Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Turkey.
The Rothman Institute at Thomas Jefferson University, Philadelphia, PA; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Arthroplasty. 2019 Jul;34(7):1502-1508. doi: 10.1016/j.arth.2019.03.005. Epub 2019 Mar 12.
Studies on prosthesis positioning and implant design in total hip arthroplasty (THA) have generally focused on the anatomy of the proximal femur in the coronal plane. The aim of this study was to investigate the proximal femur morphology in the sagittal plane to provide better positioning of the femoral component in THA and contribute to the determination of proximal femur morphology through possible outcomes that can be shown also by considering the sagittal plane in the selection and design of the femoral component.
Computerized tomography scans were obtained from 270 femoral bones belonging to adult skeletons, followed by 3D reconstruction using Leonardo Dr/Dsa Va30a software (Siemens, Erlangen, Germany) and measurements. Canal widths were measured in the coronal and sagittal planes at the lesser trochanter (LT) level, at 20 millimeters proximal to the LT(LT+20) and at various levels distal to the lesser trochanter in 25 mm jumps up to 200 mm from the lesser trochanter.
The average width was wider at the level of the lesser trochanter and all points distal to it in the sagittal plane compared to the coronal plane except LT-200 mm. At each levels from LT-25 to LT-175, the differences were statistically significant (P < .05). The ratio of the femoral width at the lesser trochanter level to the width 50 mm distal to the LT was stated as the most prevalent one, and a novel classification in the sagittal plane was developed in accordance with these findings.
A novel and simple classification in the sagittal plane was developed based on the findings of this study, and this classification may improve the accuracy, validity, and reliability of femoral stem fixation in total hip arthroplasty.
全髋关节置换术（THA）中假体定位和植入物设计的研究通常集中在股骨近端的冠状面解剖结构上。本研究旨在探讨矢状面上股骨近端的形态，以便更好地定位 THA 中的股骨部件，并通过可能的结果为股骨近端形态的确定做出贡献，这些结果也可以通过考虑矢状面来展示，从而有助于选择和设计股骨部件。
从成人骨骼的 270 个股骨中获取计算机断层扫描，然后使用 Leonardo Dr/Dsa Va30a 软件（德国西门子公司）进行 3D 重建和测量。在小转子（LT）水平、小转子上方 20 毫米（LT+20）和小转子下方 25 毫米处以 25 毫米的间隔测量冠状面和矢状面的管腔宽度，直至小转子下方 200 毫米。
与冠状面相比，矢状面在小转子水平和小转子下方的所有点的平均宽度都更宽，除了 LT-200 毫米处。从 LT-25 到 LT-175 的每个水平，差异均具有统计学意义（P <.05）。小转子水平处的股骨干宽度与 LT 下方 50 毫米处的宽度之比被认为是最常见的，根据这些发现制定了一种新的矢状面分类。
根据本研究的结果，提出了一种新的、简单的矢状面分类，这种分类可能会提高全髋关节置换术中股骨柄固定的准确性、有效性和可靠性。
