Femoral Head Sphericity in Untreated Developmental Dislocation of the Hip
Femoral Head Sphericity in Untreated Developmental Dislocation of the Hip
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DOI：
10.1097/bpo.0b013e3181e4f53e
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发表时间：
2010-09-01
影响因子：
1.7
通讯作者：
Moseley, Colin F.
中科院分区：
文献类型：
--
作者：
Sankar, Wudbhav N.;Neubuerger, Christopher O.;Moseley, Colin F.
背景：虽然许多研究讨论了髋关节发育不良(DDH)行走年龄儿童的髋臼变化，但几乎没有关于股骨头发育不良的文献数据。我们研究的目的是量化一个大型的、连续的DDH行走年龄儿童股骨头的球形度。方法：我们对连续37个髋关节进行了前瞻性研究，这些患者正在接受DDH的手术治疗。在全麻诱导后(在计划的手术前)，进行髋关节造影。然后拍摄AP X光片，患者仰卧，膝关节在手术台末端屈膝90度，腿垂直于手术台平面。然后将肢体旋转90度以拍摄侧位X线片。从股骨头中心到头部边缘，以最大直径为基准测量半径，然后以45、90和135度角测量半径。我们创建了股骨头球形评分，主要基于这四个半径之间的最大差异(对于每个切面)。结果：我们系列中的儿童的平均年龄为33.5个月(范围从6到79个月)。男4例，女26例，双侧受累7例。股骨头球形评分平均为85.2+/-5.5。结论：步行老年DDH患者的股骨头发育不良且多为非球面。我们的结果提示发育性髋关节脱位不仅会导致髋臼的形态改变，还会影响股骨头的形态。DDH患者股骨头的非球面性可能会影响治疗后的疗效。
Background: Although many studies have discussed acetabular changes in walking aged children with developmental dysplasia of the hip (DDH), almost no data exists in the literature regarding dysplasia of the femoral head. The purpose of our study was to quantify the sphericity of the femoral head in a large, consecutive series of walking aged children with DDH.Methods: We conducted a prospective study on 37 consecutive hips (30 patients) that were undergoing surgical procedures for DDH. After induction with general anesthesia (before the planned procedure), hip arthrograms were conducted. An AP radiograph was then taken with the patient positioned supine and the knee-flexed 90 degrees over the end of the operating table and the leg held perpendicular to the plane of the table. The limb was then rotated 90 degrees for the lateral radiograph. Radii were measured from the center of the femoral head to the edge of the head in line with the longest diameter, and then at 45, 90, and 135 degree angles. We created a femoral head sphericity score that was based primarily on the largest difference between these four radii (for each view).Results: The mean age of the children in our series was 33.5 months (range 6 to 79 mo). There were 4 males and 26 females; 7 patients had bilateral involvement. The mean femoral head sphericity score was 85.2 +/- 5.5. There was significant variability in the "roundness'' of the femoral head: the lowest score was 72.2 and the highest was 97.3. We did not find a relationship between age and femoral head sphericity.Conclusions: In walking aged patients with DDH, the femoral head is dysplastic and usually aspherical. Our results suggest that developmental hip dislocation results not only in morphologic changes to the acetabulum but also the femoral head. The asphericity of the femoral head in DDH may affect outcomes following treatment.Level of Evidence: Anatomic study.