小转子形状变化与股骨旋转关系的定量评估。
Quantitative assessment of changes in lesser trochanter shapes in relation to femoral rotations.
作者信息
Turgut Ali, Koca Anıl, Uzakgider Melikşah, Hancıoğlu Sertan, Erkuş Serkan, Kalenderer Önder
机构信息
Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, İzmir, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2020 Mar;54(2):149-154. doi: 10.5152/j.aott.2020.02.126.
OBJECTIVE
The aim of this study was to evaluate changes in lesser trochanter shapes in relation to femoral rotations and to develop a reference value for the determination of clinically relevant malrotation of the femur.
METHODS
Patients who underwent computed tomography angiography between January 2009 and July 2018 were identified based on a review of their institutional medical records. Thereafter, three-dimensional (3D) images of the whole femur for a total of 860 patients were obtained from their tomographic sections. The distance between the lateral outer cortex of the femur and the most medial point of the lesser trochanter with the femur in neutral rotation was measured and set as the reference value. Then, the same distance was measured at 5°, 10°, 15°, and 20° of femoral internal rotation and at 5°, 10°, 15°, 20°, and 25° of femoral external rotation. To avoid magnification errors, the reference values were divided by each measured value at these different rotation angles and then multiplied by 100.
RESULTS
The mean distances between the lateral cortex and the most medial point of the lesser trochanter at 5°, 10°, 15°, and 20° of femoral internal rotation were 97%, 93%, 90%, and 88%, respectively, of those measured with the femur in neutral rotation. The same distances at 5°, 10°, 15°, 20°, and 25° of femoral external rotation were 102%, 104%, 106%, 107%, and 108%, respectively, of those measured with the femur in neutral rotation. There was no statistically significant difference between the measured distances in males and females (p>0.05). However, significant differences were observed among each measured distance at different angles of femoral rotation (p<0.01).
CONCLUSION
The surgeon should be aware of the possible femoral malrotation if the distance between the lateral cortex of the femur and the most medial point of the lesser trochanter on the operated side is more than 106% or less than 90% of that measured with the femur in neutral rotation on the healthy side.
LEVEL OF EVIDENCE
Level IV, Diagnostic study.
目的
本研究旨在评估小转子形状相对于股骨旋转的变化，并为确定临床上相关的股骨旋转不良制定参考值。
方法
通过查阅机构医疗记录，确定2009年1月至2018年7月期间接受计算机断层血管造影的患者。此后，从断层扫描切片中获取了总共860例患者的全股骨三维（3D）图像。测量股骨中立旋转时股骨外侧皮质与小转子最内侧点之间的距离，并将其设定为参考值。然后，在股骨内旋5°、10°、15°和20°以及股骨外旋5°、10°、15°、20°和25°时测量相同的距离。为避免放大误差，将参考值除以这些不同旋转角度下的每个测量值，然后乘以100。
结果
股骨内旋5°、10°、15°和20°时，股骨外侧皮质与小转子最内侧点之间的平均距离分别为股骨中立旋转时测量值的97%、93%、90%和88%。股骨外旋5°、10°、15°、20°和25°时的相同距离分别为股骨中立旋转时测量值的102%、104%、106%、107%和108%。男性和女性的测量距离之间无统计学显著差异（p>0.05）。然而，在不同股骨旋转角度下的每个测量距离之间观察到显著差异（p<0.01）。
结论
如果手术侧股骨外侧皮质与小转子最内侧点之间的距离大于健康侧股骨中立旋转时测量值的106%或小于90%，外科医生应意识到可能存在股骨旋转不良。
证据水平
IV级，诊断性研究。
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