[骨性强直髋关节全髋关节置换术中髋臼方向确定及准确性的研究]

Fu Yingxu, Yang Desheng, Cao Li, Guo Wentao

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Apr;29(4):426-30.

OBJECTIVE

To explore the method of acetabular orientation determination in total hip arthroplasty (THA) for bony ankylosed hip and the accuracy of the postoperative evaluation.

METHODS

Between January 2009 and March 2013, 33 consecutive patients (49 hips) underwent THA. There were 25 males and 8 females with a mean age of 35.8 years (range, 18-69 years). The left hip was involved in 10 cases, the right hip in 7 cases, and bilateral hips in 16 cases. The causes were ankylosing spondylitis in 18 patients, tuberculosis in 6 patients, traumatic arthritis in 6 patients, osteoarthritis in 2 patients, and suppurative infection in 1 patient. The disease duration was 7-15 years with an average of 10.8 years. The acetabular orientation was determined with periacetabular bone marks (the upper margin of the obturator foramen, acetabular notch etc.) and soft tissue signs (acetabulum transverse ligament etc.). The hip or pelvic radiograph was taken to measure the acetabular prosthesis anteversion and abduction angle, and upward or downward, inward or outward acetabular migration degree. The acetabular anteversion angle of 15 degrees, the abduction angle of 45 degrees, and upward or downward, inward or outward acetabular migration degree of 0 served as a reference value to evaluate the accuracy of acetabular position.

RESULTS

There was no complications of neurovascular injury, fracture, joint dislocation, and infection. All of patients were followed up 13-63 months (mean, 30.3 months). The anteversion angle and abduction angle were (13.904 +/- 4.034) degrees and (42.898 +/- 7.474) degrees at last follow-up, showing no significant difference when compared with reference value (t=1.386, P=0.178; t=1.969, P=0.055). The inward or outward and upward or downward acetabulum migration degree were (2.530 +/- 2.261) mm and (3.886 +/- 3.334) mm respectively, showing significant differences when compared with reference value (t=7.830, P=0.000; t=8.159, P=0.000); it was less than 5 mm in 29 hips, 5-10 mm in 18 hips, and more than 10 mm in 2 hips; the acetabulum center coincidence rate was 59.2%.

CONCLUSION

For bony ankylosed hip having loss of normal anatomy structure, intraoperative residues and permanent anatomical structure should be used for acetabular positioning.

目的

探讨强直性髋关节全髋关节置换术（THA）中髋臼定位方法及术后评估的准确性。

方法

2009年1月至2013年3月，连续33例患者（49髋）接受THA。其中男性25例，女性8例，平均年龄35.8岁（18 - 69岁）。左髋10例，右髋7例，双侧髋16例。病因包括强直性脊柱炎18例，结核6例，创伤性关节炎6例，骨关节炎2例，化脓性感染1例。病程7 - 15年，平均10.8年。通过髋臼周围骨标志（闭孔上缘、髋臼切迹等）和软组织标志（髋臼横韧带等）确定髋臼方向。拍摄髋关节或骨盆X线片测量髋臼假体前倾角和外展角，以及髋臼向上或向下、向内或向外的移位程度。以髋臼前倾角15°、外展角45°以及髋臼向上或向下、向内或向外移位程度为0作为参考值评估髋臼位置的准确性。

结果

无神经血管损伤、骨折、关节脱位及感染等并发症。所有患者随访13 - 63个月（平均30.3个月）。末次随访时前倾角和外展角分别为（13.904±4.034）°和（42.898±7.474）°，与参考值比较差异无统计学意义（t = 1.386，P = 0.178；t = 1.969，P = 0.055）。髋臼向内或向外、向上或向下的移位程度分别为（2.530±2.261）mm和（3.886±3.334）mm，与参考值比较差异有统计学意义（t = 7.830，P = 0.000；t = 8.159，P = 0.000）；29髋移位小于5mm，18髋移位5 - 10mm，2髋移位大于10mm；髋臼中心符合率为59.2%。