Sankar Wudbhav N, Neubuerger Christopher O, Moseley Colin F
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pediatr Orthop. 2009 Dec;29(8):885-8. doi: 10.1097/BPO.0b013e3181c1e961.
Limited data exist in the literature with regard to the amount of femoral anteversion in children with developmental dysplasia of the hip (DDH). The data that do exist are variable: certain studies cite increased version in DDH compared with normal while others have found no significant difference. The purpose of our study was to quantify the degree of femoral anteversion in a large, consecutive series of children with DDH.
We performed a prospective study on 37 consecutive hips (30 patients) that were undergoing surgical procedures for DDH. After induction with general anesthesia (before the planned procedure), arthrograms were performed to allow accurate localization of the center of the femoral head. An anteroposterior radiograph was taken with the patient positioned supine and the knee flexed 90 degrees over the end of the operating table and the leg held perpendicular to the plane of the table. The limb was then rotated 90 degrees for the lateral radiograph. The offset of the center of the femoral head to the midline of the femoral shaft was measured in each view and a simple trigonometric relationship was used to calculate the femoral version.
The mean age of the children in our series was 33.5 months (range: 6 to 79 mo). There were 4 boys and 26 girls; 7 patients had bilateral involvement. The mean femoral anteversion was 50.3 degrees+/-17.9 degrees. Significant variability was found: the lowest femoral version measured 0 degrees and the highest measured 95.7 degrees.
In most of our children with DDH, femoral anteversion was increased compared with published norms; however, significant variation existed. Given the variability of femoral anteversion, we believe that an individualized surgical approach is warranted, including preoperative assessment of the femoral version followed by derotational femoral osteotomy only if indicated by the patient's specific torsional profile.
Anatomic study.
关于发育性髋关节发育不良（DDH）患儿的股骨前倾角度，文献中的数据有限。现有的数据存在差异：某些研究表明，与正常儿童相比，DDH患儿的股骨前倾角度增加，而其他研究则未发现显著差异。我们研究的目的是对一大组连续的DDH患儿的股骨前倾程度进行量化。
我们对37例连续接受DDH手术的髋关节（30例患者）进行了前瞻性研究。在全身麻醉诱导后（在计划手术前），进行关节造影以准确确定股骨头中心的位置。患者仰卧位，膝关节在手术台末端屈曲90度，腿部与手术台平面垂直，拍摄前后位X线片。然后将肢体旋转90度拍摄侧位X线片。在每个视图中测量股骨头中心到股骨干中线的偏移，并使用简单的三角关系计算股骨前倾角度。
我们研究系列中患儿的平均年龄为33.5个月（范围：6至79个月）。有4名男孩和26名女孩；7例患者为双侧受累。平均股骨前倾角度为50.3度±17.9度。发现存在显著差异：测量到的最低股骨前倾角度为0度，最高为95.7度。
在我们大多数DDH患儿中，股骨前倾角度与已发表的标准相比有所增加；然而，存在显著差异。鉴于股骨前倾角度的变异性，我们认为有必要采取个体化的手术方法，包括术前评估股骨前倾角度，只有在患者的特定扭转情况表明需要时才进行股骨旋转截骨术。
解剖学研究。
