全髋关节置换术患者的股骨近端髓腔形态与假体周围骨折发病率的相关性分析

发布时间：2018-04-24 11:31

本文选题：全髋关节置换术 + 股骨近端髓腔形态　；参考：《山东中医药大学》2017年硕士论文

【摘要】：目的:观察实施全髋关节置换术治疗患者的股骨近段髓腔形态和假体周围骨折发生情况之间的相关性,统计总结在实施全髋关节置换术中、术后出现假体周围骨折的发病因素、发病机制以及骨折类型。以期通过患者近端髓腔形态预判假体周围骨折的可能性,指导人工全髋关节置换术中假体的选择最终提升全髋关节置换的治疗效果以及治疗安全性。方法:收集我校各临床学院自2010年6月到2016年5月6年内行人工全髋关节置换术的患者的病例,选取成功回访,并且资料齐全的患者,利用随机分配原则,选取500例,利用X线影像学图片,收集并统计术中假体类型的选择、髓腔形态,统计术中、术后假体周围骨折的发生情况,并利用统计学软件对相关因素进行分析,从而分析股骨近端髓腔形态不同的患者的术中、术后假体周围骨折发病率。结果:1.患者总量为500例,男女分别为340例和160例,年龄在41-86岁,平均69.85±8.74岁。所有患者的影像学检查显示,正常髓腔患者占比80%(400例),烟囱型患者占比11%(55例),倒香槟型患者占比9%(45例)。男性患者中正常髓腔占比80.88%(275例),倒香槟型占比8.82%(30例),烟囱型占比10.29%(35例)。女性患者中正常髓腔占比78.12%(125例),倒香槟型占比9.37%(15例),烟囱型占比12.5%(20例)。2.在本次研究中,假体周围骨折的发生率为4%,包括10例女性和10例男性患者。男性患者平均年龄为75.36±3.51岁,女性患者平均年龄为70.23±5.42岁。在这20例患者中,倒香槟型8例(男3、女5),烟囱型8例(男5、女3),正常型4例(男2、女2)。各型的假体周围骨折发病率分别为:正常型1%,烟囱型14.55%,倒香槟型17.78%。通过统计学分析,女性患者发病率明显高于男性,烟囱型及倒香槟型患者的发病率明显高于正常型患者,差异均有统计学意义(P0.05)。结论:在对患者实施全髋关节置换术治疗时,女性患者的假体周围骨折发生率明显高于男性患者;而在股骨近端髓腔形态方面,倒香槟型和倒烟囱型髓腔形态患者在假体周围骨折发生率方面明显高于正常髓腔型患者;老年患者假体周围骨折的发生率明显高于年轻患者。因此在临床实施全髋关节置换术治疗时,需要关注患者性别、股骨近端髓腔形态,选择合适的假体,在手术中进行针对性的处理,对非正常髓腔形态、高龄或女性患者行人工髋关节置换时,尽量选择尽可能合适的假体,避免假体周围骨折对患者造成进一步更加严重的影响。
[Abstract]:Objective: to observe the correlation between the morphology of proximal femoral medullary cavity and the occurrence of periprosthetic fractures in patients undergoing total hip arthroplasty, and to summarize the causes of periprosthetic fractures after total hip arthroplasty. Pathogenesis and fracture type. In order to predict the possibility of periprosthetic fracture by the shape of proximal medullary cavity, to guide the choice of prosthesis in total hip arthroplasty and to improve the therapeutic effect and safety of total hip replacement. Methods: the cases of patients undergoing total hip arthroplasty from June 2010 to May 2016 were collected, and 500 patients with complete data were selected according to the principle of random distribution. The selection of prosthesis type, the shape of medullary cavity, the occurrence of periprosthetic fractures during and after operation were collected and counted by X-ray images, and the related factors were analyzed by statistical software. The incidence of periprosthetic fracture in patients with different proximal femoral medullary cavity was analyzed. The result is 1: 1. The total number of patients was 500, 340 cases of male and 160 cases of male and female, the age was 41-86 years old, the average age was 69.85 卤8.74 years old. The imaging examination of all the patients showed that there were 400 cases of normal medullary cavity, 1155 cases of chimney type and 9 cases of inverted champagne type. There were 275 cases of normal medullary cavity in male patients, 30 cases of inverted champagne type and 10.29% of chimney type. Among the female patients, the normal medullary cavity was 78.12 in 125 cases, the inverted champagne type was 9.37 and the chimney type was 12.50.2. In this study, the incidence of periprosthetic fractures was 4, including 10 women and 10 men. The average age of male patients was 75.36 卤3.51 years old, and that of female patients was 70.23 卤5.42 years old. Among the 20 cases, 8 cases were champagne type (male 3, female 5), chimney type 8 (male 5, female 3), normal type 4 cases (male 2, female 2). The incidence of periprosthetic fractures were normal type 1, chimney type 14.55 and champagne type 17.78. By statistical analysis, the incidence of female patients was significantly higher than that of men, and the incidence of chimney type and inverted champagne type patients was significantly higher than that of normal type patients, and the difference was statistically significant (P 0.05). Conclusion: the incidence of periprosthetic fractures in female patients is significantly higher than that in male patients, but in the shape of proximal femoral medullary cavity, the incidence of periprosthetic fracture in female patients is significantly higher than that in male patients. The incidence of periprosthetic fracture in the patients with inverted champagne and chimney was significantly higher than that in the normal medullary cavity, and the incidence of periprosthetic fracture in the elderly was significantly higher than that in the young. Therefore, in the clinical implementation of total hip arthroplasty, attention should be paid to the gender of the patient, the shape of the proximal femoral medullary cavity, the selection of the appropriate prosthesis, the targeted treatment during the operation, and the abnormal shape of the medullary cavity. In order to avoid the more serious effect of periprosthetic fracture, we should try to choose the most suitable prosthesis when the elderly or female patients underwent artificial hip replacement.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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