Sun Hong, Fang Shuying, Yang Zibo, Zhang Zhiqi, Kang Yan, Zhang Ziji, Liao Weiming, Fu Ming, Wu Peihui
Department of Joint Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510080, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Nov 8;30(11):1349-1353. doi: 10.7507/1002-1892.20160276.
To investigate the influence of the degree of acetabular deformity and the learning-curve on the acetabular cup positions in total hip arthroplasty (THA) for adults with developmental dysplasia of hip (DDH).
Between January 2008 and December 2015, 130 patients (144 hips) with DDH underwent primary THA, and the clinical data were analyzed retrospectively. Fifty-three patients (59 hips) were admitted before 2012, and 77 patients (85 hips) were treated after 2012. There were 32 males and 98 females, aged from 31 to 83 years (mean, 61). Unilateral replacement was performed in 116 cases and bilateral replacement in 14 cases. Of 144 hips, 48 hips were rated as Crowe type I, 57 hips as type II, and 39 hips as type of III/IV. The standard pelvic radiograph was taken within 1 week after operation. The mediCAD software was adopted to measure the angle of anteversion and abduction, bony coverage, and the distance between true rotating center and optimal rotating center to the connection of teardrops and the horizontal distance between two centers to evaluate the qualified rate of acetabular cup positions.
Compared with the patients with the same type in 2013-2015 group, the anteversion angle and qualified rate of acetabular cup position significantly decreased in patients with Crowe I (<0.05); the horizontal distance significantly increased and qualified rate of acetabular cup position significantly decreased in patients with Crowe II (<0.05); and the anteversion angle significantly decreased and the horizontal distance significantly increased in patients with Crowe III/IV (<0.05) in 2008-2012 group. But no significant difference was shown in the other indexes (>0.05). In all Crowe types, the vertical distance between the true rotating center and the optimal rotating center increased with the degree of acetabular deformity in both 2008-2012 group and 2013-2015 group, showing significant difference (<0.05), but no significant difference was found in the other indexes (>0.05).
For adults with acetabular dysplasia, there are high potential risks for unsatisfactory acetabular cup positions during primary THA. So it is necessary to evaluate acetabular deformities and to sum up operative experience so as to improve the accuracy of cups installation.
探讨髋臼畸形程度及学习曲线对发育性髋关节发育不良（DDH）成年患者全髋关节置换术（THA）中髋臼杯位置的影响。
回顾性分析2008年1月至2015年12月期间130例（144髋）DDH患者初次行THA的临床资料。2012年前收治53例（59髋），2012年后治疗77例（85髋）。男32例，女98例，年龄31～83岁（平均61岁）。单侧置换116例，双侧置换14例。144髋中，Crowe I型48髋，II型57髋，III/IV型39髋。术后1周内拍摄标准骨盆X线片。采用mediCAD软件测量前倾角、外展角、骨质覆盖情况、真旋转中心与最佳旋转中心至泪滴连线的距离以及两中心之间的水平距离，以评估髋臼杯位置的合格率。
与2013 - 2015年组相同类型患者相比，2008 - 2012年组中，Crowe I型患者髋臼杯前倾角及位置合格率显著降低（<0.05）；Crowe II型患者水平距离显著增加，髋臼杯位置合格率显著降低（<0.05）；Crowe III/IV型患者前倾角显著降低，水平距离显著增加（<0.05）。但其他指标差异无统计学意义（>0.05）。在所有Crowe类型中，2008 - 2012年组和2013 - 2015年组真旋转中心与最佳旋转中心的垂直距离均随髋臼畸形程度增加而增大，差异有统计学意义（<0.05），但其他指标差异无统计学意义（>0.05）。
对于髋臼发育不良的成年患者，初次THA时髋臼杯位置不满意的潜在风险较高。因此，有必要评估髋臼畸形并总结手术经验，以提高髋臼杯安装的准确性。
