初次全髋关节置换髋臼旋转中心重建与术后功能恢复

发布时间：2018-07-17 00:41

【摘要】：背景:随着经济的高速发展,人们生活方式的改变及人口老龄化程度加快,股骨头坏死、髋关节骨性关节炎及股骨颈骨折等髋关节病变的发生率也逐年上升。全髋关节置换术可以截去引起病人疼痛和活动受限的病变关节,用耐磨的人工关节替换发生病变的髋关节,很好的减轻病人的疼痛,重建了髋关节活动功能,受到广大临床医生的推崇。对成功的全髋关节置换术来说,重建髋臼的旋转中心是十分重要的[1],而且随着全髋关节置换术开展的越来越多,也越来越引起业内同行的关注。本文就非骨水泥假体行初次全髋关节置换术,术中旋转中心的重建对病人术后髋关节功能恢复的影响进行验证及讨论。方法:本课题为回顾性研究,选择的研究对象均为大连医科大学附属第二医院关节外科的住院病人,所有病人均在住院期间接受了单侧的全髋关节置换,所有病人都是2014年1月到2016年1月期间在我院住院的病人,总共有87个病人被纳入本次课题,其中有72个病人患有严重的股骨头坏死,还有15个病人患有严重的髋关节骨性关节炎,本课题主要想探讨全髋关节置换术后旋转中心发生较小的偏移是否会对术后髋关节的功能恢复产生影响,因此所有病人按术后髋臼旋转中心是否重建分为髋臼重建组A(62例)和髋臼未重建组B(25例)。所有的病人均有较重的疼痛伴不同程度的活动受限,生活质量均明显下降,均有明确的全髋关节置换术的适应症。所有病人查无明显禁忌症后,向患者及家属交代手术风险并签署手术同意书。由我院关节外科全髋关节置换经验丰富的主任医师主刀进行手术,所有病人使用的假体均为非骨水泥假体,都为初次人工全髋关节置换。患者术前、术后均摄标准骨盆正位片来确定旋转中心是否得到重建(假体旋转中心在解剖旋转中心5mm内即视为重建),患者随访时间为6--30个月,平均为18个月。通过对患者术前及末次随访时的Harris评分来评定患者髋关节功能恢复情况。比较两组患者术前及末次随访时Harris髋关节功能评分,并通过SPSS软件对数据进行分析,得出结论。结果:经过SPSS软件分析,末次随访时两组患者的Harris髋关节评分均较术前有显著的提高,且髋臼旋转中心重建者较未重建者更高,且差异具有统计学意义。结论:有严重疼痛伴活动受限的股骨头坏死病人及髋关节骨性关节炎病人,经过全髋关节置换术后,病人的疼痛得到了极大的减轻甚至完全消失,髋关节的伸曲旋转等各方向的活动范围得到了明显的提高,经过一段时间的康复,行走步态也接近甚至达到正常人水平,病人的生活质量得到了显著的提高。所以,全髋关节置换术是一种卓有成效的手术方式[2],是髋关节中晚期病变患者的福音。成功的全髋关节置换术应包括充足的术前准备和精准的手术操作,其中准确的重建髋关节的旋转中心对成功的全髋关节置换术中有重要意义[3],因为旋转中心的解剖重建可以产生较小的关节应力[4],有利于恢复髋关节周围的力学环境,可以得到较稳定的髋关节,因此术后经过相同康复训练可以获得更好的髋关节功能改善,患者满意度也更高,因此旋转中心的重建在全髋关节置换术中占有越来越重要的地位,如果其他因素不变的情况下,髋关节的功能恢复将从解剖重建的旋转中心中得到较大的收益。那么如何对旋转中心进行精准的重建,为了达到这个目的,需要医生术前对旋转中心进行精准的定位、手术计划尽可能详尽完善、术中仔细定位与认真的操作。由于本研究为回顾性研究,且样本量较小,组间人数差距较大,说服力不如前瞻性大样本试验,并且随访时间相对较短,只能对近期结果进行研究。缺乏远期的数据例如:晚期髋关节功能、人工髋关节的磨损率、松动率、假体寿命等数据未能纳入本试验。只能对早期的关节功能进行评价,后续的工作需要更长时间的随访以及更多的患者来进行进一步临床研究。
[Abstract]:Background: with the rapid development of economy, people's lifestyle changes and population aging, femoral head necrosis, hip osteoarthritis and femoral neck fracture and other hip joint lesions have increased year by year. Total hip arthroplasty can cut off the pain and limited movement of the joint, with wear-resistant artificial prosthesis. Joint replacement of the diseased hip joint is a good way to relieve the pain of the patient and rebuild the function of the hip joint. It is highly respected by the clinicians. For the successful total hip replacement, the reconstruction of the rotation center of the acetabulum is a very important [1], and as more and more hip arthroplasty has been carried out, it is becoming more and more important. In this paper, the effect of the primary total hip replacement on the non bone cement prosthesis and the effect of the reconstruction of the rotation center on the postoperative recovery of the hip joint were verified and discussed. Methods: the subject was a retrospective study, and the selected subjects were all hospitalized patients in the Second Affiliated Hospital of Dalian Medical University. All patients received unilateral total hip replacement during hospitalization. All patients were hospitalized in our hospital from January 2014 to January 2016. A total of 87 patients were included in the subject, of which 72 were suffering from severe femoral head necrosis and 15 patients suffered severe hip osteoarthritis. The main purpose of the study was to investigate whether the minor deviation of the rotation center after total hip replacement would affect the functional recovery of the hip joint, so all patients were divided into the acetabular reconstruction group A (62 cases) and the acetabular non reconstruction group B (25 cases) according to the reconstruction of the acetabular rotation center after