摘要
目的 报告一种新的人工全髋关节置换术(total hip arthroplasty,THA)偏心距参数——大转子偏心距(greater trochanter offset,GTO),基于临床资料分析该参数的有效性及可行性。方法 以2016年1月—2020年5月收治且符合选择标准的47例患者作为研究对象,THA术前设计以总体偏心距(global offset,GO)作为偏心距参数。首先,基于患者术后1年标准骨盆正位X线片,由同一观察者于不同时间点以及由两名观察者分别测量GTO,统计分析GTO的复测信度及观察者间信度;然后,以术侧与健侧差值在±5 mm内定义为GTO重建,将47例患者分为重建组与非重建组,记录并比较两组患者一般情况(年龄、性别、骨折类型及侧别、受伤至手术时间)、疼痛视觉模拟评分(VAS)、Harris评分及步态评分、双下肢长度差异(leg length discrepancy,LLD)。然后,对2020年6月—12月拟行THA的21例患者,以GTO作为偏心距参数进行术前设计。比较以GO(GO组)、GTO(GTO组)进行术前设计的患者临床资料,探讨GTO用于THA的可行性。结果 统计分析显示GTO具有良好的复测信度(P<0.001)以及观察者间信度(P<0.001)。GTO重建组、非重建组间以及GO组及GTO组间比较,患者性别、年龄、骨折分型及侧别、受伤至手术时间、术前VAS评分以及术后1年LLD差异均无统计学意义(P>0.05);GTO重建组术后1年Harris评分及步态评分、手术前后VAS评分差值均优于非重建组,以上指标GTO组均优于GO组(P<0.05)。GTO达重建标准者GO组23例(48.9%)、GTO组19例(90.5%),差异有统计学意义(χ^(2)=10.606,P=0.001)。GO达重建标准者GO组25例(53.2%)、GTO组13例(61.9%),差异无统计学意义(χ^(2)=0.447,P=0.504)。LLD达重建标准者GO组34例(72.3%)、GTO组19例(90.5%),差异无统计学意义(χ^(2)=2.777,P=0.096)。结论 GTO具有可靠的复测信度与观察者间信度,可作为THA术前计划偏心距参数指导术中偏心距与肢体长度重建,术后可获得较好疗效。
Objective To report a new offset parameter for total hip arthroplasty(THA)—greater trochanter offset(GTO), and analyze the effectiveness and feasibility of this parameter based on clinical data. Methods The47 patients who met the selection criteria and admitted between January 2016 and May 2020 were selected as the research object. The global offset(GO) was used as the offset parameter in preoperative design. Firstly, the test-retest reliability and inter-rater reliability of GTO were analyzed based on pelvic X-ray films. The GTO reconstruction was defined as the difference between the operative side and the healthy side within ±5 mm, and 47 patients were divided into the reconstruction group and the non-reconstruction group. General data(age, gender, type and side of fracture, the interval between injury and operation), visual analogue scale(VAS) score, Harris score, gait score, and leg length discrepancy(LLD) were recorded and compared between two groups. Then, the GTO was used as the offset parameter in preoperative design of 21 patients(GTO group) admitted between June 2020 and December 2020. The pre-and post-operative clinical data were compared between GTO group and GO group to explore the feasibility of GTO for THA. Results Statistical analysis showed that GTO had good test-retest reliability(P<0.001) and inter-rater reliability(P<0.001). There was no significant difference in gender, age, type and side of fracture, the interval between injury and operation, preoperative VAS score, and LLD at 1 year after operation between the GTO reconstruction group and the non-reconstruction group,as well as between the GO and GTO groups(P>0.05). The Harris score and gait score at 1 year after operation, and difference of VAS score between pre-and post-operation in the reconstruction group and GTO group were significantly better than those in the non-reconstruction group and GO group, respectively(P<0.05). There were 23 cases(48.9%) in the GO group and 19 cases(90.5%) in the GTO group with GTO reconstruction, and the difference was significant(χ^(2)=10.606, P=0.001). There were 25 cases(53.2%) in the GO group and 13 cases(61.9%) in the GTO group with GO reconstruction, and the difference was not significant(χ^(2)=0.447, P=0.504). There were 34 cases(72.3%) in the GO group and 19 cases(90.5%) in the GTO group with LLD reconstruction, and the difference was not significant(χ^(2)=2.777,P=0.096). Conclusion GTO has reliable test-retest reliability and inter-rater reliability. GTO as a parameter of preoperative offset reconstruction plan of THA can obtain good reconstruction of offset and limb length, and obtain a good effectiveness.
作者
屈万明
周宏斌
田鹏
秦小容
张友
沈文斌
QU Wanming;ZHOU Hongbin;TIAN Peng;QIN Xiaorong;ZHANG You;SHEN Wenbin(Department of Orthopedics,Yiling Hospital ofYichang,Yichang Hubei,443100,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2022年第4期425-430,共6页
Chinese Journal of Reparative and Reconstructive Surgery
