Sun Jingyang, Zhang Guoqiang, Shen Junmin, Du Yinqiao, Zhang Bohan, Ni Ming, Zhou Yonggang, Wang Yan
Medical School of Chinese PLA, Beijing 100853, People's Republic of China.
Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
Ther Clin Risk Manag. 2020 Oct 15;16:989-997. doi: 10.2147/TCRM.S272771. eCollection 2020.
The purpose of this study was to determine whether dislocation height can predict the use of subtrochanteric osteotomy in patients with Crowe type IV hip dysplasia.
We retrospectively included 102 patients affected by unilateral Crowe type IV developmental dysplasia who underwent primary total hip arthroplasty with modular cementless stem from April 2008 to May 2019 in our institution. Based on radiographs and operative notes, we found 62 hip arthroplasties were performed with subtrochanteric osteotomy and 40 without subtrochanteric osteotomy, which were named as the (subtrochanteric osteotomy) STO group and non-STO group, respectively. The predictive values of height of greater trochanter, height of femoral head/neck junction, and distalization of greater trochanter were analyzed using receiver operating characteristic (ROC) curves.
The ROC curves showed that distalization of greater ntrochanter had the highest areas under the ROC curve (AUC), at 0.998. This was followed by height of greater trochanter and height of head/neck junction, which had AUCs of 0.937 and 0.935, respectively. The optimal thresholds of these three indicators were 4.84 cm, 6.05 cm, and 4.26 cm. At the last follow-up, six dislocations occurred (five in the STO group and one in the non-STO group). Four hips were treated by closed reduction and two by open reduction. Three patients (all in STO group) developed femoral nerve palsy with skin numbness on the frontal thigh or tibia and all recovered in a year. At outpatient visit, the limb length was measured. LLD was <1 cm in 83/102, 1-2 cm in 18/102, and >2 cm in 1/102.
This study reveals that indicators of dislocation height are useful in predicting the use of subtrochanteric osteotomy during total hip arthroplasty for Crowe type IV hip dysplasia. However, a comprehensive, multivariate analysis may be required to validate these results.
本研究旨在确定脱位高度是否能够预测Crowe IV型髋关节发育不良患者转子下截骨术的应用情况。
我们回顾性纳入了2008年4月至2019年5月在我院接受初次全髋关节置换术并使用模块化非骨水泥柄的102例单侧Crowe IV型发育性髋关节发育不良患者。根据X线片和手术记录，我们发现62例髋关节置换术采用了转子下截骨术，40例未采用转子下截骨术，分别命名为（转子下截骨术）STO组和非STO组。使用受试者工作特征（ROC）曲线分析大转子高度、股骨头/颈交界处高度以及大转子远移的预测价值。
ROC曲线显示，大转子远移的ROC曲线下面积（AUC）最高，为0.998。其次是大转子高度和头/颈交界处高度，其AUC分别为0.937和0.935。这三个指标的最佳阈值分别为4.84 cm、6.05 cm和4.26 cm。在最后一次随访时，发生了6例脱位（STO组5例，非STO组1例）。4例髋关节通过闭合复位治疗，2例通过切开复位治疗。3例患者（均在STO组）出现股神经麻痹，伴有大腿前部或胫骨皮肤麻木，均在1年内恢复。在门诊就诊时，测量肢体长度。102例患者中，肢体长度差异（LLD）<1 cm的有83例，1 - 2 cm的有18例，>2 cm的有1例。
本研究表明，脱位高度指标有助于预测Crowe IV型髋关节发育不良患者全髋关节置换术中转子下截骨术的应用情况。然而，可能需要进行全面的多变量分析来验证这些结果。
