髋关节MR造影检查对发育性髋关节发育不良病人髋臼盂唇损伤程度的评价

摘要

目的 评价髋关节MR造影检查对发育性髋关节发育不良(DDH)病人髋臼盂唇损伤的诊断价值.方法 选取2015年12月—2016年10月进行髋关节MR造影检查的DDH病人16例,其中男3例,女13例,年龄10～20岁,平均(14.88±2.60)岁.对每例病人的患侧髋臼行超声引导下髋关节MR造影检查,分别对前、外上及后盂唇进行观察,由2名影像诊断医师评价盂唇损伤的部位及程度,并以术中诊断结果 作为金标准进行对比.采用Kappa检验计算髋关节MR造影检查与术中诊断的一致性.结果16例病人共48处盂唇,无撕裂37处(0期32处,Ⅰ期损伤5处),髋臼实质部撕裂3处,髋臼盂唇-软骨连接区撕裂8处.术中所见无撕裂38处,髋臼实质部撕裂3处,髋臼盂唇-软骨连接区撕裂7处.髋关节MR造影诊断髋臼盂唇撕裂的敏感度为100％,特异度为97.37％,阳性预测值为90.91％,阴性预测值为100％.MR髋关节造影检查与术中诊断的一致性较好(Kappa=0.939,P<0.001).髋关节MR造影显示盂唇肥大、内翻2例,均为前盂唇,与术中所见相吻合.结论 髋关节MR造影检查对DDH病人髋臼盂唇损伤诊断的敏感性和特异性均较高,可作为术前常规检查手段.%Objective To evaluate the acetabular labrumin injure in development aldysplasia of the hip (DDH) with hip MR intraarticular contrast scan. Methods Sixteen cases of DDH patients(male n=3, female n=13, age 14.88±2.60 years old, range 10-20 years old) prospectively underwent hip MR intraarticular contrast scan under ultrasonic guidance from December 2015 to October 2016, and the shape of the anterior labrum, lateral-superior labrum and the posterior labrum were observed by two radiologists, the position and severity of injury were then determined.The imaging findings were ultimately compared with the golden standard, surgical findings.The consistency between the findings in hip MR intraarticular contrast scan and surgery was tested with Kappa test. Results MR intraarticular contrast scan showed noacetabular labrum tear in 37 of 48 (phase 032/48, phaseⅠ5/48), the acetabular parenchyma tear in 3 of 48, the acetabulum-cartilaginous joint area tear in 8 of 48. And the operate shows:negative 38/48, the acetabular parenchyma tear 3/48, the acetabulum-cartilaginous joint area tear in 7 of 48. The sensitivity, specificity, positive predictive value, and the negative predictive value of the MR intraarticular contrast scan were 100％, 97.37％, 90.91％, and 100％, the consistency with the surgical findings is good (Kappa=0.939, P<0.001). In addition, MR intraarticular contrast scan showed labrum hypertrophy and introversion in 2 cases (both is anterior labrum), all were conformed by surgery. Conclusion The sensitivity and specificity of hip MR intraarticular con-trast scan under ultrasonic guidance are high in detecting the injure of the acetabular labrum in DDH, it should be used as a routine preoperative examination.