MORPHOLOGICAL STUDY ON PROXIMAL FEMUR IN ADULT PATIENTS WITH CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP AND ITS CLINICAL SIGNIFICANCE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUHongwei ^1,2 , XUNanwei ¹ , ZHANGYunkun ¹ ,  GUYong ² , SUNJunying ² , TongJing ³

1. Department of Orthopaedics, Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, P. R. China;
2. Department of Orthopaedics, the First Affiliated Hospital of Soochow University Changzhou Jiangsu, 213000, P. R. China;
3. College of IOT Engineering, Hohai University, Changzhou Jiangsu, 213000, P. R. China;

Corresponding?author：

GUYong, Email: guyongsuzhou@163.com

Keywords：

Developmental dysplasia of the hip; Total hip arthroplasty; Morphology of proximal femur; High dislocation

DOI：

10.7507/1002-1892.20150201

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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.

Citation： LIUHongwei, XUNanwei, ZHANGYunkun, GUYong, SUNJunying, TongJing. MORPHOLOGICAL STUDY ON PROXIMAL FEMUR IN ADULT PATIENTS WITH CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP AND ITS CLINICAL SIGNIFICANCE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(8): 931-935. doi: 10.7507/1002-1892.20150201 Copy

1.	Yoon PW,Kim JI,Kim DO,et al.Cementless total hip arthroplasty for patients with Crowe type Ⅲ or IV developmental dysplasia of the hip:two-stage total hip arthroplasty following skeletal traction after soft tissue release for irreducible hips.Clin Orthop Surg,2013,5(3):167-173.
2.	Crowe JF,Mani VJ,Ranawat CS.Total hip replacement in congenital dislocation and dysplasia of the hip.J Bone Joint Surg (Am),1979,61(1):15-23.
3.	Kawai T,Tanaka C,Kanoe H.Total hip arthroplasty for Crowe IV hip without subtrochanteric shortening osteotomy-a long term follow up study.BMC Musculoskelet Disord,2014,15:72.
4.	劉瑞宇,王春生,王坤正,等.CroweⅡ/Ⅲ型發育性髖關節發育不良股骨近端形態學變化及其對全髖關節置換術的意義.中國修復重建外科雜志,2007,21(10):1050-1053.
5.	Altinta? F,G?k?e A,Güven M,et al.Analyzing acetabular deficiency by computed tomography in osteoarthritis after Crowe type 2 developmental dysplasia of the hip.Eklem Hastalik Cerrahisi,2009,20(3):127-130.
6.	嚴亮,夏軍,黃鋼勇,等.成人髖關節發育不良患者股骨近端的解剖形態學特征.中華骨科雜志,2013,33(9):941-947.
7.	Nobel PC,Alexander JW,Lindahl LJ,et al.The anatomic basis of femoral component design.Clin Orthop Relat Res,1988,(235):148-165.
8.	嚴亮,夏軍,黃鋼勇.成人髖關節發育不良患者股骨髓腔形態研究.國際骨科學雜志,2013,34(5):368-370.
9.	劉宏偉,孫俊英,張云坤,等.股骨近段髓腔解剖參數測量與不同類型人工股骨假體的選擇.中國臨床解剖學雜志,2011,29(1):67-71.
10.	湯春平,嚴亮.成人髖關節發育不良患者股骨近端形態研究.南通大學學報:醫學版,2014,34(3):224-226.
11.	肖凱,張洪.股骨頸前傾角對髖關節發育不良患者臨床癥狀及治療策略的影響.中華骨科雜志,2014,34(12):1258-1263.
12.	Noble PC,Kamaric E,Sugano N,et al.Three-dimensional shape of the dysplastic femur:implications for THR.Clin Orthop Relat Res,2003,(417):27-40.
13.	肖瑜,張福江,馬信龍,等.成人髖關節發育不良不同Crowe分型的三維CT影像學特征.中華骨科雜志,2014,34(3):311-315.
14.	Sugano N,Noble PC,Kamaric E,et al.The morphology of the femur in developmental dysplasia of the hip.J Bone Joint Surg (Br),1998,80(4):711-719.
15.	王彩梅,周學玉,賀靠團.國人生物固定型股骨柄假體幾何設計系統方法.生物骨科材料與臨床研究,2006,3(4):48-53.
16.	Laine HJ,Lehto MU,Moilanen T.Diversity of proximal femoral medullary canal.J Arthroplasty,2000,15(1):86-92.
17.	魏波,李光燦,梁捷予,等.股骨近段解剖學參數分析及對內固定設計的指導意義.中國矯形外科雜志,2005,13(6):436-438.
18.	薛文東,戴尅戎,湯亭亭,等.中國人股骨近段幾何形態參數的測量和分類.生物醫學工程學雜志,2002,19(1):84-88.

