Kumar Arvind, Passey Jigyasa, Kumar Mukesh, Chouhan Dushyant, Saini Manish, Das Saubhik
Department of Orthopaedics Hamdard Institute of Medical Sciences and Research, New Delhi, 110062, India.
Department of Anatomy, Maulana Azad Medical College, New Delhi, India.
J Clin Orthop Trauma. 2020 Jul;11(Suppl 4):S522-S525. doi: 10.1016/j.jcot.2020.04.017. Epub 2020 Apr 21.
Accurate limb length restoration forms an important aspect of reconstructive surgeries around the hip joint. Among the various intraoperative methods for accurate limb length restoration, the relation between the greater trochanter and the center of the femoral head has been conventionally used owing to its simplicity and replicability. The current study aims to study the normal relation between the greater trochanter and the center of rotation of the femoral head, its population-based variation and its gender-based and contralateral differences in the Indian population.
Standard anteroposterior radiographs of normal hip joints with the proximal femur, performed over a one year period were studied. A software-based analysis was conducted to measure the difference between the levels of the greater trochanteric tip and the center of the femoral head along the longitudinal axis of the femur. The measurements among the male and female cases and the contralateral sides were compared.
The greater trochanteric tip lies at a higher level than the center of rotation of the femoral head by a mean difference of 9.20 ± 5.30 mm. No significant differences were observed among male and female groups and between the contralateral hip joints. Intraobserver and Interobserver reliability were high.
The tip of the greater trochanter and the center of the femoral head do not lie at the same level. This differential relation should be considered during the reconstructive surgeries around the hip joint to prevent an inadvertent limb length discrepancy. Considering the wide interindividual variations, this difference cannot be generalized for all the patients and restoring it to the contralateral normal hip would be more appropriate.
精确恢复肢体长度是髋关节周围重建手术的一个重要方面。在各种用于精确恢复肢体长度的术中方法中，由于大转子与股骨头中心的关系简单且可重复，传统上一直被采用。本研究旨在探讨印度人群中大转子与股骨头旋转中心的正常关系、基于人群的变异以及基于性别和对侧的差异。
研究了在一年时间内拍摄的包含股骨近端的正常髋关节标准前后位X线片。进行了基于软件的分析，以测量大转子尖与股骨头中心在股骨纵轴上的水平差异。比较了男性和女性病例以及对侧之间的测量结果。
大转子尖比股骨头旋转中心高，平均差值为9.20±5.30毫米。在男性和女性组之间以及对侧髋关节之间未观察到显著差异。观察者内和观察者间的可靠性较高。
大转子尖和股骨头中心不在同一水平。在髋关节周围重建手术中应考虑这种差异关系，以防止意外的肢体长度差异。考虑到个体差异较大，这种差异不能适用于所有患者，将其恢复到对侧正常髋关节更为合适。
