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.	刘瑞宇,王春生,王坤正,等.CroweⅡ/Ⅲ型发育性髋关节发育不良股骨近端形态学变化及其对全髋关节置换术的意义.中国修复重建外科杂志,2007,21(10):1050-1053.
5.	Altintaş F,Gökçe 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.	严亮,夏军,黄钢勇,等.成人髋关节发育不良患者股骨近端的解剖形态学特征.中华骨科杂志,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.	严亮,夏军,黄钢勇.成人髋关节发育不良患者股骨髓腔形态研究.国际骨科学杂志,2013,34(5):368-370.
9.	刘宏伟,孙俊英,张云坤,等.股骨近段髓腔解剖参数测量与不同类型人工股骨假体的选择.中国临床解剖学杂志,2011,29(1):67-71.
10.	汤春平,严亮.成人髋关节发育不良患者股骨近端形态研究.南通大学学报:医学版,2014,34(3):224-226.
11.	肖凯,张洪.股骨颈前倾角对髋关节发育不良患者临床症状及治疗策略的影响.中华骨科杂志,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,张福江,马信龙,等.成人髋关节发育不良不同Crowe分型的三维CT影像学特征.中华骨科杂志,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,周学玉,贺靠团.国人生物固定型股骨柄假体几何设计系统方法.生物骨科材料与临床研究,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,李光灿,梁捷予,等.股骨近段解剖学参数分析及对内固定设计的指导意义.中国矫形外科杂志,2005,13(6):436-438.
18.	薛文东,戴尅戎,汤亭亭,等.中国人股骨近段几何形态参数的测量和分类.生物医学工程学杂志,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. 刘瑞宇,王春生,王坤正,等.CroweⅡ/Ⅲ型发育性髋关节发育不良股骨近端形态学变化及其对全髋关节置换术的意义.中国修复重建外科杂志,2007,21(10):1050-1053.
5. Altintaş F,Gökçe 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. 严亮,夏军,黄钢勇,等.成人髋关节发育不良患者股骨近端的解剖形态学特征.中华骨科杂志,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. 严亮,夏军,黄钢勇.成人髋关节发育不良患者股骨髓腔形态研究.国际骨科学杂志,2013,34(5):368-370.
9. 刘宏伟,孙俊英,张云坤,等.股骨近段髓腔解剖参数测量与不同类型人工股骨假体的选择.中国临床解剖学杂志,2011,29(1):67-71.
10. 汤春平,严亮.成人髋关节发育不良患者股骨近端形态研究.南通大学学报:医学版,2014,34(3):224-226.
11. 肖凯,张洪.股骨颈前倾角对髋关节发育不良患者临床症状及治疗策略的影响.中华骨科杂志,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,张福江,马信龙,等.成人髋关节发育不良不同Crowe分型的三维CT影像学特征.中华骨科杂志,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,周学玉,贺靠团.国人生物固定型股骨柄假体几何设计系统方法.生物骨科材料与临床研究,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,李光灿,梁捷予,等.股骨近段解剖学参数分析及对内固定设计的指导意义.中国矫形外科杂志,2005,13(6):436-438.
18. 薛文东,戴尅戎,汤亭亭,等.中国人股骨近段几何形态参数的测量和分类.生物医学工程学杂志,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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