摘要
[目的]比较分析直接前方入路(direct anterior approach,DAA)支架辅助下DAA与传统后侧入路全髋关节置换术治疗股骨头缺血性坏死术后假体位置的影像学指标。[方法]回顾性分析2017年1月至2020年9月浙江中医药大学附属第一医院收治的80例股骨头缺血性坏死全髋关节置换术患者的临床资料,所有患者均由同一位手术医师进行手术,其中左髋40例、右髋40例,DAA支架辅助下直接DAA 40例(DAA组)、传统后侧入路40例(后路组),分析其术后双髋正位及患髋侧位X线摄片,计算髋臼假体的外展角、前倾角、双侧髋臼旋转轴差值(患髋-健髋)、股骨假体的柄-髓腔轴线夹角、柄-髓腔比以及双侧下肢长度差值(患髋-健髋)。[结果]DAA组前倾角(13.62±4.37)°、后路组(17.67±5.89)°,DAA组小于后路组,差异有统计学意义(P=0.018);DAA组柄-髓腔轴线夹角(-0.40±1.77)°、后路组(-2.28±1.59)°,DAA组小于后路组,差异有统计学意义(P=0.001);DAA组正位柄尖端近侧1cm处的柄-髓腔比(73.20±11.22)%、后路组(63.57±8.52)%,DAA组大于后路组,差异有统计学意义(P=0.004)。此外,髋臼假体的外展角、双侧髋臼旋转轴差值,股骨假体其他位置柄-髓腔比及双侧下肢长度差值两组比较差异无统计学意义(P>0.05)。[结论]在术后影像学评价方面,DAA支架辅助下直接DAA全髋关节置换术治疗股骨头缺血性坏死较传统后侧入路更具优势,尤其在髋臼杯、股骨假体精准置入方面。
[Objective] To compare and analyze the imaging indexes of prosthesis position after direct anterior approach(DAA) stent-assisted direct anterior and traditional posterior total hip arthroplasty in the treatment of avascular necrosis of the femoral head. [Methods] The clinical data of 80 patients with avascular necrosis of the femoral head and total hip arthroplasty in the First Affiliated Hospital of Zhejiang Chinese Medicine University from January 2017 to September 2020 were analyzed retrospectively, and all patients were operated by the same surgeon, including 40 cases of left hip and 40 cases of right hip. There were 40 cases of DAA assisted by DAA stent and 40 cases of traditional posterior approach. The X-ray of both hips and the lateral position of the affected hip were analyzed, and the abduction angle, anterior inclination angle and bilateral acetabular rotation axis difference of the acetabular prosthesis(affected hip minus healthy hip), the angle between the stalk and medullary cavity axis of the femoral prosthesis, the ratio of the stalk to the medullary cavity, and the length difference of the bilateral lower extremities(affected hip minus healthy hip) were calculated.[Results] Anterior inclination angle in DAA group was(13.62±4.37)°, and it was(17.67±5.89)°in posterior approach group, it was smaller in DAA group than posterior approach group, and the difference was statistically significant(P=0.018);the angle between stalk and medullary cavity axis was(-0.40±1.77)°in DAA group, and it was(-2.28±1.59)°in posterior approach group, it was smaller in DAA group than posterior approach group(P=0.001);the stalk to medullary cavity ratio at the proximal1 cm of the tip of the positive stalk was(73.20±11.22)% in DAA group, and it was(63.57±8.52)% in posterior approach group, it was larger in DAA group than posterior approach group(P =0.004). In addition, there was no significant difference in the abduction angle of the acetabular prosthesis, bilateral acetabular rotation axis difference of the acetabular prosthesis, the ratio of the stalk to the medullary cavity and the length difference of the bilateral lower extremities between the two groups(P>0.05).[Conclusion] In postoperative imaging evaluation, direct anterior total hip arthroplasty assisted by DAA stent has more advantages than traditional posterior approach in the treatment of avascular necrosis of the femoral head, especially in the precise placement of acetabular and femoral prosthesis.
作者
田园
季卫锋
汪翔
潘志铖
沈景
TIAN Yuan;JI Weifeng;WANG Xiang(The First Clinical Medical College of Zhejiang Chinese Medical University,Hangzhou(310053),China;The First Affiliated Hospital of Zhejiang Chinese Medical University)
出处
《浙江中医药大学学报》
CAS
2021年第5期512-517,共6页
Journal of Zhejiang Chinese Medical University
基金
国家自然科学基金面上项目(81974576)。
关键词
直接前方入路支架
全髋关节置换术
股骨头缺血性坏死
影像学评价
前倾角
柄-髓腔轴线夹角
柄-髓腔比
DAA stent
total hip arthroplasty
avascular necrosis of the femoral head
imaging evaluation
anterior inclination angle
angle between stalk and medullary cavity axis
the stalk to medullary cavity ratio
