Argenson Jean-Noel A, Flecher Xavier, Parratte Sebastien, Aubaniac Jean-Manuel
Aix-Marseille University, Department of Orthopedic Surgery, Hôpital Sainte-Marguerite, Marseille, France.
Clin Orthop Relat Res. 2007 Dec;465:40-5. doi: 10.1097/BLO.0b013e3181576052.
Total hip arthroplasty in dysplastic hips is challenging because of the modified anatomy of the proximal femur and acetabulum. We studied three-dimensional anatomic parameters in 247 dysplastic hips from 218 adult patients using radiographs and computed tomography, and analyzed the consequences for total hip arthroplasty. A cohort of 310 primary osteoarthritic hips was used as a control group. According to the classification of Crowe et al, 78 of the dislocated hips were graded Class I, 26 as Class II, 20 as Class III or IV, and 169 dysplastic hips had no subluxation. Compared with primary osteoarthritis, the intramedullary femoral canal had reduced mediolateral and anteroposterior dimensions. With high grade subluxations the femoral neck shaft angle decreased but with low grades, especially in Class II, the neck shaft angle increased. The proximal femur had more anteversion with individual variations ranging from 1 degrees to 80 degrees. The true acetabulum had a reduced anteroposterior diameter. The large individual morphologic variability across all levels of dysplastic hips suggests the femoral prosthesis cannot be chosen on the basis of the severity of the subluxation alone.
发育性髋关节发育不良患者的全髋关节置换术具有挑战性，因为股骨近端和髋臼的解剖结构发生了改变。我们使用X线片和计算机断层扫描研究了218例成年患者247个发育性髋关节的三维解剖参数，并分析了其对全髋关节置换术的影响。选取310例原发性骨关节炎髋关节作为对照组。根据Crowe等人的分类方法，78例脱位髋关节为I级，26例为II级，20例为III级或IV级，169例发育性髋关节无半脱位。与原发性骨关节炎相比，股骨髓腔的内外侧和前后径减小。高度半脱位时，股骨颈干角减小，但低度半脱位时，尤其是II级，颈干角增大。股骨近端前倾角增大，个体差异范围为1度至80度。真髋臼的前后径减小。发育性髋关节各程度间巨大的个体形态学差异表明，不能仅根据半脱位的严重程度来选择股骨假体。
