Résumé
En la literatura actual se encuentra escasa información referente a la fóvea de la cabeza del fémur (fóvea de la cabeza del hueso fémur). Este estudio tuvo como propósito recolectar datos morfológicos y biométricos respecto a la fóvea de la cabeza del fémur y reconocer variaciones que podrían ser de utilidad en las diversas patologías de la región. Se utilizaron 46 huesos fémures humanos pertenecientes al Departamento de Ciencias Básicas de la Universidad de La Frontera, Chile. Para la medición de datos se utilizó material ad hoc y los datos fueron analizados el programa Excel y los softwares ImageJ e Image Pro Plus. La longitud promedio de los huesos fémures fue de 43,8 ± 2,9 cm; el ángulo de torsión del cuello fue de 23,0 ± 2,0°. En el 100 % de las muestras se observó una fóvea en el cuadrante posteroinferior de la cabeza del fémur. El área promedio de la fóvea de la cabeza del fémur fue de 1,51 ± 0,7 cm2. El perímetro fue de 4,72 ± 1,0 cm; la forma de la fóvea fue: 60,9% ovalada, 23,9% triangular y 15,2 % circular, teniendo como base la fórmula derivada del índice craneal, dejando la fórmula como feret mínimo/feret máximo, con el cual los valores mayores a 0,8 se clasificaban como circulares y los menores como ovalados. Conocer la ubicación de la fóvea de la cabeza del fémur adquiere implicancia médica, ya que una fóvea en posición anormalmente alta, en imágenes radiológicas, es un indicador de displasia pélvica. La importancia de las variaciones de la fóvea de la cabeza del fémur debe ser más investigadas para una correcta comprensión de las patologías que afectan a la cabeza femoral.
SUMMARY: In the current literature there is little information regarding the fovea for ligament of head of femur. The aim of this study was to collect morphological and biometric data regarding the fovea for ligament of head of femur and recognize variations that could be useful in the various pathologies of the region. Forty six human femur bones belonging to the Department of Basic Sciences of the University of La Frontera, Chile were used. For data measurement, ad hoc material was used and the data were analyzed with the Excel program and the ImageJ and Image Pro Plus software. The average length of the femur bones was 43.8 ± 2.9 cm; the neck torsion angle was 23.0 ± 2.0°. In 100% of the samples, a fovea was observed in the posteroinferior quadrant of the head of femur. The average area of the fovea for ligament of head of femur was 1.51 ± 0.7 cm3. The perimeter was 4.72 ± 1.0 cm; The shape of the fovea was: 60.9% oval, 23.9% triangular and 15.2% circular, based on the formula derived from the cranial index, leaving the formula as minimum feret/maximum feret, with which the values greater than 0.8 were classified as circular and those less as oval. Knowing the location of the fovea for ligament of head of femur acquires medical implications, since a fovea in an abnormally high position, in radiological images, is an indicator of pelvic dysplasia. The importance of variations in the fovea for ligament of head of femur must be further investigated for a correct understanding of the pathologies that affect the femoral head.
Sujets)
Humains , Fémur/anatomie et histologie , Ligaments/anatomie et histologie , Tête du fémur/anatomie et histologie , Variation anatomiqueRésumé
Introducción: Los trastornos congénitos músculo-esqueléticos presentan frecuentemente malformaciones de cadera que afectan la marcha y actividades funcionales, por ello la importancia de detectarlas oportunamente. Objetivo: Determinar la presencia de displasia y luxación de la cadera en niños con alteraciones congénitas que asisten a un instituto nacional de rehabilitación. Material y Métodos: Estudio observacional, descriptivo, retrospectivo y transversal con 150 historias clínicas de niños de 0 a 2 años con alteraciones congénitas con afectación músculo-esquelética. Resultados: Los pacientes presentaron una mediana de edad de 11 meses y 64 % fue del sexo femenino. La alteración más frecuente fue la deformidad congénita de la cadera con 52 %, seguida de la espina bífida, deformidad congénita del ECOM, artrogriposis múltiple y deformidad congénita de los pies con 23,3 %, 6,7 %, 5,3 % y 4 % respectivamente. El 17,3 % de los pacientes con alteraciones congénitas tenía luxación, 56,7 % displasia y 72,7 % alguna de las dos. En los pacientes con deformidad congénita de la cadera, 100 % tenía displasia y/o luxación. En los pacientes con espina bífida, 54,3 % al menos una de ellas. El 75 % de los pacientes con artrogriposis múltiple y 33,3 % de los que tenían deformidades congénitas de los pies presentaron displasia y/o luxación. Conclusiones: La displasia y/o luxación de cadera son frecuentes en niños con diagnóstico de deformidad congénita de cadera, espina bífida, artrogriposis múltiple congénita y deformidades congénitas de los pies.
