Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany.
Department of Orthopaedics and Traumatology, Royal Bolton Hospital, Farnworth, Greater Manchester, England, UK.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5221-5227. doi: 10.1007/s00402-023-04833-x. Epub 2023 Mar 19.
In the case of stemmed implants for lower limb joint arthroplasty procedures, implant stability and survivorship generally rely on the strength of fixation in the medullary canal regardless of whether the procedure is primary or revision surgery. This study aimed to investigate the relationship between the proximal (Dorr classification) and distal (Citak classification) femoral canal geometry classification systems.
A total of 200 patients who received standing long leg radiographs (hip to ankle) at our institution were identified using our institutional electronic radiology database. Patients were recruited into 4 groups. There were 100 male and 100 female patients with each of those being split into 50 right-sided and 50 left-sided long-leg standing anteroposterior (AP) radiographs. Two independent, blinded observers reviewed each radiograph on two separate occasions, with a minimum of a one-week interval between sittings to review each respective radiograph.
No statistically significant correlation was found between demographic data and clinical measurements. A statistically significant correlation was found between the patient's age and BMI results and Citak and Dorr measurements. There was excellent inter-observer and intra-observer agreement for the Citak and Dorr Classifications. The mean Cronbach's α coefficient was 0.96 (range 0.93-0.98) for the Citak Classification and 0.95 (range 0.83-0.97) for the Dorr Classification. There was also an excellent intra-observer agreement with 95% average pairwise per cent agreement for the Citak Classification and 95% average pairwise per cent agreement for the Dorr classification. A statistically significant positive correlation was found between Dorr Calcar Isthmus and Citak Ratio (p < 0.05).
In this study, the Dorr and Citak classifications are put into relation to each other for the first time. The morphology of the femur was investigated in its entirety and it was shown that there was a positive correlation between the anatomical shape of the proximal and distal medullary canals.
对于下肢关节置换手术的带柄植入物，植入物的稳定性和存活率通常取决于髓腔内固定的强度，无论手术是初次手术还是翻修手术。本研究旨在探讨近端（Dorr 分类）和远端（Citak 分类）股骨髓腔几何分类系统之间的关系。
使用我们机构的电子放射学数据库，在我们机构确定了 200 名接受站立位全长下肢 X 线（从髋关节到踝关节）的患者。患者被分为 4 组，每组 100 名男性和 100 名女性，其中每 50 名患者分为右侧和左侧 50 名站立位全长前后位（AP）X 线片。两名独立的、盲目的观察者在两次不同的时间对每张 X 线片进行了评估，两次评估之间至少间隔一周以评估每张 X 线片。
在人口统计学数据和临床测量值之间未发现统计学显著相关性。在患者的年龄和 BMI 结果与 Citak 和 Dorr 测量值之间发现了统计学显著相关性。Citak 和 Dorr 分类之间具有极好的观察者间和观察者内一致性。Citak 分类的平均 Cronbach's α 系数为 0.96（范围 0.93-0.98），Dorr 分类的平均 Cronbach's α 系数为 0.95（范围 0.83-0.97）。Citak 分类的观察者内一致性也非常好，95%平均成对百分比一致性为 95%，Dorr 分类的观察者内一致性为 95%。在 Dorr 卡尔卡峡部和 Citak 比值之间发现了统计学显著的正相关性（p<0.05）。
在这项研究中，首次将 Dorr 和 Citak 分类进行了相互关联。对整个股骨形态进行了研究，结果表明近端和远端髓腔的解剖形状之间存在正相关。