1. Yoon PW,Kim JI,Kim DO,et al.Cementless total hip arthroplasty for patients with Crowe type Ⅲ or IV developmental dysplasia of the hip:two-stage total hip arthroplasty following skeletal traction after soft tissue release for irreducible hips.Clin Orthop Surg,2013,5(3):167-173.
2. Crowe JF,Mani VJ,Ranawat CS.Total hip replacement in congenital dislocation and dysplasia of the hip.J Bone Joint Surg (Am),1979,61(1):15-23.
3. Kawai T,Tanaka C,Kanoe H.Total hip arthroplasty for Crowe IV hip without subtrochanteric shortening osteotomy-a long term follow up study.BMC Musculoskelet Disord,2014,15:72.
4. 劉瑞宇,王春生,王坤正,等.CroweⅡ/Ⅲ型發育性髖關節發育不良股骨近端形態學變化及其對全髖關節置換術的意義.中國修復重建外科雜志,2007,21(10):1050-1053.
5. Altinta? F,G?k?e A,Güven M,et al.Analyzing acetabular deficiency by computed tomography in osteoarthritis after Crowe type 2 developmental dysplasia of the hip.Eklem Hastalik Cerrahisi,2009,20(3):127-130.
6. 嚴亮,夏軍,黃鋼勇,等.成人髖關節發育不良患者股骨近端的解剖形態學特征.中華骨科雜志,2013,33(9):941-947.
7. Nobel PC,Alexander JW,Lindahl LJ,et al.The anatomic basis of femoral component design.Clin Orthop Relat Res,1988,(235):148-165.
8. 嚴亮,夏軍,黃鋼勇.成人髖關節發育不良患者股骨髓腔形態研究.國際骨科學雜志,2013,34(5):368-370.
9. 劉宏偉,孫俊英,張云坤,等.股骨近段髓腔解剖參數測量與不同類型人工股骨假體的選擇.中國臨床解剖學雜志,2011,29(1):67-71.
10. 湯春平,嚴亮.成人髖關節發育不良患者股骨近端形態研究.南通大學學報:醫學版,2014,34(3):224-226.
11. 肖凱,張洪.股骨頸前傾角對髖關節發育不良患者臨床癥狀及治療策略的影響.中華骨科雜志,2014,34(12):1258-1263.
12. Noble PC,Kamaric E,Sugano N,et al.Three-dimensional shape of the dysplastic femur:implications for THR.Clin Orthop Relat Res,2003,(417):27-40.
13. 肖瑜,張福江,馬信龍,等.成人髖關節發育不良不同Crowe分型的三維CT影像學特征.中華骨科雜志,2014,34(3):311-315.
14. Sugano N,Noble PC,Kamaric E,et al.The morphology of the femur in developmental dysplasia of the hip.J Bone Joint Surg (Br),1998,80(4):711-719.
15. 王彩梅,周學玉,賀靠團.國人生物固定型股骨柄假體幾何設計系統方法.生物骨科材料與臨床研究,2006,3(4):48-53.
16. Laine HJ,Lehto MU,Moilanen T.Diversity of proximal femoral medullary canal.J Arthroplasty,2000,15(1):86-92.
17. 魏波,李光燦,梁捷予,等.股骨近段解剖學參數分析及對內固定設計的指導意義.中國矯形外科雜志,2005,13(6):436-438.
18. 薛文東,戴尅戎,湯亭亭,等.中國人股骨近段幾何形態參數的測量和分類.生物醫學工程學雜志,2002,19(1):84-88.

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Chinese Journal of Reparative and Reconstructive Surgery

MORPHOLOGICAL STUDY ON PROXIMAL FEMUR IN ADULT PATIENTS WITH CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP AND ITS CLINICAL SIGNIFICANCE

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