生物型髋臼假体大小选择策略及研究进展

发布时间：2018-01-21 08:53

本文关键词： 全髋关节置换术生物型髋臼假体大小影响因素相关分析　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究全髋关节置换术中生物型髋臼假体大小选择的影响因素,为术前及术中选择大小合适的髋臼假体提供依据。方法:在电子病历系统中,收集2013年1月至2016年6月在河北医科大学第三医院骨病科行初次生物型全髋关节置换术病人806例,1011侧髋,剔除假体周围骨折、假体周围感染、假体无菌性松动、脱位、假体磨损、骨水泥型髋臼假体、髋臼壁锉穿、髋臼打压植骨、失访及病历资料不全病人74例,收集病例资料完整的病人732例918侧髋(双髋186例,单髋546例),其中男性466例592侧髋,女性266例326侧髋,男女比例1.75:1,年龄18-85岁,平均年龄(50.24±0.43)岁,收集病人年龄、性别、身高、体重、手术侧别、临床诊断及术中应用的髋臼假体直径大小,记录于Microsoft Office Excel 2003表格中,根据最新年龄划分标准将年龄分为45岁、45-59岁、60-74岁、75-89岁四组,性别分为男性、女性组,手术侧别分为左侧、右侧组,参考实用骨科学临床诊断分为股骨颈骨折、股骨头缺血性坏死、髋关节骨关节炎、髋臼发育不良、类风湿性关节炎、强直性脊柱炎伴髋关节僵直六组,使用SPSS 20.0软件,分析性别、手术侧别、年龄、临床诊断等因素对髋臼假体直径大小选择的影响及身高、体重、BMI与髋臼假体大小的相关性。结果:1 918侧髋臼假体大小服从正态分布;2不同性别的病人髋臼假体直径大小差异有统计学意义(P0.001),男性(51.06±1.88)mm明显大于女性(48.12±2.02)mm;(表1)3不同手术侧所用髋臼假体直径大小不同,右侧使用的髋臼假体直径(50.11±2.45)mm大于左侧(49.93±2.32)mm,差异无统计学意义(P=0.2610.05);(表2)4不同年龄组所用髋臼假体直径大小不同,60-74岁年龄组小于其他年龄组,差异无统计学意义(P=0.410.05);(表3)5不同髋关节病种应用的髋臼假体直径大小有差异,强直性脊柱炎伴髋关节僵直使用的髋臼假体直径最大(51.38±1.70)mm、其次为髋关节骨关节炎(50.30±2.42)mm、股骨头缺血性坏死(50.16±2.17)mm、股骨颈骨折(49.26±2.13)mm、类风湿性关节炎(49.00±3.70)mm,髋臼发育不良使用的髋臼假体直径最小(48.32±2.09)mm,其中强直性脊柱炎伴髋关节僵直组与其他各组差异均有统计学意义;(表4)6应用的髋臼假体大小与病人身高存在直线相关关系(R2=0.364),回归方程为:Y=16.661+0.200X;与病人体重也存在直线相关关系(R2=0.134),回归方程为:Y=44.720+0.075X;与BMI之间无相关性(r=0.053,P=0.112);(表5、表6、表7)7髋臼假体直径大小与身高(X1)、性别(X2)、年龄(X3)、体重(X4)及临床诊断(X5)有线性回归关系,且性别为选用髋臼假体直径大小最重要的影响因素,其线性回归方程为(表8):Y =30.277+0.119X1-1.628X2+0.301X3+0.016 X4+0.15 X5结论:1男、女性髋臼假体大小差异具有统计学意义,男性大于女性;2不同年龄组、不同侧别髋臼假体大小无明显统计学差异;3髋臼假体大小与病人身高、体重有直线相关关系;与BMI无相关性。4髋关节病种为选择髋臼杯直径大小的影响因素,强直性脊柱炎伴髋关节僵直使用的髋臼假体直径偏大,髋臼发育不良使用的髋臼假体直径偏小。5髋臼假体直径大小与身高、性别、年龄及临床诊断有线性回归关系,性别为选用髋臼假体直径大小最重要的影响因素。
[Abstract]:Objective: To study the effect of biological factors in total hip arthroplasty of acetabular prosthesis size selection, provide the basis for the selection of the proper size of acetabular prosthesis before and during surgery. Methods: in the electronic medical record system, from January 2013 to June 2016 in 806 cases of orthopedics, the Third Hospital of Hebei Medical University underwent primary cementless total hip replacement in 1011 patients. Hip, excluding periprosthetic fractures, periprosthetic infection, aseptic loosening, dislocation, prosthesis wear, cementless acetabular component, acetabular wall burrs wear, acetabular impaction bone grafting, lost and incomplete medical records of 74 patients, patients with complete data were collected in 732 cases (918 hip Hip 186 with a single hip in 546 cases), including 466 cases of male female 266 cases 592 hips, 326 hips, the proportion of male and female 1.75:1, aged 18-85 years old, average age (50.24 + 0.43) years old, collection of patient age, gender, height, weight, operation side, pro The clinical application of diagnosis and treatment of acetabular prosthesis size, recorded in the Microsoft Office Excel 2003 in the table, according to the division of the new standard age will be divided into 45 years of age, 45-59 years, 60-74 years, 75-89 years of age four group, sex male, female group, the operation side is divided into left and right reference group. Practical Department of orthopedics clinical diagnosis points of femoral neck fracture, avascular necrosis of the femoral