髋关节骨性强直行全髋关节置换术中髋臼方位的确定及其准确性研究

发布时间：2018-03-26 12:27

本文选题：髋关节　切入点：骨性强直　出处：《新疆医科大学》2015年硕士论文

【摘要】：目的:探讨骨性强直的髋关节在全髋关节置换术(total hip arthroplasty,THA)中髋臼方位的确定方法及其术后X线的准确性评价。方法:2009年1月至2015年3月期间在我院骨科中心接受初次THA(骨性及软组织解剖标记联合定位)的髋关节骨性强直患者中筛选32例(49髋),其中男25例,女7例;单侧15例,双侧17例;BMI为(25.5±3.7)kg/m2;年龄18~69岁,平均(35.8±12.7)岁。病因:强直性脊柱炎18例,结核6例,创伤5例,骨性关节炎2例,化脓性感染1例。术后运用PACS系统软件测量骨盆正位片髋臼的前倾角、外展角、股骨偏心距(femoral offset,FO)及髋臼中心(acetabular center,AC)位置。并以前倾角15°、AC偏移度为0作为参考值评价前倾角及AC偏移度的准确性,同时将术后外展角及FO分别与健侧比较以判断其准确性。所选病例中无骨盆及严重腰椎畸形改变。结果:32例患者均完成随访,随访时间13~63个月,平均(30.3±14.7)月。术后骨性强直髋患者的髋臼前倾角与放置目标值(前倾角15°)相比在统计学上无显著差异(P=0.630)。髋臼假体外展角、FO与健侧髋臼解剖外展角、FO相比差异无统计学差异(P=0.233,P=0.168),髋臼假体垂直偏移度平均(2.1±3.6),水平偏移度平均(0.4±3.2),术后髋臼假体中心与髋臼解剖中心符合率73.5%(符合率:偏差在5mm以内者认为达到AC解剖复位)。结论:对于丧失正常解剖结构的骨性强直的髋关节,充分利用术中残留的骨性及软组织解剖标记结构进行髋臼定位的策略是能够比较准确的定位髋臼。
[Abstract]:Objective: to investigate the determination of acetabular orientation in total hip arthroplasty (THAs) of hip joints with osteotonic ankylosis and to evaluate the accuracy of postoperative X-ray. Methods: from January 2009 to March 2015, the patients received initial treatment in the orthopedic center of our hospital from January 2009 to March 2015. 32 cases (25 males) with osteotropic ankylosis of hip joint were screened by THA (bone and soft tissue anatomical markers combined localization). Female 7 cases, unilateral 15 cases, bilateral 17 cases with BMI of 25.5 卤3.7 kg / m2; age 1869 years, mean 35.8 卤12.7 years old. Etiology: ankylosing spondylitis 18 cases, tuberculosis 6 cases, trauma 5 cases, osteoarthritis 2 cases, the etiology: ankylosing spondylitis 18 cases, tuberculosis 6 cases, trauma 5 cases, osteoarthritis 2 cases. 1 case of suppurative infection. The anteversion and abduction angle of the acetabular were measured by PACS system software after operation. The position of femoral eccentricity and acetabular center of Acetabular center-ac). The accuracy of anteversion angle and AC deviation was evaluated with the reference value of 15 掳AC deviation of 15 掳anteversion angle as the reference value. At the same time, the postoperative abduction angle and FO were compared with the healthy side to determine the accuracy. There were no pelvic or severe lumbar deformity changes in the selected cases. Results all 32 cases of the patients were followed up for 13 ~ 63 months. There was no statistical difference between the acetabular anteversion angle (15 掳) and the placement target value (15 掳). There was no statistical difference between the acetabular extension angle FO and the contralateral acetabular abduction angle (FO). The average vertical deviation and horizontal deviation of acetabular prosthesis were 2.1 卤3.6 and 0.4 卤3.2, respectively. The coincidence rate between acetabular prosthesis center and acetabular anatomic center was 73.5% (coincidence rate: deviation within 5mm). Conclusion: for loss of acetabular prosthesis and acetabular anatomic center, AC anatomical reduction is achieved. The bony ankylosis of the hip joint with abnormal anatomical structure, The strategy of acetabular localization is to make full use of the remaining bone and soft tissue anatomical markers to locate the acetabulum accurately.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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