From Ascension Genesys Hospital, Grand Blanc, MI (Dr. Meyers, Dr. Ballard, and Dr. Sorscher); Department of Orthopaedic Surgery, the Michigan State University, Statewide Campus System, East Lansing, MI (Dr. Ames, Dr. Meyers, Dr. Ballard, and Dr. Sorscher); Department of Orthopaedic Surgery, the New England Baptist Hospital, Boston, MA (Dr. Ames); and Department of Orthopaedic Surgery, the Tufts University School of Medicine, Boston, MA (Dr. Ames).
J Am Acad Orthop Surg Glob Res Rev. 2022 Dec 12;6(12). doi: 10.5435/JAAOSGlobal-D-22-00149. eCollection 2022 Dec 1.
Accurate restoration of leg length and proximal femoral geometry is essential for achieving satisfactory outcomes in both primary and revision total hip arthroplasty. Although common landmarks such as the greater trochanter and the lesser trochanter (LT) may be used to measure limb length intraoperatively in primary cases, these landmarks may be absent or disrupted in fractures and revision procedures. We propose the distance between the gluteus maximus tendon gluteal sling (GS) and the center of the femoral head (FHC) as a novel anatomic landmark beyond the zone of injury, which can be used to restore limb length in the setting of proximal femoral bone loss or fracture.
One hundred healthy hips were retrospectively reviewed using MRI to determine the distance between the proximal edge of the GS and the FHC. Additional measurements were collected including the distance between the GS and the greater trochanter and LT, as well as the FHC to the LT and greater trochanter.Results: The distance between the GS and the femoral head was consistent and measured 8.0 cm (±1.88 cm, SD = 0.66). A moderate positive correlation (r = 0.37, P < 0.001) was observed between patient height and GS to FHC distance.
The distance between the GS and the center of the femoral head consistently measures 8 cm and can be used to set implant height to restore proximal femoral geometry and leg length in total hip arthroplasty with proximal femoral bone loss.
在初次和翻修全髋关节置换术中，准确恢复下肢长度和股骨近端几何形状对于获得满意的结果至关重要。尽管在初次手术中，大转子和小转子（LT）等常见的解剖标志可用于术中测量肢体长度，但这些标志在骨折和翻修手术中可能缺失或受损。我们提出臀大肌肌腱臀肌吊带（GS）与股骨头中心（FHC）之间的距离作为一种新的解剖标志，可用于在股骨近端骨丢失或骨折的情况下恢复肢体长度。
回顾性分析 100 例健康髋关节的 MRI 检查结果，以确定 GS 近端与 FHC 之间的距离。还收集了其他测量值，包括 GS 与大转子和 LT 之间的距离，以及 FHC 与 LT 和大转子之间的距离。
GS 与股骨头之间的距离是一致的，测量值为 8.0 厘米（±1.88 厘米，标准差=0.66）。患者身高与 GS 至 FHC 距离之间存在中度正相关（r=0.37，P<0.001）。
GS 与股骨头中心之间的距离始终为 8 厘米，可以用于设置植入物的高度，以恢复股骨近端几何形状和肢体长度，特别是在股骨近端骨丢失的全髋关节置换术中。
