摘要
目的研究CroweⅣ型成人发育性髋关节发育不良(developmental dysplasia of the hip,DDH)的股骨近段解剖形态,为DDH患者股骨侧假体的选择及专属DDH股骨柄的设计提供参考。方法以2004年6月-2014年12月收治的49例58髋CroweⅣ型成人DDH患者为研究对象,其中男7例8髋,平均年龄47.3岁;女42例50髋,平均年龄30.0岁。所有患者均摄股骨近段正侧位X线片,17例17髋行三维CT扫描。采用Osiri X v.5.8.5软件测量股骨近段相关解剖参数。结果 49例58髋股骨头均为完全脱位,脱位距离(6.09±1.04)cm;8髋(13.8%)股骨头、颈完全消失;11髋(19.0%)股骨头明显萎缩、变形,股骨颈基本消失;小粗隆中点处髓腔内径(1.53±0.29)cm、峡部髓腔内径(0.69±0.09)cm、髓腔开大指数(canal flare index,CFI)为(3.50±0.42)cm、股骨前倾角(37.0±18.2)°与国内正常人群及CroweⅠ、Ⅱ、Ⅲ型患者相比,差异均有统计学意义(P<0.05);股骨颈干角(132.3±9.1)°及峡部高度(11.66±2.67)cm与之比较,差异无统计学意义(P>0.05)。其中烟囱型髓腔占51.7%,比例明显高于正常人群。股骨干骺端CFI与CFI成正相关(r=0.63,P=0.00)、与股骨远端CFI无相关性(r=—0.17,P=0.21)。结论 CroweⅣ型成人DDH患者的股骨近段髓腔明显狭窄,前倾角增大,烟囱型髓腔比例高,与正常人群及CroweⅠ、Ⅱ、Ⅲ型相比存在显著差异,因此需要设计符合其股骨近段髓腔特征的专属DDH股骨柄或定制型股骨假体。
Objective To investigate the anatomical morphology of the proximal femur in adult patients with Crowe type IV developmental dysplasia of the hip （DDH） so as to provided a reference for the selection of femoral components or personalized artificial prosthesis for DDH. Methods Between June 2004 and December 2014, 49 patients （58 hips） with Crowe type IV DDH were included in this study. There were 7 males （8 hips） with an average age of 47.3 years and 42 females （50 hips） with an average age of 30.0 years. X-ray films were taken in all cases and CT scanning in 17 cases （17 hips）. The anatomical parameters were measured through Osirix V 5.8.5 software. Results The distance of femoral head dislocation was （6.09~1.04） cm; the femoral head and neck disappeared completely in 8 hips （13.8%）; femoral head atrophy and deformation and femoral neck disappearance were observed in 11 hips （19.0%）. The midpoint width of the small trochanteric canal was （1.53~0.29） cm; the isthmus diameter was （0.69＋0.09） cm; the canal flare index （CFI） value was （3.50~0.42） cm; the femoral neck anteversion angle was （37.0~18.2）~; and all indexes showed significant difference when compared with ones of normal population and Crowe type I, II, and III patients. But there was no significant difference in femoral neck-shaft angle （132.3_9.1~）, isthmus height （11.66~2.67） cm （P〉0.05）. The chimney type cavity （CFI〈3） accounted for 51.7%, which was significantly higher than the value of normal population. There was a positive correlation between metaphyseal CFI and CFI （r=0.63, P=0.00）, but there was no correlation between metaphyseal CFI and distal CFI （r= -0.17, P=0.21）. Conclusion The proximal femur has the morphological characteristics of narrow medullary cavity, increased anteversion angle, and high ratio of chimney type cavity, so it is necessary to design specialized femoral components or personalized artificial prosthesis for the DDH.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第8期931-935,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
浙江大学CAD&CG国家重点实验室开放课题资助项目(A1405)~~
