致。研究发现,受累髋关节的关节面转子间距离指标定期降低;同时,反映大转子单一性发育的转子间距(TTD)在正常和病理状态下几乎相同(p < 0.05)。

结论:ROGT由多种病因下的松果腺生长板及股骨颈损害所致。X线解剖学改变包括股骨颈进行性缩短。这些改变在学龄前儿童中较为明显,其在患儿发育过程中呈进行性发展,造成髋关节慢性创伤。

作者简介

Ivan Pozdnikin

The Turner Scientific Research Institute for Children’s Orthopedics

编辑信件的主要联系方式.
Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
SPIN 代码: 3744-8613

MD, PhD, Research Associate of the Department of Hip Pathology

俄罗斯联邦, Saint Petersburg

Vladimir Baskov

The Turner Scientific Research Institute for Children’s Orthopedics

Email: drbaskov@mail.ru
ORCID iD: 0000-0003-0647-412X

MD, PhD, Head of the Department of Hip Pathology

俄罗斯联邦, Saint Petersburg

Dmitry Barsukov

The Turner Scientific Research Institute for Children’s Orthopedics

Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634

MD, PhD, Senior Research Associate of the Department of Hip Pathology

俄罗斯联邦, Saint Petersburg

Pavel Bortulev

The Turner Scientific Research Institute for Children’s Orthopedics

Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817

MD, Research Associate of the Department of Hip Pathology

俄罗斯联邦, Saint Petersburg

Andrey Krasnov

The Turner Scientific Research Institute for Children’s Orthopedics

Email: turner02@mail.ru

MD, PhD, Orthopedic and Trauma Surgeon of the Consultative and Diagnostic Department

俄罗斯联邦, Saint Petersburg

参考

  1. Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003(417):112-120. https://doi.org/10.1097/01.blo.0000096804.78689.c2.
  2. Shaw C. Femoroacetabular impingement syndrome: a cause of hip pain in adolescents and young adults. Mo Med. 2017;114(4):299-302.
  3. Хусаинов Н.О. Фемороацетабулярный импинджмент: обзор литературы // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2015. – Т. 3. – № 2. – C. 42–47. [Khusainov NO. Femoroatsetabulyarnyi impindzhment: obzor literatury. Femoroacetabular impingement: literature review. 2015;3(2):42-47. (In Russ.)]. https://doi.org/10.17816/PTORS3242-47.
  4. de Sa D, Alradwan H, Cargnelli S, et al. Extra-articular hip impingement: a systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement. Arthroscopy. 2014;30(8):1026-1041. https://doi.org/10.1016/j.arthro.2014.02.042.
  5. Bardakos NV. Hip impingement: beyond femoroacetabular. J Hip Preserv Surg. 2015;2(3):206-223. https://doi.org/10.1093/jhps/hnv049.
  6. Cheatham SW. Extra-articular hip impingement: a narrative review of the literature. J Can Chiropr Assoc. 2016;60(1):47-56.
  7. Kelikian AS, Tachdjian MO, Askew MJ, Jasty M. Greater trochanteric advancement of the proximal femur: a clinical and biomechanical study. Hip. 1983:77-105.
  8. Schneidmueller D, Carstens C, Thomsen M. Surgical treatment of overgrowth of the greater trochanter in children and adolescents. J Pediatr Orthop. 2006;26(4):486-490. https://doi.org/10.1097/01.bpo.0000226281.01202.94.
  9. Bech NH, Haverkamp D. Impingement around the hip: beyond cam and pincer. EFORT Open Rev. 2018;3(2):30-38. https://doi.org/10.1302/2058-5241.3.160068.
  10. Краснов А.И. Многоплоскостные деформации проксимального отдела бедренной кости у детей и подростков после консервативного лечения врожденного вывиха бедра (диагностика, лечение) // Травматология и ортопедия России. – 2002. – № 3. – С. 80–83. [Krasnov AI. Mnogoploskostnye deformatsii proksimal’nogo otdela bedrennoi kosti u detei i podrostkov posle konservativnogo lecheniya vrozhdennogo vyvikha bedra (diagnostika, lechenie). Travmatologiia i ortopediia Rossii. 2002;(3):80-83. (In Russ.)]
  11. Норкин И.А., Адамович Г.А., Решетников А.Н., и др. Рентгенодиагностика заболеваний костей и суставов. – Саратов, 2016. – 134 с. [Norkin IA, Adamovich GA, Reshetnikov AN, et al. Rentgenodiagnostika zabolevanii kostei i sustavov. Saratov; 2016. 134 p. (In Russ.)]
  12. McCarthy JJ, Weiner DS. Greater trochanteric epiphysiodesis. Int Orthop. 2008;32(4):531-534. https://doi.org/10.1007/s00264-007-0346-5.
  13. Mazzini JP, Martin JR, Ciruelos RM. Coxa vara with proximal femoral growth arrest as a possible consequence of extracorporeal membrane oxygenation: a case report. Cases J. 2009;2:8130. https://doi.org/10.4076/1757-1626-2-8130.
  14. Omeroglu H, Ucar DH, Tumer Y. A new measurement method for the radiographic assessment of the proximal femur: the center-trochanter distance. Acta Orthop Traumatol Turc. 2004;38(4):261-264.
  15. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: Part II. Instr Course Lect. 2004;53:531-542.
  16. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62(6):876-888.
  17. Поздникин И.Ю., Басков В.Е., Волошин С.Ю., и др. Ошибки диагностики и начала консервативного лечения детей с врожденным вывихом бедра // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2017. – Т. 5. – № 2. – С. 42–51. [Pozdnikin IY, Baskov VE, Voloshin SY, et al. Errors of diagnosis and the initiation of conservative treatment in children with congenital hip dislocation. Pediatric traumatology, orthopaedics and reconstructive surgery. 2017;5(2):42-51. (In Russ.)]. https://doi.org/10.17816/PTORS5242-51.
  18. Chaudhry H, Ayeni OR. The etiology of femoroacetabular impingement: what we know and what we don’t. Sports Health. 2014;6(2):157-161. https://doi.org/10.1177/1941738114521576.
  19. Macnicol MF, Makris D. Distal transfer of the greater trochanter. J Bone Joint Surg Br. 1991;73(5): 838-841.
  20. Leunig M, Ganz R. Relative neck lengthening and intracapital osteotomy for severe Perthes and Perthes-like deformities. Bull NYU Hosp Jt Dis. 2011;69 Suppl 1:S62-67.

补充文件

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1. JATS XML
2. 图2.本研究患者疾病分类HJ, 髋关节;SCFE,股骨骺滑脱

下载 (70KB)
3. 图7.不同年龄正常髋关节关节面转子间距离(ATD)、转子间距(TTD) 和小转子关节面距离(LTA)图。圆圈代表正常ATD;方块代表正常TTD;三角形代表正常LTA

下载 (255KB)
4. 图8.不同年龄层受损髋关节关节面转子间距离(ATD)、转子间距(TTD) 和小转子关节面距离(LTA)图

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5. 图9.患者B 13岁时的放射片。该病于先天性双侧髋 关节半脱位后确诊,半脱位由股骨头和股骨颈无菌性 坏死所致。大转子位置偏高。转子-骨盆撞击由严重 解剖学异常改变引发,患者有典型临床表现和疼痛

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6. 图10.不同年龄层正常状态下和病理状态下关节面转子间距离(ATD)改变图

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7. 图11.不同年龄层正常状态下和病理状态下转子间距(ATD)改变图

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版权所有 © Pozdnikin I., Baskov V., Barsukov D., Bortulev P., Krasnov A., 2019

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