Moraleda Luis, Bravo Christian, Forriol Francisco, Albiñana Javier
Hospital Universitario La Paz, Unidad de Traumatología y Ortopedia Infantil.
Hospital del IESS Jose Carrasco Arteaga, Cuenca, Ecuador.
J Pediatr Orthop. 2019 Sep;39(8):416-421. doi: 10.1097/BPO.0000000000000974.
Derotational osteotomy of the proximal femur has proved to be effective in the treatment of residual acetabular dysplasia. However, the reason why this osteotomy is effective remains debatable. The purpose of this study is to investigate if an alteration of femoral head orientation affects acetabular growth.
A proximal femoral osteotomy was performed in 21 lambs aged 3 months: 5 varus osteotomies (110 degrees), 4 valgus osteotomies (150 degrees), and 12 derotation osteotomies. Results were compared with a control group (5 animals). Osteotomy was fixed with a screw-plate device. Version was controlled intraoperatively with K-wires. Animals were killed 3 months after surgical procedure. A morphometric study of both proximal femur and acetabulum was performed, including deepness, volume and diameters of the acetabulum, neck-shaft angle and femoral version.
The average neck-shaft angle for the normal, anteversion, and retroversion groups was 129 degrees, whereas it was 110 degrees for the varus group and 149 degrees for the valgus group. The average femoral version for the normal, valgus, and varus groups was 21 degrees of anteversion, whereas it was 38 degrees of anteversion for the so-called anteversion group and 17 degrees of retroversion for the retroversion group. Nor the neck-shaft angle, nor the femoral version correlated with the acetabular anteroposterior diameter (P=0.698, 0.6, respectively), the acetabular inferosuperior diameter (P=0.083, 0.451, respectively) or the acetabular deepness (P=0.14, 0.371, respectively). The neck-shaft angle correlated significantly with acetabular volume (P=0.023), so that the lower the neck-shaft angle, the higher the acetabular volume (r=-0.453). The femoral version did not correlated with acetabular volume (P=0.381).
Decreasing the neck-shaft angle provokes an increase in acetabular volume, whereas changes in femoral version do not affect the acetabular growth. Extra-articular osteotomies that alter femoral orientation affect intra-articular gross morphology.
Level II-therapeutic study.
股骨近端旋转截骨术已被证明在治疗残留髋臼发育不良方面是有效的。然而，这种截骨术有效的原因仍存在争议。本研究的目的是调查股骨头方向的改变是否会影响髋臼的生长。
对21只3个月大的羔羊进行股骨近端截骨术：5例内翻截骨术（110度），4例外翻截骨术（150度），以及12例旋转截骨术。将结果与对照组（5只动物）进行比较。截骨术用螺钉钢板装置固定。术中用克氏针控制旋转角度。术后3个月处死动物。对股骨近端和髋臼进行形态学研究，包括髋臼的深度、体积和直径、颈干角和股骨旋转角度。
正常组、前倾角组和后倾角组的平均颈干角为129度，而内翻组为110度，外翻组为149度。正常组、外翻组和内翻组的平均股骨旋转角度为前倾角21度，而所谓的前倾角组为前倾角38度，后倾角组为后倾角17度。颈干角和股骨旋转角度均与髋臼前后径（分别为P = 0.698、0.6）、髋臼上下径（分别为P = 0.083、0.451）或髋臼深度（分别为P = 0.14、0.371）无关。颈干角与髋臼体积显著相关（P = 0.023），因此颈干角越低，髋臼体积越高（r = -0.453）。股骨旋转角度与髋臼体积无关（P = 0.381）。
减小颈干角会导致髋臼体积增加，而股骨旋转角度的改变不会影响髋臼的生长。改变股骨方向的关节外截骨术会影响关节内的大体形态。
二级治疗性研究。
