Gharanizadeh Kaveh, Mohammadyahya Elham, Bahaeddini Mohammad Reza, Amiri Shayan, Gravand Sajad Noori, Pezeshki Sepideh, Aminian Amir, Eslami Arvin, Tayyebi Hamed, Abolghasemian Mansour
Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Cardiology, School of Medicine, Mehrad Hospital, Iran University of Medical Sciences, Tehran, Iran.
BMC Musculoskelet Disord. 2025 Feb 3;26(1):108. doi: 10.1186/s12891-024-08201-7.
The best stem type and location for femoral shortening in high-riding developmental dysplasia of the hip (DDH) in not clear. We evaluated the morphology of the proximal femur on EOS™ images, focusing on the anatomical landmarks and measurements relevant to the stem selection in high-riding DDH. Our goal is to identify and define the differences in the anatomy of the proximal femur between patients with Crowe type IV DDH and normal individuals, in order to determine the appropriate neck cut location in these patients to increase the chances of successfully using a wedge femoral stem.
EOS™ images of 40 hips with Crowe type-IV DDH and 40 normal hips were included. The distances between the tip of the greater trochanter and vastus ridge (GT-VR), vastus ridge and proximal border of lesser trochanter (VR-LT), greater- and lesser trochanters (GT-LT), base width of the LT, and the proportion of these distances to the femoral length were evaluated. Canal Flare Index (CFI) was also measured, at two different levels.
The mean GT-LT index was not different between the two groups (p = 0.46). The GT-VR index was smaller in the case group (p < 0.001), while the VR-LT index was greater (p < 0.001). The LT base width index was larger in the case group (P < 0.001). CFI was smaller at the LT level in dysplastic hips (P < 0.001), but the values were similar with a cut 1.5 cm above the LT (P = 0.67).
In Crowe IV hips, the GT height is shorter and the LT is located far more distally along the femoral metaphysis, resulting in a narrower canal width at the upper border of the lesser trochanter. Also, the CFI at the LT level is smaller, and to fit a wedge stem, the neck cut should be made at a higher level.
对于高位发育性髋关节发育不良（DDH）患者，股骨缩短的最佳截骨类型和位置尚不清楚。我们在EOS™影像上评估了股骨近端的形态，重点关注与高位DDH患者假体柄选择相关的解剖标志和测量指标。我们的目标是确定并明确Crowe IV型DDH患者与正常个体股骨近端解剖结构的差异，以便确定这些患者合适的颈截骨位置，增加成功使用楔形股骨柄的几率。
纳入40例Crowe IV型DDH髋关节和40例正常髋关节的EOS™影像。评估大转子尖与股外侧嵴（GT-VR）、股外侧嵴与小转子近端边界（VR-LT）、大转子与小转子（GT-LT）之间的距离、小转子基部宽度，以及这些距离与股骨长度的比例。还在两个不同水平测量了髓腔扩张指数（CFI）。
两组间平均GT-LT指数无差异（p = 0.46）。病例组的GT-VR指数较小（p < 0.001），而VR-LT指数较大（p < 0.001）。病例组的小转子基部宽度指数较大（P < 0.001）。发育不良髋关节在小转子水平的CFI较小（P < 0.001），但在小转子上方1.5 cm处截骨时CFI值相似（P = 0.67）。
在Crowe IV型髋关节中，大转子高度较短，小转子沿股骨干骺端向远侧移位更多，导致小转子上缘处的髓腔宽度变窄。此外，小转子水平的CFI较小，为适配楔形假体柄，颈截骨应在更高水平进行。
