Liu Ruiyu, Wang Chunsheng, Wang Kunzheng
Department of Orthopedics, Second Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710004, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007 Oct;21(10):1050-3.
To investigate the morphological changes of the proximal femur and their implication to the total hip arthroplasty in patients with Crowe II/III developmental dysplasia of the hip (DDH).
The experimental group was composed of 15 hips in 14 patients (Crowe II, 9 hips; Crowe III, 6 hips ) with osteoarthritis secondary to Crowe II/III DDH (2 males, 12 females; age, 35-61 years). None of the patients had accepted any osteotomy treatment. The control group was composed of 15 normal hips in 15 patients with unilateral DDH (3 males, 12 females; age, 35-57 years). Twelve hips came from the experimental group and the other 3 came from the patients with unilateral Crowe I DDH. The femurs were examined with the CT scanning. The following parameters were measured: the height of the center of the femoral head (HCFH), the isthmus position (IP), the neck-shaft angle(NS), the anteversion angle, the canal flare index, and the canal width. Then, the analysis of the data was conducted.
HCFH and IP in the experimental group and the control group were 50.1 +/- 6.7 mm, 50.1 +/- 7.4 mm, and 107.4 +/- 21.5 mm, 108.7 +/- 18.1 mm, respectively, which had no significant difference between the two groups (P > 0.05). In the experimental group and the control group, the NS were 138.3 +/- 10.0 degrees and 126.7 +/- 5.7 degrees, the anteversion angles were 36.5 +/- 15.9 degrees and 18.8 +/- 5.4 degrees, and the canal flare indexes were 4.47 +/- 0.40 and 5.01 +/- 0.43. There was a significant difference between the two groups in the above 3 parameters (P < 0.05). As for the canal width of the femur, there was a significant difference in the interior/exterior widths and the anterior/posterior widths at the level of 2 cm above the lesser trochanter and 4 cm below the lesser trochanter between the two groups (P < 0.05); however, there was no significant difference in the canal width of the femur at the isthmus between the two groups (P > 0.05).
It is necessary to evaluate the morphology of the proximal femur before the total hip arthroplasty performed in patients with Crowe II /III DDH. The straight and smaller femoral prosthesis should be chosen and implanted in the proper anteversion position during operation.
探讨Crowe II/III型发育性髋关节发育不良（DDH）患者股骨近端的形态学变化及其对全髋关节置换术的影响。
实验组由14例患者的15个髋关节组成（Crowe II型，9个髋关节；Crowe III型，6个髋关节），继发于Crowe II/III型DDH的骨关节炎（男性2例，女性12例；年龄35 - 61岁）。所有患者均未接受过任何截骨治疗。对照组由15例单侧DDH患者的15个正常髋关节组成（男性3例，女性12例；年龄35 - 57岁）。其中12个髋关节来自实验组，另外3个来自单侧Crowe I型DDH患者。对股骨进行CT扫描检查。测量以下参数：股骨头中心高度（HCFH）、峡部位置（IP）、颈干角（NS）、前倾角、髓腔扩张指数和髓腔宽度。然后进行数据分析。
实验组和对照组的HCFH分别为50.1±6.7mm和50.1±7.4mm，IP分别为107.4±21.5mm和108.7±18.1mm，两组间差异无统计学意义（P>0.05）。实验组和对照组的NS分别为138.3±10.0°和126.7±5.7°，前倾角分别为36.5±15.9°和18.8±5.4°，髓腔扩张指数分别为4.47±0.40和5.01±0.43。上述3个参数两组间差异有统计学意义（P<0.05）。关于股骨髓腔宽度，两组在小转子上方2cm和小转子下方4cm水平的内外宽度及前后宽度差异有统计学意义（P<0.05）；然而，两组在峡部的股骨髓腔宽度差异无统计学意义（P>0.05）。
对Crowe II/III型DDH患者行全髋关节置换术前，评估股骨近端形态很有必要。术中应选择直的、较小的股骨假体，并以合适的前倾角植入。
