Archibald Hunter D, Petro Kathleen F, Liu Raymond W
Department of Orthopedic Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH.
J Pediatr Orthop. 2019 Jan;39(1):e50-e53. doi: 10.1097/BPO.0000000000001070.
Femoral anteversion is generally asymptomatic but can result in lower extremity issues like patellofemoral instability and pain. Surgical correction of anteversion can be performed proximal, mid shaft or distal. A better understanding of the specific location of the rotational deformity can help guide the optimal location of the osteotomy. In this study we examine the contribution of the femoral neck and shaft to total femoral version.
We studied 590 pairs of well-preserved cadaveric femurs. Total femoral version was defined as the axial plane angle between the femoral neck and posterior femoral condyles. Femoral shaft torsion was defined as the axial plane angle between the lesser trochanter and posterior femoral condyles. Neck version was the mathematical difference between total femoral version and shaft version.
Neck version (right femur R=0.582; left femur R=0.632) contributed slightly more than shaft version (right femur R=0.505; left femur R=0.480) to overall femoral version, but both were substantial and neither completely predicted overall femoral version. Age was not found to contribute to femoral version, and sex and race had statistically significant but small contributions.
Our data show that both the femoral neck and femoral shaft substantially contribute to femoral version, and to our knowledge is the first to statistically demonstrate that neither level can be used to predict total femoral version. This suggests that one cannot generalize a single optimal site for correction or prediction of femoral version from an osteological perspective, and that individualized assessment may be beneficial.
This study suggests that methodologies for determining the level of femoral version might be important as the level in any given patient can vary.
股骨前倾通常无症状，但可导致下肢问题，如髌股关节不稳定和疼痛。股骨前倾的手术矫正可在近端、骨干中部或远端进行。更好地了解旋转畸形的具体位置有助于指导截骨术的最佳位置。在本研究中，我们研究了股骨颈和股骨干对总股骨扭转角度的影响。
我们研究了590对保存完好的尸体股骨。总股骨扭转角度定义为股骨颈与股骨后髁之间的轴平面角度。股骨干扭转定义为小转子与股骨后髁之间的轴平面角度。颈扭转角度是总股骨扭转角度与骨干扭转角度的数学差值。
颈扭转角度（右侧股骨R = 0.582；左侧股骨R = 0.632）对总股骨扭转角度的贡献略大于骨干扭转角度（右侧股骨R = 0.505；左侧股骨R = 0.480），但两者的贡献都很大，且均不能完全预测总股骨扭转角度。未发现年龄对股骨扭转角度有影响，性别和种族的影响在统计学上有显著意义，但贡献较小。
我们的数据表明，股骨颈和股骨干对股骨扭转角度均有显著贡献，据我们所知，这是首次通过统计学证明任何一个水平都不能用于预测总股骨扭转角度。这表明从骨学角度来看，不能一概而论地确定一个单一的最佳矫正或预测股骨扭转角度的部位，个体化评估可能是有益的。
本研究表明，确定股骨扭转角度水平的方法可能很重要，因为在任何给定患者中该水平可能会有所不同。
