Hu Yi, Zou Diyang, Sun Qi, Jiang Mengda, Li Huiwu, Tsai Tsung-Yuan, Zhang Jingwei
Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.
Front Bioeng Biotechnol. 2022 Feb 28;10:831647. doi: 10.3389/fbioe.2022.831647. eCollection 2022.
Total hip arthroplasty (THA) for hip dysplasia patients is sometimes complex and compromises pathomorphological changes in these patients. However, it remains unclear whether it is preoperative deformities or postoperative structures or anatomic changes during THA that have the most remarkable correlation with the hip dynamic function during gait. The purpose of this study was to investigate this relationship and propose insights into the surgical reconstruction strategy in patients with developmental dysplasia of the hip. A total of 21 unilateral hip dysplasia patients received computed tomography scans for the creation of 3D hip models before surgery and at the last follow-up. Acetabular and femoral orientations, hip center positions, and femoral length were measured before and after THA. Hip kinematics of the operated side during gait was quantified using a dual fluoroscopic imaging technique. Pearson correlation and multiple linear regression were performed to evaluate the relationship between hip maximum range of motion in six directions and demographics characters and above hip anatomic parameters before and after THA and their changes in surgery. Pearson correlation analysis found significant correlations with the gait range of motion mainly in postoperative structures, including postoperative hip center positions and acetabulum and combined anteversion. Further multiple linear regression indicated that a laterally placed hip center was significantly correlated with an increased internal rotation ( = 0.25, = 0.021), which together with increased postoperative acetabulum anteversion explained 45% of external rotation decreasing ( = 0.004). A proximally placed hip center was correlated with more extension ( = 0.30, = 0.010). No significant demographic characters or preoperative deformities or surgical changes were included into other multiple regression models. Strong correlations between postoperative structures, especially hip center positions and gait range of motion in unilateral hip dysplasia patients after THA were found. It indicated that postoperative prosthesis structures, particularly hip center positions had significant impact on the hip gait motion range and should be treated with particular caution in surgery.
对于髋关节发育不良患者而言，全髋关节置换术（THA）有时较为复杂，且会使这些患者出现病理形态学改变。然而，目前仍不清楚在全髋关节置换术中，究竟是术前畸形、术后结构还是解剖学变化与步态期间的髋关节动态功能具有最为显著的相关性。本研究的目的是探究这种关系，并对发育性髋关节发育不良患者的手术重建策略提出见解。共有21例单侧髋关节发育不良患者在术前及最后一次随访时接受了计算机断层扫描，以创建三维髋关节模型。在全髋关节置换术前后测量髋臼和股骨的方向、髋关节中心位置以及股骨长度。使用双荧光透视成像技术对步态期间患侧的髋关节运动学进行量化。进行Pearson相关性分析和多元线性回归，以评估全髋关节置换术前后髋关节在六个方向上的最大运动范围与人口统计学特征及上述髋关节解剖学参数之间的关系，以及它们在手术中的变化。Pearson相关性分析发现，与步态运动范围存在显著相关性的主要是术后结构，包括术后髋关节中心位置、髋臼及联合前倾角。进一步的多元线性回归表明，髋关节中心位置偏外与内旋增加显著相关（r = 0.25，P = 0.021），术后髋臼前倾角增加与外旋减少45%相关（P = 0.004）。髋关节中心位置偏上与伸展增加相关（r = 0.30，P = 0.010）。其他多元回归模型未纳入显著的人口统计学特征、术前畸形或手术变化。研究发现，术后结构之间存在很强的相关性，尤其是单侧髋关节发育不良患者在全髋关节置换术后的髋关节中心位置与步态运动范围之间的相关性。这表明术后假体结构，特别是髋关节中心位置对髋关节步态运动范围有显著影响，在手术中应特别谨慎对待。
