Schidlo C, Becker C, Jansson V, Refior J
Orthopädische Klinik und Poliklinik der Ludwig-Maximilians-Universität München.
Z Orthop Ihre Grenzgeb. 1999 May-Jun;137(3):259-64. doi: 10.1055/s-2008-1037404.
The aim of the present study was to measure and interpret the change of the collodiaphyseal (CCD) angle and femoral anteversion after total hip replacement.
We prospectively examined 52 patients with coxarthrosis, who were treated by total hip replacement. Preoperatively and postoperatively we used a standard X-ray ap view to measure the CCD angle and computerized tomography to determine the femoral anteversion. These projected angles were converted into the real angles by using the method of König and Schult.
On average the preoperative real CCD angle was 128 degrees (+/- 8.9 degrees) and the postoperative angle 145 degrees (+/- 4.8 degrees), preoperatively the real femoral anteversion angle was 14.1 degrees (+/- 6.9 degrees) and postoperatively 10.8 degrees (+/- 6.2 degrees).
The effect of the postoperative valgisation can be explained by the given CCD angle of the used femoral stem prosthesis of 140 degrees (cemented Weller II stem) and 145 degrees (cementless CLS classic stem). It is possible that due to the valgisation and the decreased offset of the femoral stem prosthesis compared to the preoperative conditions the gluteal muscles are insufficient and overloaded. It is also known that the change of the femoral anteversion from the physiological conditions causes an increase of the torsional moment. The resulting increased interface load could possibly be a reason for loosening of the femoral stem. The conclusion can be drawn that the CCD angle and the femoral anteversion should more carefully be considered by the surgeon in total hip replacement. This could be reached by an exact implantation technique and the choice of the appropriate stem prosthesis with different CCD angles.
本研究旨在测量并解释全髋关节置换术后股骨干骺端（CCD）角和股骨前倾角的变化。
我们前瞻性地检查了52例接受全髋关节置换术治疗的髋关节病患者。术前和术后，我们使用标准X线前后位片测量CCD角，并通过计算机断层扫描确定股骨前倾角。这些投影角度通过König和Schult方法转换为实际角度。
术前实际CCD角平均为128度（±8.9度），术后为145度（±4.）；术前实际股骨前倾角为1度（±6.9度），术后为10.8度（±6.2度）。
术后外翻的效果可以用所用股骨柄假体的给定CCD角来解释，即骨水泥型Weller II柄为140度及非骨水泥型CLS经典柄为145度。与术前情况相比，由于股骨柄假体的外翻和偏移减少，臀肌可能不足且负荷过重。还已知股骨前倾角偏离生理状态会导致扭矩增加。由此产生的界面负荷增加可能是股骨柄松动的一个原因。可以得出结论，在全髋关节置换术中，外科医生应更仔细地考虑CCD角和股骨前倾角。这可以通过精确的植入技术和选择具有不同CCD角的合适柄假体来实现。