Introduction: Congenital musculoskeletal disorders often present hip malformations that affect gait and functional activities, therefore the importance of detecting them in a timely manner. Objective: To determine the presence of dysplasia and hip dislocation in children with congenital disorders who attend a national rehabilitation institute. Material and Methods: An observational, descriptive, retrospective and cross-sectional study was conducted using 150 medical records of children from 0 to 2 years of age with congenital disorders with musculoskeletal involvement. Results: The patients had a median age of 11 months and 64% were female. The most frequent alteration was congenital deformity of the hip (52%), followed by spina bifida, congenital deformity of the ECOM, multiple arthrogryposis, and congenital deformity of the feet (23.3%, 6.7%, 5.3% and 4%, respectively). In addition, 17.3% of patients with congenital abnormalities had dislocation, 56.7% had dysplasia and 72.7% had either of the two. In patients with congenital hip deformity, 100% had dysplasia and/or dislocation. In patients with spina bifida, 54.3% had at least one of them. Moreover, 75% of patients with arthrogryposis multiplex and 33.3% of those with congenital deformities of the feet presented dysplasia and/or dislocation. Conclusions: Dysplasia and/or dislocation of the hip are common in children with a diagnosis of congenital hip deformity, spina bifida, congenital arthrogryposis multiplex, and congenital foot deformities.
Résumé
ABSTRACT Objective: While several radiographic parameters have been established to describe the geometry and pathology of the hip, their reference values and clinical significance remain a matter of dispute. The present study tests the hypothesis that age has a relevant impact on radiographic hip parameters. Method: Pelvic antero-posterior views were measured for CE angle, Sharp's angle, acetabular depth-to-width ratio, femoral head extrusion index, roof obliquity, caput-collum-diaphyseal (CCD) angle, and Murray's femoral head ratio, and the values obtained were correlated with age. Results: Significant weak and moderate linear correlations (all Ps<0.001) were observed between age and CE angle (ρ=0.31), Sharp's angle (ρ=-0.38), extrusion index (ρ=-0.22), CCD angle (ρ=-0.15), depth-to-width ratio (ρ=-0.38), and roof obliquity (ρ=-0.19), while Murray's femoral head ratio (ρ=0.05; P=0.274) was not associated with age. Interestingly, the parameters describing the acetabulum all showed a relevant increase in coverage with age, leading to CE-angles well beyond 40° and a Sharp's angle below 35° in a large portion of asymptomatic older adults. Conclusion: While a decrease in CCD angle with age is described in most orthopedic textbooks, the changes observed with age in acetabular geometry far exceed those measured at the femoral head-neck junction. We recommend considering these alterations that may be attributable to age when formulating a radiographic diagnosis. Level of Evidence III, Diagnostic Studies - Investigating a Diagnostic Test.
RESUMO Objetivo: Embora tenham sido estabelecidos vários parâmetros radiográficos para descrever a geometria e a patologia do quadril, seus valores de referência e significância clínica continuam sendo uma questão controversa. O presente estudo testa a hipótese de que a idade tem impacto relevante sobre os parâmetros radiográficos do quadril. Método: As vistas pélvicas anteroposteriores foram medidas quanto ao ângulo CE, ângulo de Sharp, proporção entre profundidade e largura acetabular, índice de extrusão da cabeça do fêmur, obliquidade do lábio do acetábulo (teto), ângulo cabeça-colo-diafisário (CCD) e razão da cabeça do fêmur de Murray e os valores obtidos foram correlacionados com a idade. Resultados: Foram observadas correlações lineares significantes, fracas e moderadas (todos os P < 0,001) entre idade e ângulo CE (ρ = 0,31), ângulo de Sharp (ρ = -0,38), índice de extrusão da cabeça do fêmur (ρ = -0,22), ângulo CCD (ρ = -0,15), proporção entre profundidade e largura acetabular (ρ = -0,38) e obliquidade do lábio do acetábulo (ρ = -0,19), enquanto a razão da cabeça do fêmur de Murray (ρ = 0,05; P = 0,274) não foi associada à idade. Curiosamente, todos os parâmetros que descrevem o acetábulo mostraram um aumento relevante de cobertura com idade, levando a ângulos CE bem além de 40° e ângulos de Sharp abaixo de 35° em uma grande parcela de idosos assintomáticos. Conclusão: Embora a diminuição do ângulo CCD com a idade seja descrita na maioria dos livros didáticos de ortopedia, as alterações na geometria acetabular observadas com a idade ultrapassam, de longe, as medidas na junção entre cabeça e colo do fêmur. Recomendamos considerar essas alterações que podem ser atribuídas à idade ao formular um diagnóstico radiográfico. Nível de Evidência III, Estudos Diagnósticos - Investigação de um Exame para Diagnóstico.