Sefa Giray BATIBAY, Ömer POLAT, Alper GÜLTEKİN

Toplumumuzda Femur Tibia Oranı ile Diz ve Kalça Artrozu İlişkisi

GİRİŞ ve AMAÇ: Bu çalışmamızda amaç; femur tibia uzunluk uyumunun uzun dönem sonuçlarını değerlendirmek ve toplumumuzda ortalama femur ve tibia uzunluk oranının tespiti amaçlı, bacak uzunluk grafileri ölçümü yapmaktır. YÖNTEM ve GEREÇLER: 2013-2017 yılları arasında bacak uzunluk grafisi çekilmiş 411 hasta tespit edilmiştir. Hastaların 40-65 yaş arası olanları dahil edildi. Dışlama kriteri olarak; geçirilmiş femur ve/veya tibia kırığı, bilinen romatolojik hastalık, gelişimsel kalça displazisi mevcut olması, bilinen septik artrit öyküsü mevcudiyeti olarak belirlendi. Çalışmaya 171 hasta dahil edildi. BULGULAR: 171 hastanın 104’ü kadın ve 67’si erkekti. Ölçülen ortalama femur uzunluğu 42,89 cm +/- SD 3,95 cm olarak ölçüldü. ( minimum 30,6 cm – maksimum 49,5 cm). Ortalama tibia uzunluğu 36,75 cm +/- SD 2,966 cm (minimum 29,6 cm – maksimum 43,8 cm) olarak ölçüldü. Femur uzunluğu ve tibia uzunluğu oranı 1,167 +/- SD 0,059 olarak ölçüldü (minimum 1,004 ile maksimum 1,289). Hastaların femur/tibia oranı ile gonartroz evreleri arasında istatistiki olarak anlamlı korelasyon tepit edilmedi (p=0,6876). Hastaların femur /tibia oranı ile koksartroz evreleri olarak istatistiki olarak anlamlı korelasyon bulundu (p=0,0317). TARTIŞMA ve SONUÇ: Çalışmamızda artan femur tibia oranı ile diz dejenerasyonu arasında ilişki tespit edilmemiş olmakla beraber; kalça ekleminin bu orandan etkilendiği beirlenmiştir. Ancak daha geniş serilerle ve kontrol grubu ile yapılacak çalışmalara ve biomekanik araştırmalara ihtiyaç bulunduğunu düşünmekteyiz. Ayrıca, bu çalışmalarda antropometrik olarak farklar olduğu gözetilerek, yapılacak uzatma cerrahilerinde bölgesel çalışmalar dikkate alınmalıdır.

Femur Tibia Length Ratio and Relationship Between Gonarthrosis and Coxarthrosis

INTRODUCTION: The aim of this study was to evaluate the long-term results of femoral and tibia length compliance and to measure the mean length of femur and tibia in our population. METHODS: Between 2013 and 2017, 411 patients with orthoroentgenogram were detected. Patients between the ages of 40-65 were included. As exclusion criteria; the presence of septic arthritis, femoral and / or tibial fracture, known rheumatologic disease, developmental dysplasia of the hip, were identified. 171 patients were included in the study. RESULTS: Of 171 patients, 104 were female and 67 were male. The mean femoral length measured was 42.89 cm +/- SD 3.95 cm. (minimum 30.6 cm - maximum 49.5 cm). The mean tibia length was measured as 36.75 cm +/- SD 2,966 cm (minimum 29.6 cm cm maximum 43.8 cm). Femur length and tibia length ratio was measured as 1,167 +/- SD 0.059 (minimum 1,004 to maximum 1,289). There was no correlation between femoral / tibial ratio and gonarthrosis stage (p = 0.6876). Significant correlation was found between femur / tibia ratio and coxarthrosis stage (p = 0.0317). DISCUSSION and CONCLUSION: In our study, no relation was found between femoral tibia ratio and knee degeneration. The hip joint was affected by this rate. However, we believe that there is a need for further studies with larger series and control groups. In addition, regional studies should be taken into consideration in the limb lengthening surgeries by considering the anthropometric differences.

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1. Littler JW. On the adaptability of man’s hand (with reference to the equiangular curve). Hand 5, 187-91.
2. Hamilton R, Dunsmuir RA. Radiographic assessment of the relative lengths of the bones of the fingers of the human hand. JHand Surg Br 2002;27, 546-8.
3. Hutchison AL, Hutchison RL. Fibonacci, Littler, and the hand: a brief review. Hand (NY) 2010;5, 364-8.
4. Pietak A, Ma S, Beck W C, Stringer M D. Fundamental ratios and logarithmic periodicity in human limb bones. J Anat. 2013 May; 222(5): 526-37.
5. Codivilla A. On the means of lengthening , in the lower limbs, the muscles and tissues which are shortened through deformity. J Bone Joint Surg. Am. 1905;2:353-69
6. İlizarov GA, Ledyaev VI. The replacement of long tubular bone defects by lengthening distraction osteotomy of one of the fragments. 1969. Clin Orthop Relat Res. 1992;280:7-10
7. Paley D. Problems , obstacles,and complications of limb lengthening by the İlizarov technique. Clin Orthop Relat Res. 1990;250:81-104
8. Weinberg DS, Liu RW. The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees. J Pediatr Orthop. 2017 Jul/Aug; 37(5):317-22.
9. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.
10. Mary L. McHugh. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012 Oct; 22(3): 276–82.
11. Nakamae A, Adachi N, Deie M, Ishikawa M, Nakasa T, Ikuta Y, Ochi M. Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction. Bone Joint J. 2018 Mar 1;100-B(3):285-93.
12. Strecker W, Keppler P, Gebhard F, Kinzl L. Length and torsion of the lower limb. J Bone Joint Surg Br. 1997 Nov;79(6):1019-23.
13. Lohmander LS, Gerhardsson de Verdier M, Rollof J, Nilsson PM, Engström G. Incidence of severe knee and hip osteoarthritis in relation to different measures of body mass: a population-based prospective cohort study. Ann Rheum Dis. 2009 Apr;68(4):490-6.
14. W F Harvey, J Niu,Y Zhang,P I McCree,D T Felson,M Nevitt,L Xu,P Aliabadi,D J Hunter.Knee alignment differences between Chinese and Caucasian subjects without osteoarthritis. Ann Rheum Dis 2008, 67(11):1524-8.
15. Andrew J Teichtahl,Anita E Wluka,Boyd J Strauss,Yuanyuan Wang,Patricia Berry,Miranda Davies-Tuck,Flavia M Cicuttini.The associations between body and knee height measurements and knee joint structure in an asymptomatic cohort. BMC Musculoskeletal Disorders 2012, 13:19.
16. Watelain E, Dujardin F, Babier F, et al. Pelvic and lower limb compensatory actions of subjects in an early stage of hip osteoarthritis. Arch Phys Med Rehabil. 2001;82:1705–11.