Kordelle J, Mamisch C, Kikinis R, Seibel R, Richolt J A
Department of Orthopedic Surgery, University Hospital of Giessen, Germany.
Minim Invasive Ther Allied Technol. 2000;9(3-4):269-76. doi: 10.1080/13645700009169657.
SCFE is defined as the slippage of the femoral head relative to the femoral neck along the proximal femoral growth plate. The femoral head shifts and rotates along the proximal end of the femoral neck, usually posteriorly and interiorly. The pathoanatomical findings are characterised by the changed relationship between the femoral head and femoral metaphysis, and between the femoral head and the acetabulum. A reduced femoral anteversion, a varus deformity of the femur, a shortening of the femoral metaphysis and an anterior metaphyseal prominence are also regularly observed. This may lead to impingement between the femoral metaphysis and the acetabular rim. Potential consequences of this complex 3D deformity are pain, a reduced range of hip motion and an early degenerative joint disease. In moderate and severe cases a redirectional femoral osteotomy is recommended. Different techniques, such as subcapital, base-of-neck, intertrochanteric and subtrochanteric osteotomies, have been described. These correctional osteotomies aim towards a reconstruction of the hip joint geometry, to prevent early arthritic degeneration. Currently, the planning of surgical treatment in these cases is based on measurements on antero-posterior and lateral plain radiographs. The relevant angle for planning of correctional osteotomies is the physis-shaft angle, determined in both plains. These angles describe the degree of slippage, thereby helping the surgeon to indicate and plan a correctional osteotomy. However, plain radiographs are projectional images and therefore carry inaccuracies caused by the overlay of anatomical structures and an incorrect positioning of the patient. 3D reconstructions are more accurate and provide substantial additional information for the surgeon, such as, for example, the anteversion of the acetabulum. We have developed interactive 3D software to measure projected angles, to analyse the geometry of the proximal femur and to determine the orientation of the acetabulum based on 3D reconstructions of CT data-sets. A program was also developed to simulate different techniques of osteotomies and to evaluate the postoperative range of hip motion and the hip-joint geometry. Accurate 3D measurements, additional anatomical information, simulations of different techniques of osteotomies and the evaluation of simulated postoperative results enables the surgeon to determine the best surgical treatment, based on the clinical findings.
股骨头骺滑脱（SCFE）的定义为股骨头沿股骨近端生长板相对于股骨颈的滑移。股骨头沿股骨颈近端移位并旋转，通常向后内侧移位。病理解剖学表现的特征是股骨头与股骨干骺端之间以及股骨头与髋臼之间的关系发生改变。还经常观察到股骨前倾角减小、股骨内翻畸形、股骨干骺端缩短以及干骺端前缘突出。这可能导致股骨干骺端与髋臼缘之间的撞击。这种复杂的三维畸形的潜在后果是疼痛、髋关节活动范围减小以及早期退行性关节病。在中度和重度病例中，建议进行股骨重新定向截骨术。已经描述了不同的技术，如股骨头下、股骨颈基底、转子间和转子下截骨术。这些矫正性截骨术旨在重建髋关节几何结构，以防止早期关节炎退变。目前，这些病例的手术治疗计划基于前后位和侧位平片的测量。矫正性截骨术计划的相关角度是在两个平面上确定的骺-骨干角。这些角度描述了滑移程度，从而帮助外科医生指示和计划矫正性截骨术。然而，平片是投影图像，因此存在因解剖结构重叠和患者定位不正确而导致的不准确之处。三维重建更准确，并为外科医生提供大量额外信息，例如髋臼的前倾角。我们开发了交互式三维软件，用于测量投影角度、分析股骨近端的几何结构以及根据CT数据集的三维重建确定髋臼的方向。还开发了一个程序来模拟不同的截骨技术，并评估术后髋关节活动范围和髋关节几何结构。准确的三维测量、额外的解剖信息、不同截骨技术的模拟以及模拟术后结果的评估使外科医生能够根据临床发现确定最佳手术治疗方案。
