联合前倾角对髋关节翻修术旋转中心的指导意义

发布时间：2018-04-04 14:49

本文选题：联合前倾角　切入点：垂直偏距　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:随着进入社会老龄化,我国全髋关节置换术(THA)逐年增多,髋关节翻修术数量也呈逐年增多趋势。有效重建恢复髋关节功能、降低并发症是髋关节翻修术的最终目的。在初次全髋关节置换术中,因可利用髋臼横韧带、髋臼缘等解剖标志辅助定位髋臼杯的外展角和前倾角,故可较容易获得满意的假体位置及角度。而对于髋关节翻修病例,往往存在解剖标志的破坏,髋臼及股骨近端结构异常,这使得髋关节翻修术的困难明显增加。因诸多因素存在,难以获得理想的假体“安全区”,难以获得正常的旋转中心。联合前倾角被用于髋关节发育不良的全髋关节置换术,根据该技术,髋关节假体可被安装在较为理想的位置和方向。而未见其在髋关节翻修术中应用的报道。本文回顾性研究联合前倾角在髋关节翻修术中旋转中心的意义,以及预防术后脱位、撞击及松动等的作用。方法:本文回顾性研究自2010,02-2016,02我院行采用联合前倾角技术成功实施髋关节翻修手术15例15髋,年龄38-72岁,平均61.40±8.45岁,其中男性15例10髋,年龄38-72岁,平均年龄60.54±8.78岁;女性2例2髋,年龄分别是66岁和68岁,平均年龄67岁。所有病例均采用联合前倾角技术,根据股骨前倾角调整髋臼前倾角及外展角。术后行CT检查髋臼假体的外展角度、前倾角及联合前倾角。根据骨盆X线平片测量垂直偏距、水平偏距及其与对侧差值。结果:所有患者均得到随访,随访时间1-5年,平均3年。术后CT片检查测得的髋臼外展角度为:27.27±7.81°(20-35°),髋臼前倾角为:16.93±3.63°(13-21°),联合前倾角为:42.87±7.08°(35-50°)。手术组垂直偏距为:3.89±0.42cm,水平偏距为:4.10±0.28cm。对侧或健侧垂直偏距为:4.10±0.44cm,水平偏距为:3.90±0.36cm。术前Harris评分为:41.07±4.65分(37-45分),术后Harris评分为:88.33±2.99分(85-91分)。髋关节功能评分明显改善。其中2例联合前倾角超出安全区,但患者无髋关节明显疼痛,自我感觉手术满意。所有患者均未出现脱位、假体松动及感染。结论:联合前倾角测量技术对髋关节翻修手术有着指导意义。良好的髋臼假体及股骨假体植入角度决定良好的髋关节旋转中心,对髋臼稳定性、降低磨损、防止脱位有着重要意义。但由于该研究纳入的病例数量有限,统计结果有一定的局限性,需要增加病例数,以进一步提高其临床指导作用。
[Abstract]:Objective: with the aging of the society, the total hip replacement (THA) is increasing year by year, and the number of hip revision is increasing year by year.Effective reconstruction and recovery of hip function and reduction of complications are the ultimate goals of hip revision.In the primary total hip arthroplasty, the position and angle of the prosthesis can be easily obtained by using the anatomical markers such as transverse acetabular ligament and acetabular edge to assist in locating the abduction angle and the antegrade angle of the acetabular cup.However, for the revision of the hip, the destruction of anatomic markers and the abnormal structure of the acetabular and proximal femur make the revision of the hip more difficult.Because of many factors, it is difficult to obtain the ideal prosthesis "safe area" and the normal rotation center.Combined anteversion is used in total hip arthroplasty with dysplasia of hip, according to which hip prosthesis can be installed in ideal position and direction.There was no report of its application in hip revision surgery.In this paper, the significance of combined antegrade angle in the rotation center of hip revision and the role of preventing dislocation, impact and loosening after operation were studied retrospectively.Methods: a retrospective study was conducted on 15 hips of 15 patients (38-72 years old, mean 61.40 卤8.45 years old) who underwent revision hip arthroplasty with combined anteversion technique in our hospital from February to February 2012.There were 15 males (10 hips, 38-72 years old) with an average age of 60.54 卤8.78 years.Two hips (66 and 68 years old, mean age 67 years) were found in 2 female patients.The acetabular anteversion and abduction angle were adjusted according to the femoral anteversion.The abduction angle, anteversion angle and combined anteversion angle of acetabular prosthesis were examined by CT.The vertical deviation, horizontal deviation and their difference with the opposite side were measured according to the pelvic X-ray plain film.Results: all patients were followed up for 1-5 years with an average of 3 years.After operation, the acetabular abduction angle measured by CT film was 1: 27.27 卤7.81 掳/ 20 ~ 35 掳/ L, the acetabular anteversion angle was: 1 / 16.93 卤3.63 掳/ 13-21 掳/ m, and the combined anteversion angle was: 1 / 42.87 卤7.08 掳/ v 35-50 掳/ m.In the operation group, the vertical deviation was 3.89 卤0.42 cm and the horizontal deviation was 4.10 卤0.28 cm.The vertical deviation of the contralateral side and the normal side was: 1: 4.10 卤0.44 cm, and the horizontal deviation was: 3. 90 卤0. 36 cm.The preoperative Harris score was 1: 41.07 卤4.65 min, 37-45 min, and the postoperative Harris score was 8% 88.33 卤2.99 min (85-91 min).The score of hip joint function was improved obviously.Two of them had combined antegrade angle beyond the safety zone, but the patients had no obvious pain in hip joint and were satisfied with self-sensory surgery.No dislocation, loose prosthesis and infection were found in all patients.Conclusion: combined antegrade measurement technique is of guiding significance for hip revision surgery.The good angle of acetabular prosthesis and femoral prosthesis determines the rotation center of hip joint, which is of great significance to the stability of acetabular, the reduction of wear and the prevention of dislocation.However, due to the limited number of cases included in the study, the statistical results have some limitations, so it is necessary to increase the number of cases in order to further improve its clinical guidance.
【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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