head, hip osteoarthritis, hip dysplasia, rheumatoid arthritis, ankylosing spondylitis, hip ankylosis in six groups, gender analysis using SPSS 20 software, operation, side, age, weight and other factors on the clinical diagnosis of acetabular prosthesis diameter influence of size selection and height, the correlation between BMI and acetabular prosthesis size. Results: 1918 acetabular prosthesis size obeys normal distribution; 2 different gender patients with acetabular prosthesis size difference was statistically significant (P0.001), male (51.06. 1.88) mm were significantly larger than females (48.12 + 2.02) mm; (Table 1) with acetabular prosthesis diameter 3 different surgical side, the diameter of the right to the use of the acetabular prosthesis (50.11 + 2.45) mm greater than left (49.93 + 2.32) mm, there was no statistically significant difference (P=0.2610.05); (Table 2) acetabular prosthesis the diameter of the 4 different age groups of different age group 60-74 less than other age groups, the difference was not statistically significant (P=0.410.05); (Table 3) acetabular prosthesis diameter 5 different hip joint disease application are different, ankylosing spondylitis with stiff hip with acetabular prosthesis diameter (51.38 + 1.70) mm, followed by hip osteoarthritis (50.30 + 2.42) mm, avascular necrosis of the femoral head (50.16 + 2.17) mm, femoral neck fracture (49.26 + 2.13) mm, rheumatoid arthritis (49 + 3.70) mm, acetabular dysplasia using acetabular minimum diameter (48.32 + 2.09) mm. The ankylosing spondylitis Hip joint ankylosis group with other groups, the differences were statistically significant (Table 4) with inflammation; there was a linear correlation between the 6 Application of the acetabular prosthesis size and patient height (R2=0.364), the regression equation is: Y=16.661+0.200X; also had a linear relationship with body weight (R2=0.134), the regression equation is: Y=44.720+0.075X; no correlation between BMI and (r=0.053, P=0.112); (Table 5, table 6, table 7) 7 acetabular prosthesis diameter and height (X1), gender (X2), age (X3), weight (X4) and clinical diagnosis (X5) linear regression relation, and gender factors affect the selection of the most important diameter of acetabular prosthesis and the linear regression equation (Table 8): Y =30.277+0.119X1-1.628X2+0.301X3+0.016 X4+0.15 X5 conclusion: 1 male, with significant female acetabular prosthesis size difference in male than female; 2 different age groups, different side of acetabular prosthesis size had no significant difference; 3 acetabulum The height and size of the prosthesis patients showed a linear correlation between body weight; there was no correlation between BMI.4 hip diseases affecting factors of acetabular cup diameter, ankylosing spondylitis, hip joint stiffness of acetabular prosthesis diameter using large diameter acetabular acetabular dysplasia using small.5 acetabular prosthesis diameter and height, gender age and clinical diagnosis, linear regression relation, gender factors for selection of acetabular prosthesis size is the most important.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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