Rezidüel Asetabular Displazi Hastalarının Yönetiminde Manyetik Rezonans Görüntüleme ile Kıkırdak Asetabulum Değerlendirilmesinin Rolü

Öz

Amaç: Rezidüel asetabular displazi RAD takibinde Manyetik rezonans görüntüleme MRG ile kıkırdak asetabulumun değerlendirmesinin önemini incelemektir. Gereç ve Yöntemler: Çalışmaya 2005-2010 yılları arasında gelişimsel kalça displazisi nedeniyle tek taraflı medial girişim uyguladığımız ve takiplerinde asetabular displazisi devam eden 20 hasta dahil edildi. Preoperatif kalça dislokasyon seviyesi Tönnis evrelemesine göre belirlendi. Son kontrollerinde radyolojik sonuçlar için Severin sınıflaması kullanıldı. X-ray’de Asetabular İndeks AI , Modifiye Asetabular İndex MAI , Wiberg’in Merkez-Köşe Wiberg CE ve Ogata’nın Merkez-Köşe Ogata CE açısı ölçümleri yapıldı. MRG’de Osseoz Asetabular İndeks OAI , Kıkırdak Asetabular İndeks CAI ve Kıkırdak Merkez-Köşe açısı CCE ölçümleri yapıldı. İstatistiksel analiz SPSS 11.5 programıyla yapıldı. Bulgular: Yirmi 17K/3E hastanın, ortalama yaşı 6,8±1,05 aralık 5-9 , ortalama takip süresi 5,9±1,09 aralık, 4-8 yıldı. X-ray ölçümlerinde opere tarafta; AI ve MAI açısındaki artma ile Wiberg CE ve Ogata CE açısındaki azalma anlamlı bulundu p= 0,000 . MRG ile yapılan ölçümlerde sağlıklı ve opere kalçalar arasında OAI, CAI, CCE açısından anlamlı bir fark bulunamadı p=0,556, p= 0,170, p= 0,072 . Opere kalçalarda direkt grafide ölçülen AI ve CE açıları ile MRG'de ise CAI açısı anlamlı olarak daha düşük, CCE açısı anlamlı olarak daha büyük bulundu p= 0,032 . Sonuç: RAD hastalarında; MRG ile kıkırdak asetabular örtünmenin değerlendirilmesinin, hem asetabuler gelişimin prognozunun belirlenmesinde hem de sekonder cerrahi zamanlaması açısından faydalı olacağını anlamaktayız.

Anahtar Kelimeler

• Asetabular remodelizasyon, Rezidüel asetabular displazi, Manyetik rezonans görüntüleme, Asetabular indeks, Kıkırdak asetabular indeks, Wiberg merkez köşe açısı, Ogata merkez köşe açısı

The Role of the Assessment of Cartilage Acetabulum with Magnetic Resonance Imaging in the Management of Residual Acetabular Dysplasia Patients

Abstract

Objective: Examining the importance of the evaluation of cartilage acetabulum by magnetic resonance imaging MRI in residual acetabular dysplasia RAD patients during follow-up.Material and Methods: Twenty patients with RAD who underwent the unilateral medial approach for developmental dysplasia of the hip between 2005 and 2010 were included. The preoperative hip dislocation level was determined with Tönnis staging. The Severin classification was used for determination of radiological results according to the last X-ray. Acetabular Index AI , Modified Acetabular Index MAI angle, Wiberg Center-Edge Wiberg CE angle and Ogata Center-Edge Ogata CE angle measurements were made on the X-ray graphs. Osseous Acetabular Index OAI , Cartilage Acetabular Index CAI and Cartilage Center-Edge angle CCE measurements were performed on MRI images. Statistical analysis was performed with SPSS Version 11.5.Results: The median age of the 20 patients 17F/3M was 6.8±1.05 years and the median follow-up time was 5.9±1.09 years. X-ray measurements on the operated side showed that the increase in the AI and MAI angles and decrease in the Wiberg CE and Ogata CE were significant p= 0.000 . No significant difference was found between the normal and operated hips for OAI, CAI, and CCE measurements on MRI p=0.556, p= 0.170, p= 0.072 . The angles of CAI of the operated hip were significantly lower and the CCE angle was significantly greater compared to the AI and CE angles, respectively p = 0.032 on MRI .Conclusion: It is understood that evaluation of cartilage acetabulum coverage with MRI in RAD patients is beneficial for both the determination of the prognosis of acetabular development and the timing for secondary surgeries

Keywords

• Acetabular remodelization, Residual acetabular dysplasia, Magnetic resonance imaging, Acetabular index, Cartilage acetabular index, Wiberg central edge angle, Ogata central edge angle

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