Waisbrod Guy, Schiebel Florian, Beck Martin
Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland.
Clinic of Orthopaedic and Trauma Surgery, Luzerner Kantonspital, Spitalstrasse, Luzern 6000, Switzerland.
J Hip Preserv Surg. 2017 Apr 12;4(2):153-158. doi: 10.1093/jhps/hnx013. eCollection 2017 Jul.
Femoral rotational malalignment is associated with pain and functional disability and may be a contributing factor to hip impingement as well as to instability. In general, the deformity can be addressed surgically by rotational osteotomy. However, the anatomic location of the deformity is debated. The goal of the present study was to narrow down the anatomic site of deformity using the lesser trochanter (LT) as an additional landmark. One hundred and eight patients underwent computer tomography (CT)-based rotational analysis of their lower extremities. Femoral torsion (FT) and LT torsion (LTT) were measured. The combined angle (CoA) between FT and LTT was calculated. Statistical evaluation was done by multiple regression analysis. Ninety-seven extremities were examined for FT and LTT. Average age was 41 years (SD = 16.9) with a range of 18-85 years. Mean values were 20° for FT (SD = 12.2) and -16° for LTT (SD = 11.3). Mean CoA was 37.2 (SD = 8.7). Statistical analysis reveals a strong linear relationship between FT and LTT (=31+0.74) and a weaker relationship between FT and CoA (=31+0.24). This study identifies the LT as a reliable landmark and shows a strong linear relationship between the orientation of the LT and the overall torsion of the femur below and above the LT with about two-thirds of torsional changes occurring distal to it. These results provide a considerable indication for a subtrochanteric osteotomy to address correction of femoral rotational deformity at its anatomical origin. Level III, observational study.
股骨旋转排列不齐与疼痛和功能障碍相关，可能是髋关节撞击以及不稳定的一个促成因素。一般来说，这种畸形可以通过旋转截骨术进行手术矫正。然而，畸形的解剖位置存在争议。本研究的目的是使用小转子（LT）作为额外的标志来缩小畸形的解剖部位。108例患者接受了基于计算机断层扫描（CT）的下肢旋转分析。测量了股骨扭转（FT）和小转子扭转（LTT）。计算了FT和LTT之间的组合角（CoA）。通过多元回归分析进行统计评估。对97条下肢进行了FT和LTT检查。平均年龄为41岁（标准差=16.9），范围为18 - 85岁。FT的平均值为20°（标准差=12.2），LTT的平均值为 -16°（标准差=11.3）。平均CoA为37.2（标准差=8.7）。统计分析显示FT和LTT之间存在强线性关系（=31 + 0.74），FT和CoA之间存在较弱的关系（=31 + 0.24）。本研究确定LT是一个可靠的标志，并显示LT的方向与LT上下股骨的整体扭转之间存在强线性关系，约三分之二的扭转变化发生在其远端。这些结果为转子下截骨术在解剖学起源处矫正股骨旋转畸形提供了重要依据。三级，观察性研究。
