成人髋关节发育不良患者股骨近端的解剖形态学特征

目的 探讨成人髋关节发育不良(developmental dysplasia of the hip,DDH)患者股骨近端解剖形态的CT三维重建特征及其临床意义.方法 通过CT三维重建测量70例(76髋)DDH患者与54例(54髋)健康志愿者股骨近端的解剖学参数,包括股骨头直径、股骨头高度、颈干角、头心-千轴距、股骨颈前倾角、股骨髓腔冠状径、股骨髓腔矢状径、股骨髓腔最长径、股骨各断面髓腔扭转角、股骨峡部距小转子距离及髓腔开口指数.比较DDH患者与健康志愿者股骨近端的解剖学参数有无差异,分析DDH患者各解剖参数的相关性,并与国外研究中DDH患者的相关数据进行比较.结果 DDH组与健康志愿者相比,股骨头高度(4.82±0.95)cm与(5.18±0.57) cm]、头心-千轴距(2.66±0.74) cm与(3.16±0.51) cm]、髓腔开口指数(4.12±1.05与4.53±0.65)及小转子远端40 mm处(LT-40水平)的股骨髓腔扭转角(46.86°±49.53°与66.38°±28.75°)均较小,差异有统计学意义.DDH组股骨头高度与头心-干轴距呈正相关(r=0.491,P=0.000),股骨头直径与股骨颈前倾角呈负相关(r=-0.443,P=O.001).散点图显示DDH组峡部以上不同股骨冠状面的扭转角差异较大且无规律.与国外同类研究比较,股骨头直径的差异无统计学意义,其他参数的差异有统计学意义.结论 DDH患者股骨的解剖形态与正常股骨存在差异.对DDH患者施行全髋关节置换术前必须进行CT扫描及三维重建评估股骨近端解剖形态,对股骨畸形严重者应使用个体化定制假体.

Morphological analysis of the proximal femurs in adults with developmental hip dysplasia: a computed tomographic study

Objective To investigate the morphological characteristics of the proximal femurs in adults with developmental dysplasia of the hip (DDH) by CT three-dimensional reconstruction. Methods CT scans were obtained from 70 adults with DDH (76 hips) and 54 healthy controls (54 hips). Morphometric parameters of the femurs, including femoral head diameter, femoral head height, neck-shaft angle, femoral offset, femoral neck anteversion angle, coronal femoral canal diameter, sagittal femoral canal diameter, the longest femoral canal diameter, torsion angle of femur, the distance from the lesser trochanter to the isthmus and the canal flare index (CFI), were derived from CT reconstructions. These anatomical parameters were compared between the DDH hips and healthy hips to show the difference and correlation. Results The femoral head height, femoral offset, CFI and torsion angle of femur in DDH group and control group were 4.82±0.95 cm and 5.18±0.57 cm, 2.66±0.74 cm and 3.16±0.51 cm, 4.12±1.05 and 4.53±0.65, 46.86°±49.53° and 66.38°±28.75°, respectively. There were statistical differences for parameters above. In DDH group, there was a positive correlation between femoral head height and femoral offset (r=0.491, P=0.000), while a negative correlation between femoral head diameter and femoral neck anteversion angle (r=-0.443, P=0.001). The scatter plots showed that the DDH patients had a large irregular variance in coronal torsion angle of femur. Conclusion The shape of the dysplastic femur is abnormal, and the preoperative CT evaluation of the proximal femur in DDH patients is necessary, which can provide valuable information for THA. Custom prostheses are recommended to fit the abnormal morphologic characteristics of the severely dysplastic femurs.