高位脱位髋臼发育不良中不同亚型的股骨形态差异

目的明确高位脱位髋臼发育不良中C1型与C2型股骨近端的形态有无差别,以及C1型与C2型股骨脱位高度是否相同。方法回顾性分析54例高位脱位近端股骨患者的临床资料,C1型28髋,C2型26髋。在髋关节正位、侧位平片上测量股骨干及髓腔的内外径,同时测量股骨头高度、股骨脱位高度、大转子高度。由两名独立研究者对测量的可重复性进行试验,发现测量者内和测量者间的一致性很好。结果与C1型股骨相比,C2型股骨近端股骨窄,髓腔指数更小（2.7±0.6）,更像烟囱型。C2型股骨脱位比C1型高18 mm。结论两种亚型股骨形态的差异在手术处理时需要采用不同的方式和不同形态的假体来重建近端股骨。

Femoral morphologic differences in subtypes of high developmental dislocation of the hip

Objective To identify（1） whether the proximal femoral shape and dimension in Type C1 and Type C2 hips associated with the developmental dislocation of the hip（DDH） is different from each other;（2） whether the femur dislocated with the same height in Type C1 and Type C2 hips.Methods Totally 54 proximal femurs from 54 patients with high DDH（Type C1 28 hips,Type C2 26 hips） were examined.The ML widths of the cortical and medullary canals were measured both on AP and lateral radiographs.The height of femoral head,dislocation,and the greater trochanter were all measured.Reproducibility of the measurements was tested by two researchers with high interobserver agreement and intraobserver agreement.Results The proximal femur in Type C2 hips was narrower and stovepipe shaped,with a smaller flare index（2.7±0.6）,compared with Type C1 hips（3.5±1.2）.The proximal femur migrated an average of 18 mm more superiorly in Type C2 than that in Type C1 hips.Conclusion：Special implants such as conical-shaped femoral stems or custom-made prostheses are more useful for the reconstruction of Type C2 high dislocations.