the operation. All patients had heavier pain and different degrees. There was a clear reduction in the quality of life and a clear indication of total hip arthroplasty. After all patients without contraindications, the patients and their families were presented with the operation risk and signed the operation consent. All prostheses were non bone cement prostheses for the first time artificial total hip replacement. Before surgery, a standard pelvis was taken to determine whether the center of rotation was rebuilt (the center of the rotation of the prosthesis was rebuilt in the anatomical rotation center 5mm). The patient was followed up for a period of 6--30 months, averaging 18 months. The Harris score was used to evaluate the recovery of hip joint function. The Harris hip joint function score was compared between the two groups before and after the last follow-up, and the data were analyzed by the SPSS software. Results: after the SPSS software analysis, the Harris hip scores of the two groups were significantly higher than those before the operation. High, and the reconstruction of acetabular rotation center is higher than that of the non rebuilt, and the difference is statistically significant. Conclusion: the patients with severe pain with limited activity of the femoral head and hip osteoarthritis, after total hip replacement, the patient's pain has been greatly reduced or even completely disappeared, the hip joint extension rotation and so on. The range of activities in all directions has been obviously improved. After a period of rehabilitation, the walking gait is close to even the normal level. The quality of life of the patient has been significantly improved. Therefore, total hip arthroplasty is an effective surgical method, [2], the gospel of the patients with middle and late hip lesions. Joint replacement should include adequate preoperative preparation and accurate operation, in which accurate reconstruction of the hip rotation center is important for successful total hip replacement ([3]), because the anatomical reconstruction of the rotation center can produce a smaller joint stress [4], which is beneficial to the recovery of the mechanical environment around the hip joint and can be obtained. A more stable hip joint, so after the same rehabilitation training, can achieve better hip function improvement and higher patient satisfaction. Therefore, the reconstruction of the center of rotation plays an increasingly important role in total hip replacement. If other factors are constant, the recovery of the hip joint function will be rotated from the anatomical reconstruction. In order to achieve this goal, it is necessary for the doctor to accurately locate the center of rotation, the operation plan is as detailed as possible, the operation is carefully positioned and the operation is careful. Because this research is a retrospective study, the sample size is small and the number of groups is poor. Greater distance, less persuasive force than prospective large sample trials and relatively short follow-up, only a relatively short follow-up time, only a study of recent results. Data such as late hip joint function, artificial hip wear rate, loosening rate, and prosthesis life were not included in this test. Work requires longer follow-up and more patients for further clinical studies.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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