强直性脊柱炎髋关节影像学特征的初步研究

发布时间：2018-12-21 19:16

【摘要】：目的通过测量初次行人工全髋关节置换术(total hip arthroplasty,THA)的强直性脊柱炎(ankylosing spondylitis,AS)患者手术前后骨盆、髋臼及股骨相关影像学参数,初步分析其影像学特征,以期为此类患者THA手术方法及假体选择提供参考。方法以2015年1月—7月初次行THA且符合选择标准的AS患者38例(56髋)作为研究对象(AS组),并以同期接受THA的股骨头缺血性坏死患者36例(45髋)作为对照(对照组)。两组患者病变侧别比较,差异无统计学意义(χ~2=1.14,P=0.95)。所有患者术前均行髋关节CT扫描及三维重建,测量髋臼外展角、前倾角、中心颈干角(center collum diaphyseal,CCD)、偏心距、旋转中心至小粗隆高度以及大、小粗隆间距;术前摄X线片测量两组股骨髓腔开大指数(canal flare index,CFI)、皮质指数(cortical thickness index,CTI),以及AS组骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT);术后摄X线片测量股骨假体髓腔填充率,并测量髋臼外展角、前倾角。结果两组术前髋臼前倾角以及手术前后髋臼外展角比较,差异均无统计学意义(P0.05);术后髋臼前倾角比较,差异有统计学意义(t=6.71,P=0.00)。AS组患者PI为41~58°,平均48.37°;SS为2~11°,平均5.64°;PT为5~26°,平均12.85°。AS组患者CCD、CFI、CTI与对照组比较,差异均有统计学意义(t=3.63,P=0.04;t=5.12,P=0.02;t=3.91,P=0.04);而偏心距、旋转中心至小粗隆高度以及大、小粗隆间距比较,差异无统计学意义(t=0.41,P=0.36;t=0.33,P=0.56;t=0.59,P=0.12)。根据Noble等提出的分型标准,AS组中股骨髓腔为烟囱型32髋、正常型18髋、倒立香槟型6髋,对照组分别为4、28、13髋。AS组假体柄远端髓腔填充率显著低于对照组(t=5.64,P=0.02);两组近端及中段髓腔填充率比较,差异无统计学意义(t=0.29,P=0.61;t=0.55,P=0.13)。结论 AS患者术前髋臼外展角、前倾角与股骨头缺血性坏死患者相比无明显差异,但术后髋臼假体前倾角明显偏大。AS患者股骨髓腔多为烟囱型,采用锥形柄假体置换后中、远端髓腔填充率偏小,解剖型假体填充率更高。
[Abstract]:Objective to analyze the imaging features of patients with ankylosing spondylitis (ankylosing spondylitis,AS) before and after total hip replacement (total hip arthroplasty,THA) by measuring the imaging parameters of pelvis, acetabular and femur before and after operation. In order to provide reference for THA operation and prosthesis selection in these patients. Methods from January to early July 2015, 38 patients (56 hips) with THA who met the selection criteria were selected as study subjects (AS group) and 36 patients (45 hips) with avascular necrosis of femoral head who received THA at the same time as control group (control group). There was no significant difference between the two groups (蠂 ~ 2 ~ 1.14 ~ 0.95). The acetabular abduction angle, anteversion angle, central neck trunk angle (center collum diaphyseal,CCD), eccentricity, the height of rotation center to small trochanter and the distance between large and small trochanter were measured. Preoperative radiographs were taken to measure the femoral medullary opening index (canal flare index,CFI), cortical index (cortical thickness index,CTI), pelvic incidence angle (pelvic incidence,PI), sacral obliquity angle (sacral slope,SS) and pelvic obliquity angle (pelvic tilt,) in the AS group. PT); The filling rate of femoral prosthesis and acetabular abduction angle and anteversion angle were measured by X-ray film after operation. Results there was no significant difference in acetabular anteversion and acetabular abduction between the two groups before and after operation (P0.05). There was significant difference in acetabular antegrade angle between the two groups (PI: 41 掳, mean 48.37 掳, SS: 2 掳, mean: 5. 64 掳) in). AS group. PT was 5 掳, with an average of 12.85 掳. The difference of CCD,CFI,CTI between the AS group and the control group was statistically significant (t = 3.63, P = 0.04, P = 5.12, P = 0.02, n = 3.91, P = 0.04). However, there was no significant difference in eccentricity, the height from the center of rotation to the small trochanter, and the distance between large and small trochanters (t = 0.41, P ~ (0.36) ~ (0.36) (0.33 ~ 0.33 ~ 0.56 ~ 0.56 ~ 0.59 ~ 0.12). According to the classification criteria proposed by Noble et al, the femoral medullary cavity in AS group was of chimney type (32 hips), normal type (18 hips), inverted champagne type (6 hips) and control group (42.28%). The filling rate of distal medullary cavity of prosthetic handle in AS group was significantly lower than that in control group (t = 5.64). (P0. 02); There was no significant difference in the filling rate of proximal and middle medullary cavity between the two groups (t = 0.29, P = 0.61, P = 0.65, P = 0.13). Conclusion there is no significant difference in acetabular abduction angle and anteversion angle between AS patients and patients with avascular necrosis of femoral head before operation, but the anteversion angle of acetabular prosthesis is obviously larger after operation. The femoral medullary cavity of AS patients is mostly chimney type. The filling rate of distal medullary cavity was small and the filling rate of anatomic prosthesis was higher.
【作者单位】：首都医科大学附属北京康复医院肌骨关节科;中国人民解放军总医院骨科;
【分类号】：R593.23

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