SHAO Yongke,LI Huiwu,CHANG Yongyun,SUN Qi,YUAN Yao,ZHANG Jingwei,ANG Fei.Preoperative Measurement to Estimate Stem Anteversion in DDH Patients after Total Hip Arthroplasty[J].Journal of medical biomechanics,2019,34(4):346-351
术前测量预估DDH患者全髋置换术后股骨柄前倾角方法
Preoperative Measurement to Estimate Stem Anteversion in DDH Patients after Total Hip Arthroplasty
Received:July 11, 2018  Revised:August 24, 2018
DOI:
Chinese key words:  复合前倾角  股骨前倾角  股骨柄前倾角  髋关节发育不良  全髋置换术
English Key words:combined antevertion (CA)  femoral anteversion  stem anteversion  developmental dysplasia of the hip (DDH)  total hip arthroplasty (THA)
Fund project:余姚市科技计划项目(2018YYB09),宁波市医学科技计划项目(2018A35),上海交通大学医工交叉项目(YG1*2017MS09),国家自然科学基金项目(81672181),宁波市医学科技计划项目(2017A37)
Author NameAffiliation
SHAO Yongke Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Orthopaedics, Yuyao Peopole’s Hospital 
LI Huiwu Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine 
CHANG Yongyun Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine 
SUN Qi Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine 
YUAN Yao Department of Orthopaedics, Yuyao Peopole’s Hospital 
ZHANG Jingwei Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine 
ANG Fei Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine 
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Chinese abstract:
      目的 根据生物型股骨柄设计原理,通过比较全髋置换术(total hip arthroplasty,THA)术前不同CT平面测量所得股骨前倾角与术后股骨柄前倾角,找到术前测量预估发育性髋关节不良(developmental dysplasia of the hip,DDH)患者THA后股骨柄前倾角方法。方法 选取2007年9月~2013年5月在上海交通大学医学院附属第九人民医院行初次THA符合 DDH诊断的患者21位(28髋),术前及术后均行CT扫描,术前选取头下平面、小粗隆平面和小粗隆平面上1 cm及2 cm 4个平面的前后皮质角平分线与股骨远端内外侧髁最大时后缘连线的夹角,以及大、小粗隆顶点中间平面后侧皮质切线与小粗隆中心上2 cm平面前侧皮质切线的角平分线与股骨远端内外侧髁最大时内外侧髁后方连线夹角(分别记为股骨前倾角1~5)。术后选取股骨柄假体最长水平层面,测量假体前后对称轴线与股骨远端内外侧髁最大时后缘连线的夹角作为术后股骨柄前倾角。同时测量髋臼杯假体前倾角、股骨假体矢状位矢状倾斜角度。比较术前各个股骨前倾角与术后股骨柄假体前倾角并进行相关性分析。结果 股骨前倾角1~5分别为17.70°±10.54°、35.59°±7.21°、31.09°±7.98°、24.71°±9.11°、21.94°±10.10°。股骨柄假体前倾角为20.52°±10.90°。术后假体柄前倾角与股骨前倾角1~4之间差值分别为2.82°±6.27°、-15.08°±7.99°、-13.80°±15.68、-4.19°±5.69°、-1.42°±4.07°,髋臼假体前倾角为25.60°±11.65°,术后复合前倾角为46.11°±13.28°,假体矢状倾斜角为1.13°±1.53°。术前股骨前倾角1~4与术后假体前倾角均有统计学差异(P<0.05),股骨前倾角5与术后假体前倾角无统计学差异;术前各前倾角与术后假体前倾角相关系数分别为0.829、0.681、0.689、0.853、0.928。结论 股骨前倾角5与术后股骨柄前倾角具有高相关性,可作为替代股骨柄前倾角的有效方法 。
English abstract:
      Objective Based on the principle of uncemented stem design, the femoral anteversion in different CT planes before total hip arthroplasty (THA) and stem anteversion after THA was compared, so as to find out the preoperative measurement to estimate stem anteversion in patients with developmental dysplasia of the hip(DDH) after THA. Methods Twenty-one primary THA patients (28 hips) who were diagnosed with DDH between September 2007 and May 2013 in Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were selected. Preoperative and postoperative CT scans were performed on all patients. The femoral anteversion angle was defined as the angle between the midcortical line between the anterior and posterior cortical line in five CT slices and the posterior condylar axis. The slice levels for the 4 femoral sites were selected,including the area just distal to the femoral head, the center of the lesser trochanter,1 cm height above center of the lesser trochanter, 2 cm height above center of the lesser trochanter (marked as femoral anteversion 1-4). Femoral anteversion 5 was defined as the midcortical line of the anterior cortical line in the slice of 2 cm height above center of the lesser trochanter and the posterior cortical line in the slice of 50% of the distance from the top of greater trochanter to the center of the lesser trochanter above the center of the lesser trochanter. The stem anteversion angle was defined as the angle formed by the stem neck major axis and the posterior aspect of the femoral condylar line. The cup version and stem alignment were also calculated. The difference value and correlation coefficients of femoral anteversion 1-5 and stem anteversion were compared. Results Femoral anteversion 1-5 was 17.70°±10.54°, 35.59°±7.21°, 31.09°±7.98°, 24.71°±9.11°, 21.94°±10.10°, respectively。Stem anteversion was 20.52°±10.90°. The difference value between stem anteversion and femoral anteversion 1-5 was 2.82°±6.27°, -15.08°±7.99°, -13.80°±15.68°, -4.19°±5.69°, -1.42°±4.07°, respectively. Cup anteversion was 25.60°±11.65°, and combined antevertion was 46.11°±13.28°,sagittal stem tilt was 1.13°±1.53°. There were statistically significant differences between femoral anteversion 1-4 and stem anteversion (P<0.05), and no statistical difference was found between femoral anteversion 5 and stem anteversion. The correlation coefficients of femoral anteversion 1-5 and stem anteversion were 0.829, 0.681, 0.689, 0.853, 0.928, respectively. Conclusions Femoral anteversion 5 had a highly positive correlation with stem anteversion, which was an effective a substitute of stem anteversion before THA.
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