背景:发育性髋关节发育不良(DDH)代表了从髋臼发育不良到固定脱位的频谱,通过过早的骨关节炎给予残疾。大多数DDH病例继续存在,没有任何已知的危险因素,如臀位。女性性别,和家族史。由于使用不同类型的检查的许多DDH定义和分类,因此很难可靠地确定DDH的发病率和基于人群的结果。
目的:本综述从历史角度探讨影像学在DDH中的作用。
方法:骨盆X光片(X射线)是识别DDH的第一批医学图像之一,但由于缺乏骨化,这些在婴儿期的作用有限。在1980年代,超声导致婴儿DDH筛查的大幅扩张。不幸的是,即使是训练有素的用户,DDH的超声指标通常缺乏可重复性,并导致轻度DDH的过度诊断。CT和MRI更彻底地评估DDH的3D髋关节畸形,但是很昂贵,较少可用,涉及辐射剂量和/或麻醉。
结果:最近,3D超声已用于更全面地表征DDH的3D畸形,具有改进的观察者间可靠性,尤其是新手用户。3D超声也非常适合自动图像分析,但是高分辨率的3D探头成本很高,而且没有广泛使用。
结论:将最新的手持式便携式超声探头和人工智能分析相结合,可以产生一种廉价的工具,允许实际的大规模人群筛查DDH。总的来说,我们对DDH的理解在很大程度上受到用于可视化它的成像工具的影响,并且随着现代技术的迅速变化。
BACKGROUND: Developmental dysplasia of hip (DDH) represents a spectrum from acetabular dysplasia to fixed dislocation, giving disability through premature osteoarthritis. Most DDH cases continue to present without any known risk factors such as breech presentation, female sex, and family history. Incidence and population-based outcomes of DDH are difficult to reliably establish due to many DDH definitions and classifications using different types of examinations.
OBJECTIVE: This
review takes a historical perspective on the role of imaging in DDH.
METHODS: Pelvic radiographs (X-Ray) were amongst the first medical images identifying DDH, but these have a limited role in infancy due to absent ossification. In the 1980s, ultrasound led to a large expansion in infant DDH screening. Unfortunately, even for well-trained users, DDH indices on ultrasound generally lack reproducibility, and have led to overdiagnosis of mild DDH. CT and MRI more thoroughly evaluate the 3D hip deformity in DDH, but are costly, less available and involve radiation dose and/or anaesthesia.
RESULTS: Recently 3D ultrasound has been used to characterize the 3D deformity of DDH more fully, with improved inter-observer reliability, particularly amongst novice users. 3D ultrasound is also well suited to automated image analysis, but high-resolution 3D probes are costly and not widely available.
CONCLUSIONS: Combining the latest handheld portable ultrasound probes and artificial intelligence analysis could lead to an inexpensive tool permitting practical mass population screening for DDH. Overall, our understanding of DDH is heavily influenced by the imaging tools used to visualize it and changing quickly with modern technology.