发育性髋关节脱位（DDH）股骨粗隆间旋转截骨术后股骨颈干角对股骨头球形度的影响

Effect of Postoperative Femoral Neck Shaft Angle on Femoral Head Sphericity Following Proximal Femoral Osteotomy in Legg-Calve-Perthes Disease.

机构信息

Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Dong-gu, Gwangju Republic of Korea.

出版信息

J Pediatr Orthop. 2022 Sep 1;42(8):432-438. doi: 10.1097/BPO.0000000000002200. Epub 2022 Jul 7.

DOI:10.1097/BPO.0000000000002200

PMID:35794820

Abstract

BACKGROUND

Herein, we aimed to examine the relationship between the postoperative neck shaft angle (NSA) and the Stulberg outcome at skeletal maturity in patients with Legg-Calvé-Perthes disease (LCPD) who underwent proximal femoral varus osteotomy (PFVO) and to determine the optimal angle of varization.

METHODS

In this retrospective study, we analyzed the data of 90 patients aged older than 6 years at the time of diagnosis with LCPD who underwent PFVO at our institution between 1979 and 2014. Univariate and multivariate logistic regression analyses were used to examine the effects of variables on the sphericity of the femoral head at skeletal maturity, including the age at onset, sex, stage at operation, extent of epiphyseal involvement and epiphyseal collapse, presence of specific epiphyseal, metaphyseal, and acetabular changes, and postoperative NSA. The sphericity of the femoral head on the final plain follow-up radiographs of the hip joint at skeletal maturity was assessed using the Stulberg classification. Cases of spherical femoral head (Stulberg I or II) were rated as good, whereas those of ovoid or flat femoral head (Stulberg III, IV, or V) were rated as bad.

RESULTS

The mean age at diagnosis was 7.93 (range, 6.0-12.33) years. The average follow-up period was 10.11 (range, 5.25-22.92) years. The pre and postoperative mean NSAs were 137.31±6.86 degrees (range, 115.7-158 degrees) and 115.7±9.83 degrees (range, 88.6-137.6 degrees), respectively. The age at diagnosis, lateral pillar classification, and postoperative NSA were found to be closely related to the sphericity of the femoral head at skeletal maturity. Patients with a postoperative NSA of <105 degree or more than 125 degree were less likely to have a spherical femoral head.

CONCLUSIONS

Our study showed that patients with a postoperative NSA between 105 and 125 degrees were more likely to have a spherical femoral head. When performing PFVO in patients with LCPD, reasonable varus angulation of PFVO should be taken into consideration for the success of the operation.

LEVEL OF EVIDENCE

Level III retrospective cohort study.

摘要

背景

本研究旨在探讨接受股骨近端内翻截骨术（PFVO）的儿童期 Legg-Calvé-Perthes 病（LCPD）患者术后颈干角（NSA）与骨骼成熟时 Stulberg 结果之间的关系，并确定最佳的内翻角度。

方法

本回顾性研究分析了 1979 年至 2014 年期间在我院接受 PFVO 的 90 例年龄大于 6 岁的 LCPD 患者的临床资料。采用单变量和多变量逻辑回归分析来评估变量对骨骼成熟时股骨头球形度的影响，这些变量包括发病年龄、性别、手术时的分期、骺板受累和骺板塌陷的程度、特定骺板、干骺端和髋臼变化的存在以及术后 NSA。在骨骼成熟时的髋关节最终平片随访中，采用 Stulberg 分类法评估股骨头的球形度。股骨头呈球形（Stulberg I 或 II）者为良好，呈卵圆形或扁平形（Stulberg III、IV 或 V）者为不良。

结果

平均诊断年龄为 7.93 岁（范围，6.0-12.33 岁）。平均随访时间为 10.11 年（范围，5.25-22.92 年）。术前和术后平均 NSA 分别为 137.31±6.86 度（范围，115.7-158 度）和 115.7±9.83 度（范围，88.6-137.6 度）。研究发现，诊断年龄、外侧柱分类和术后 NSA 与骨骼成熟时股骨头的球形度密切相关。术后 NSA＜105 度或＞125 度的患者更容易出现股骨头非球形。