Sun Jingyang, Guo Lingfei, Ni Ming, Shen Junmin, Du Yinqiao, Zhang Bohan, Zhang Guoqiang, Zhou Yonggang
Department of Orthopedics, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China.
Ther Clin Risk Manag. 2021 May 3;17:389-396. doi: 10.2147/TCRM.S302298. eCollection 2021.
The purpose of this study was to evaluate the distribution of lower limb alignment in Crowe IV developmental dysplasia of the hip (DDH) before and after total hip arthroplasty (THA).
We retrospectively included 64 Crowe IV DDH patients (87 hips) who underwent THA between February 2010 and May 2019. Radiographic parameters were measured on full limb length standing anteroposterior radiographs, including hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), anatomical lateral distal femoral angle (aLDFA), and anatomical tibiofemoral angle (aTFA).
HKA improved from 176.54°±3.52° preoperatively to 179.45°±4.31° at the last followup (P<0.001). According to the preoperative HKA, 40 hips were defined as knee valgus alignment. The majority of them were characteristic of a valgus mLDFA and a valgus or neutral mMPTA (35%, 47.5%). After THA, there were still 22 hips defined as knee valgus alignment. More than 50% of them were characteristic of a valgus mLDFA and a neutral mMPTA. Five hips (22.7%) revealed valgus alignment in both mLDFA and mMPTA. Twenty-one hips (24.1%) remained knee valgus alignment before and after surgery. One hip, defined as neutral alignment, preoperatively turned into valgus alignment after surgery.
Both preoperative and postoperative sources of valgus alignment were mainly from the femoral side among Crowe IV DDH patients. THA mainly played a positive role in the reconstruction of lower limb alignment in these patients.
本研究旨在评估全髋关节置换术（THA）前后Crowe IV型发育性髋关节发育不良（DDH）患者下肢力线的分布情况。
我们回顾性纳入了2010年2月至2019年5月间接受THA的64例Crowe IV型DDH患者（87髋）。在全下肢站立位前后位X线片上测量影像学参数，包括髋-膝-踝角（HKA）、股骨机械性外侧远端角（mLDFA）、胫骨机械性内侧近端角（mMPTA）、股骨解剖学外侧远端角（aLDFA）和胫股角（aTFA）。
HKA术前为176.54°±3.52°，末次随访时改善至179.45°±4.31°（P<0.001）。根据术前HKA，40髋被定义为膝外翻力线。其中大多数表现为mLDFA外翻和mMPTA外翻或中立（35%，47.5%）。THA后，仍有22髋被定义为膝外翻力线。其中超过50%表现为mLDFA外翻和mMPTA中立。5髋（22.7%）在mLDFA和mMPTA上均表现为外翻力线。21髋（24.1%）在手术前后均保持膝外翻力线。1髋术前定义为中立力线，术后变为外翻力线。
Crowe IV型DDH患者术前和术后外翻力线的来源主要在股骨侧。THA在这些患者下肢力线重建中主要发挥了积极作用。
