从髋翻修术中分析双下肢不等长影响因素及处理方法

发布时间：2018-05-27 13:39

本文选题：髋关节翻修术 + 双下肢不等长　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的:在全髋关节置换术(THA)后,双下肢不等长(LLD)已经成为患者不满意的主要因素,并且是术后诉讼的主要原因,翻修术前患者大多存在LLD,纠正LLD也是翻修手术需要解决的重要问题。我们从髋关节翻修术中分析下肢不等长的来源,研究每个因素的可处理性和处理方式,在临床中以此为参考,更好的做到双下肢长度的平衡。方法:通过病历系统及影像学系统收集2014年10月至2016年10月我院病房收治及骨科门诊随访的THA术后行髋关节翻修术的病例、影像学资料及随访资料,并整理分析。根据预先设定的纳入标准、剔除标准筛选研究对象,对纳入研究内的患者进行定期随访,随访内容主要为髋关节功能评分及影像学资料。我们将LLD的来源分为髋臼侧、股骨侧和关节间隙三大部分以及外展角、前倾角、髋臼最下点至泪点连线的垂直距离差、股骨偏心距、FCR(FCR)至经大粗隆顶点水平线的垂直距离差,FCR至经小粗隆凸点水平线的垂直距离差、经髋臼旋转中心(ACR)和FCR俩条水平线的垂直距离差等多个因素及评价指标,然后测量术前及术后双下肢长度总差值以及每个因素的差值,根据统计数据对下肢长度及各因素进行相关分析,髋关节Harris评分和每个因素采用t检验以分析术前术后是否有差异。每个因素和双下肢总差异的术前术后差值采用多组线性回归的统计方法,分析LLD的来源、每个因素所占比例、可处理性以及处理方式。对纳入患者根据自愿原则分为两组,术后一周一组运用中医“理筋”手法,另一组对照,对两周后髋关节Harris评分进行统计分析,评价其临床疗效。结果:本研究共筛选35例患者,均获得随访,随访时间为14-47个月,平均随访25.9个月。翻修前Harris评分为12-57分,平均为(36.9±3.2)分。髋关节Harris评分为72-95分,平均为(90.3±3.5)。翻修前后双下肢长度总差值统计学比较,差值有显著性意义。每个部分的各种因素翻修术前术后的统计学比较中,外展角和前倾角差异无统计学意义(p0.05),髋臼最下点至泪点连线的垂直距离差、股骨偏心距、FCR至经大粗隆顶点水平线的垂直距离差,FCR至经小粗隆凸点水平线的距离差具有统计学意义(p0.05),其中股骨侧因素所占比例较其它大(FCR至经小粗隆凸点水平线的垂直距离差有27例术前术后变化),在每个因素和双下肢总差异的术前术后变化多组线性回归分析中,股骨侧的FCR至经小粗隆中点水平线的垂直距离术前术后的差值与双下肢总差异的术前术后差值存在线性关系(t=3.352,p=0.003)。运用中医“理筋”手法组12例,对照组13例,两周后髋关节Harris评分差异有统计学意义(p0.05)。结论:我们将LLD的来源分为髋臼侧、股骨侧和关节间隙三大部分以及多个因素能够帮助在临床中有目的的去分析LLD的原因。我们在翻修手术中为了纠正LLD,主要关注髋臼下缘至泪点连线的垂直距离、股骨偏心距、FCR至经小粗隆中点水平线的垂直距离这些主要影响下肢的因素,其中股骨侧因素出现几率高,可处理性强,可作为调整下肢长度主要考虑对象。术后运用中医“理筋”手法对髋关节功能恢复有良好作用。
[Abstract]:Objective: after total hip replacement (THA), the dissatisfaction of the lower limbs (LLD) has become the main factor of dissatisfaction of the patients, and it is the main cause of the postoperative procedure. Most of the patients before the refurbishment of the operation are LLD, and the correction of LLD is an important problem to be solved for the refurbishment operation. The treatment and treatment of each factor can be used as a reference for the balance of the length of the lower extremities. Methods: through the medical records system and the imaging system, the cases, imaging data and follow-up data of the hip arthroplasty after THA from October 2014 to October 2016 in our hospital ward and Department of orthopedics are collected. According to the predefined inclusion criteria, the standard screening subjects were eliminated, and the patients included in the study were followed up regularly. The follow-up contents were mainly the hip function score and the imaging data. We divided the LLD sources into the acetabular side, the femur side and the joint space three most and the abductor angle, the pretilt angle, the acetabulum most The vertical distance difference between the lower point and the tear point line, the femur eccentricity, the vertical distance difference between FCR (FCR) and the horizontal line of the great trochanter, the vertical distance difference between FCR to the horizontal line of the small trochanter point, the vertical distance difference between the acetabular rotation center (ACR) and the horizontal line of the FCR, and the evaluation index, and then measure both the two lower limbs before and after the operation. The total difference of length and the difference of each factor, the correlation analysis of the length and factors of the lower extremities according to the statistical data, the Harris score of the hip joint and the t test for the analysis of whether there were differences before and after the operation. The statistical method of multiple linear regression for the difference between the preoperative and postoperative of each factor and the total difference of the lower limbs was used to analyze the LLD The proportion of each factor, the proportions of each factor, the disposition and the way of treatment. According to the voluntary principle, the patients were divided into two groups according to the voluntary principle. After the one Monday group, the traditional Chinese medicine "tendons" technique was used, and the other group was compared, and the Harris score of the hip joint was statistically analyzed after two weeks. Results: the results of this study were selected in 35 patients. The follow-up time was 14-47 months with an average follow-up of 25.9 months. The Harris score was 12-57 minutes before refurbishment, with an average of (36.9 + 3.2) points. The Harris score of the hip joint was 72-95, the average was (90.3 + 3.5). The difference between the two lower limbs' length was statistically significant before and after the refurbishment. The difference between the various factors of each part refurbished the statistics before and after the operation. In comparison, the difference between the abduction angle and the front tilt angle was not statistically significant (P0.05), the vertical distance difference between the lowest point of the acetabulum to the tear point line, the femur eccentricity, the vertical distance between the FCR to the vertex horizontal line of the great trochanter, and the distance difference between FCR and the horizontal line of the small trochanter point had statistical significance (P0.05), and the proportion of the femur side factors was larger than that of the others. (FCR to 27 cases of preoperative and postoperative changes in the vertical distance difference between the horizontal line of the small trochanter point). In the multiple linear regression analysis of the preoperative and postoperative changes in the total difference between each factor and the lower limbs, the difference value between the FCR to the vertical distance of the femur side to the middle point of the midpoint of the trochanter and the difference between the two lower limbs and the total difference of the lower limbs was on line. T=3.352 (p=0.003). 12 cases and 13 cases in the control group were used in the group of traditional Chinese medicine and 13 cases in the control group. The Harris score of the hip joint was statistically significant (P0.05) after two weeks. Conclusion: we divide the origin of LLD into the acetabular side, the femur side and the joint space, and many factors can help to analyze the cause of LLD in clinical. In order to correct LLD during the refurbishment operation, we mainly focus on the vertical distance from the lower margin of the acetabulum to the tear point line, the femur eccentricity, the vertical distance from the FCR to the midpoint of the midpoint of the trochanter, which mainly affect the lower extremities, among which the side factors of the femur are high, and the treatment is strong, and can be considered as the main object for adjusting the length of the lower extremity. The use of Chinese medicine "tendon reinforcement" has a good effect on the recovery of hip joint function.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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