Objective To investigate the key parameters of three-dimensional anatomy of the proximal humerus and compare the differences between male and female, and between left and right sides in Chinese by volume rendering technique with multi-slice spiral CT (MSCT) so as to provide a reference for a new prosthesis of the proximal humerus which can adjust to the anatomical characteristics of Chinese. Methods A total of 100 healthy volunteers were collected from Chongqing of China, including 59 males and 41 females with an average age of 40.4 years (range, 21-57 years). The humeral retroversion angle (RA), neck-shaft angle (NSA), medial offset (MO), and posterior offset (PO) were measured by volume rendering technique with MSCT. The average values were compared between male and female and between left and right sides, the correlation of these parameters was also analysed. Results In 100 volunteers (200 sides), the RA was (19.9 ± 10.6)°, the NSA was (134.7 ± 3.8)°, the MO was (4.0 ± 1.1) mm, and the PO was (2.6 ± 1.3) mm. There were significant differences in RA and MO between left and right sides (Plt; 0.05); there was no significant difference in NSA and PO between left and right sides (P gt; 0.05). The PO and RA of both sides in male were significantly larger than those in female (P lt; 0.05); the NSA and MO in male were similar to those in female (P gt;0.05). PO was correlated positively with RA (r=0.617, P=0.000); MO was not correlated with NSA (r= —0.124, P=0.081). Conclusion Because of significant side differences in RA and MO, and significant gender differences in RA and PO, the differences should be considered in the design of new proximal humeral prosthesis and proximal humerus reconstruction.
ObjectiveTo observe the influence of different humeral neck-shaft angle on the efficacy in the treatment of proximal humeral fractures with locking plate. MethodsA total of 106 patients with proximal humeral fractures were treated by locking plate between March 2009 and March 2013, and the clinical data were retrospectively analyzed. Of 106 cases, 58 were male and 48 were female, aged from 26 to 71 years (mean, 52.3 years). The causes were traffic accident injury in 54 cases, falling injury from height in 23 cases, falling injury in 21 cases, and others in 8 cases. According to the Neer classification, there were 32 cases of two-part fractures, 65 cases of three-part fractures, and 9 cases of four-part fractures. The time from injury to operation was 1-7 days (mean, 2.7 days). According to neck-shaft angle by X-ray measurements at 1-3 days after operation, the patients were divided into 3 groups:valgus group (>145°), normal group (126-145°), and varus group (<126°) to observe the influence of neck-shaft angle on efficacy. ResultsAccording to postoperative humeral neck-shaft angle, there were 10 cases in valgus group, 75 cases in normal group, and 21 cases in varus group. There was no significant difference in general clinical data among 3 groups (P>0.05). The patients were followed up 6-12 months. The X-ray results showed fracture healing, and no significant difference was found in fracture healing time among 3 groups (P>0.05). After 6 months, the varus angle of femoral head and visual analogue scale (VAS) score of normal group were significantly lower than those of valgus group and varus group (P<0.05). The excellent and good rate of Constant-Murley score was 78.67% (59/75) in normal group, and it was significantly higher than that in valgus group (60.00%, 6/10) and varus group (42.86%, 9/21) (P<0.05), but there was no significant difference between valgus group and varus group (P>0.05). The complication rate was 28.57% (6/21) in varus group, was 10.67% (8/75) in normal group, and was 20.00% (2/10) in valgus group, showing no significant difference among 3 groups (χ2=4.31, P=0.12). ConclusionReconstruction of normal neck-shaft angle is the key to good shoulder function and clinical efficacy in the treatment of proximal humeral fracture.
ObjectiveTo compare the short-term effectiveness of femoral prosthesis with different neck-shaft angles for the reconstruction of proximal femoral anatomy after total hip arthroplasty (THA). MethodsBetween January 2012 and December 2013, 101 patients undergoing unilateral THA who accorded with selection criteria were selected for a retrospective study. The patients were divided into 2 groups:during THA, femoral prosthesis with 135° neck-shaft angle was used in 52 patients (group A) and femoral prosthesis with 127° neck-shaft angle was used in 49 patients (group B). There was no significant difference in gender, age, weight, body masss index, pathogeny, disease duration, preoperative neck-shaft angle, leg discrepancy, and preoperative Harris score between 2 groups (P>0.05). The postoperative Harris score was recorded to evaluate the effectiveness. And the femoral offset of the operated and contralateral sides, the change value of the femoral offset (xFO), the ratio of xFO to the offset of contralateral side (sdFO), the number of patients whose sdFO was more than 15% or less than -15% (outlier), the global offset, the height of femoral head rotation center, and leg discrepancy were measured at postoperation. ResultsOperative incision healed by first intension in 2 groups; no complication of infection, dislocation, or revision was found. All patients were followed up 12-32 months (mean, 23 months). The Harris score at last follow-up were significantly improved when compared with preoperative score in 2 groups (P＜0.05), but there was no signficant difference between 2 groups (t=1.267, P=0.832). The xFO and sdFO of group B were significantly larger than those of group A (P＜0.05); the number of outlier was 20 in group A and was 33 in group B, showing significant difference (P=0.005). The height of femoral head rotating center and global offset at 3 months after operation showed no signficant difference between 2 groups (P>0.05). And significant improvement in leg discrepancy was found at 3 months in 2 groups (P＜0.05), but there was no significant difference between 2 groups (t=0.403, P=0.689). ConclusionBoth of the two femoral prosthesis with different neck-shaft angles can restore the proximal femoral anatomy well and gain similar early effectiveness after THA. However, the Stryker Trident femoral prosthesis with 127° neck-shaft angle may have the tendency to enlarge the femoral offset.