Department of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China.
Department of Orthopedics, Northeast International Hospital, Shenyang, China.
Orthop Surg. 2021 Aug;13(6):1787-1792. doi: 10.1111/os.13039. Epub 2021 Aug 5.
To evaluate the predictive values of femoral proximal medullary morphology for the use of subtrochanteric osteotomy (STO) in unilateral Crowe IV developmental dysplasia of the hip (DDH).
Ninety four patients with unilateral Crowe type IV DDH (59 hips in STO group and 35 hips in the non-STO group) between April 2008 and June 2019 were enrolled. All patients underwent THA using the Pinnacle acetabular shell, ceramic liner and femoral head, the S-ROM stem with proximal sleeve. Three parameters on the standard anteroposterior hip radiographs were measured: the widths of medullary canals at 20 mm above the center of lesser trochanter (CLT)，20 mm below the CLT and the isthmus. Canal flare index (CFI), metaphyseal canal flare index (MCFI), diaphyseal canal flare index (DCFI) were calculated. A S-ROM femoral stem was used in all patients during total hip arthroplasty (THA).
The CFI and DCFI in the STO group were lower than those in the non-STO group. However, there was no statistical difference in MCFI between the two groups. The receiver operating characteristic (ROC) curves shown that DCFI had the highest area under the curve (AUC), at 0.885. This was followed by the CFI, which had an AUC of 0.847. The AUC of MCFI was 0.579. The optimal threshold for DCFI was 1.44, which lead to a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.771, 0.898, 0.869, and 0.818, respectively. For CFI, the optimal threshold was 3.28, resulting in a sensitivity, specificity, PPV, and NPV of 0.829, 0.729, 0.878, and 0.644, respectively.
The DCFI and CFI may be potent indicators in predicting the use of STO in unilateral Crowe IV DDH. The optimal threshold for CFI and DCFI were 3.28 and 1.44 and had good sensitivity and specificity for predicting the use of STO during THA.
评估股骨近端髓腔形态对使用股骨转子下截骨术（STO）治疗单侧 Crowe Ⅳ 型发育性髋关节发育不良（DDH）的预测价值。
纳入 2008 年 4 月至 2019 年 6 月间 94 例单侧 Crowe Ⅳ型 DDH 患者（STO 组 59 髋，非 STO 组 35 髋）。所有患者均采用 Pinnacle 髋臼杯、陶瓷内衬和股骨头、近端套筒的 S-ROM 柄进行全髋关节置换术（THA）。在标准前后位髋关节 X 线片上测量 3 个参数：小转子中心上方 20mm（CLT）、CLT 下方 20mm 和峡部处髓腔宽度。计算髓腔指数（CFI）、骨干髓腔指数（MCFI）、骨干髓腔指数（DCFI）。所有患者在 THA 中均使用 S-ROM 股骨柄。
STO 组的 CFI 和 DCFI 均低于非 STO 组，但两组 MCFI 无统计学差异。ROC 曲线显示，DCFI 的曲线下面积（AUC）最高，为 0.885。其次是 CFI，AUC 为 0.847。MCFI 的 AUC 为 0.579。DCFI 的最佳阈值为 1.44，其灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 0.771、0.898、0.869 和 0.818。对于 CFI，最佳阈值为 3.28，灵敏度、特异性、PPV 和 NPV 分别为 0.829、0.729、0.878 和 0.644。
DCFI 和 CFI 可能是预测单侧 Crowe Ⅳ DDH 使用 STO 的有效指标。CFI 和 DCFI 的最佳阈值分别为 3.28 和 1.44，对预测 THA 中 STO 的使用具有良好的灵敏度和特异性。
