摘要
背景:随着髋关节置换病例的增加,再次翻修的病例也逐渐增多,偏心距对于翻修手术的要求较高。目的:探讨人工全髋关节翻修术中股骨偏心距的重建方法和影响因素。设计、时间及地点:回顾性分析,于2001-12/2007-12在天津中医药大学第一附属医院完成。对象:选择天津中医药大学第一附属医院、天津市第一中心医院6年间收治的人工股骨头置换术后行全髋关节翻修术患者36例,男15例,女21例,平均年龄68.2岁(64～75岁),初次置换至翻修手术的平均时间为7.8年(5～17年)。按术中是否进行股骨偏心距重建分为股骨偏心距重建组27例,未重建组9例。患者对治疗均知情同意。方法:拍摄患者骨盆正位X射线片,对术后股骨偏心距重建率、髋关节功能Harris评分、初次置换术后和翻修术后股骨矩保留值进行统计学分析。主要观察指标:①股骨矩保留值与股骨偏心距重建的关系。②术前模板设计所选假体与术中假体符合率。③翻修术后髋关节功能优良率比较。结果:术前模板设计所选股骨假体与术中选用假体符合率为80.56%(29/36),股骨偏心距重建率为75.0%(27/36)。股骨偏心距重建组术后髋关节Harris评分明显高于股骨偏心距未重建组(t=2.987,P=0.005)。股骨偏心距重建组髋关节功能优良率明显高于股骨偏心距未重建组(P=0.026)。股骨偏心距重建组、股骨偏心距未重建组初次置换术后和翻修术后股骨矩保留值差异有显著性(t=2.645,P=0.012;t=2.827,P=0.008)。结论:人工全髋关节翻修术中股骨偏心距重建是术后关节功能恢复的重要影响因素,应使用规范、细致的术前测量,减少术中股骨矩的损伤,重建髋关节的软组织平衡。
BACKGROUND： More and more patients undergoing total hip arthroplasty require a revision, and the offset should be highly match the revision.
OBJECTIVE： To investigate the techniques and the factors of recovery and restoration of femoral offset in total hip arthroplasty revision.
DESIGN, TIME AND SETTING： A retrospective analysis was performed in the First Teaching Hospital, Tianjin University of Traditional Chinese Medicine from December 2001 to December 2007.
PARTICIPANTS： A total of 36 cases （15 males and 21 females） underwent failed hemiarthroplasty received the revision of total hip arthroplasty in the First Teaching Hospital, Tianjin University of Traditional Chinese Medicine. The average age was 68.2 years （from 64 to 75 years）. The interval from hemiarthroplasty to revision of total hip arthroplasty was from 5 to 17 years （mean 7.8 years）. Patients were divided into femoral offset restoration group （n=27） and failed restoration group （n=9）. Informed consents were obtained from all patients.
METHODS： The restoration rate of femoral offset and the length of femoral neck after hemiarthroplasty and after revised arthroplasty were measured in the orthophoric hip joint X-ray photograph. Harris evaluation system was used to evaluate joint function. The results were statistically analyzed.
MAIN OUTCOME MEASURES： The relation between restoration rate of femoral offset and the length of femoral neck; coincidence rate between designed prosthesis and operative prosthesis; excellence and good rate of hip joint function after the revision.
RESULTS： The coincidence rate of all cases was 80.56% （29/36）, and the restoration rate was 75.0% （27/36）. Harris evaluation score in the femoral offset restoration group was obviously higher than that in failed restoration group （t=2.987, P=0.005）. The excellence and good rate of hip joint function was also remarkably increase after the revision （P=0.026）. The difference of the length of femoral neck after hemiarthroplasty and after total hip arthroplasty revision was significant statistically between the two groups （t=2.645, P=0.012; t=2.827, P=0.008）.
CONCLUSION： The restoration of femoral offset contributes to the recovery of joint function after total hip arthroplasty revision. It is very important to template both sides of hip preoperatively and protect the femoral neck length operatively for the reconstruction of the hip soft tissue balance.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第39期7623-7626,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
