CT三维重建下股骨解剖参数变化与全髋关节置换术患者Harris评分的相关性

Correlation between Changes of Femoral Anatomical Parameters under CT Three-dimensional Reconstruction and Harris Score of Patients Undergoing Total Hip Arthroplasty

目的探讨电子计算机断层扫描(CT)三维重建下股骨解剖参数变化与全髋关节置换术(THA)患者Harris评分的相关性。方法回顾性分析2018年6月-2020年1月期间于我院行THA及各项检查的80例患者临床资料,比较患者手术前后CT三维重建下股骨解剖参数水平(股骨前倾角、颈干角、股骨偏心距)。术后采用Harris评分评估患者关节功能状态,按照Harris评分高低将THA患者分为功能良好组(n=47,Harris评分≥80分者)和功能低下组(n=33,Harris评分<80分者),比较两组术后早期CT三维重建下股骨解剖参数水平(股骨前倾角、颈干角、股骨偏心距),采用spearman相关性分析法分析THA患者术后早期CT三维重建下股骨前倾角、颈干角、股骨偏心距与Harris评分的相关性,采用受试者工作特征(ROC)曲线评估CT三维重建下股骨前倾角、颈干角、股骨偏心距对THA患者关节功能恢复情况的预测效能。结果术后,患者股骨前倾角显著低于术前(P<0.05),颈干角、股骨偏心距显著高于术前(P<0.05)。功能良好组股骨前倾角显著低于功能低下组(P<0.05),功能良好组颈干角、股骨偏心距显著高于功能低下组(P<0.05);spearman相关分析结果表明,THA患者Harris评分与股骨前倾角呈负相关(P<0.05),与颈干角、股骨偏心距呈正相关(P<0.05);经ROC曲线评估得出,术后早期CT三维重建下股骨前倾角、颈干角、股骨偏心距预测THA患者关节功能恢复情况的ROC曲线AUC分别为0.931、0.772、0.903,截断值分别为10.43°、130.41°、41.86 mm,股骨前倾角、颈干角、股骨偏心距ROC曲线AUC与参考线相比差异具有统计学意义(P<0.05)。结论THA患者Harris评分与CT三维重建下股骨前倾角、颈干角、股骨偏心距均具有显著相关性,后三者可为临床预测此类患者关节功能恢复效果提供早期参考。

Objective This paper aims to explore the correlation between changes of femoral anatomical parameters under computed tomography(CT)three-dimensional reconstruction and Harris score of patients undergoing total hip arthroplasty(THA).Methods The clinical data of 80 patients who underwent THA and various examinations in our hospital from June 2018 to January 2020 were retrospectively analyzed,and the femoral anatomical parameters(femur anteversion angle,collodiaphyseal angle,femoral offset)under CT three-dimensional reconstruction were compared before and after surgery.After surgery,Harris score was used to evaluate the joint function status of patients.According to Harris score,patients with THA were divided into good function group(n=47,Harris score≥80 points)and low function group(n=33,Harris score<80 points).The early postoperative femoral anatomical parameters(femoral anteversion angle,collodiaphyseal angle,femoral offset)under CT three-dimensional reconstruction were compared between the two groups,and spearman correlation analysis was used to analyze the correlation between early postoperative femoral anteversion angle,collodiaphyseal angle and femoral offset under CT three-dimensional reconstruction and Harris score.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of femoral anteversion angle,collodiaphyseal angle and femoral offset under CT three-dimensional reconstruction on joint function recovery of patients with THA.Results After surgery,the femoral anteversion angle was significantly lower than that before surgery(P<0.05)while the collodiaphyseal angle and femoral offset were significantly higher than those before surgery(P<0.05).The femoral anteversion angle in good function group was significantly lower than that in low function group(P<0.05)while the collodiaphyseal angle and femoral offset in good function group were significantly higher than those in low function group(P<0.05).Results of spearman correlation analysis showed that the Harris score of patients with THA was negatively correlated with femoral anteversion angle(P<0.05),and was positively correlated with collodiaphyseal angle and femoral offset(P<0.05).After ROC curve evaluation,the AUC values of ROC curves of early postoperative femoral anteversion angle,collodiaphyseal angle and femoral offset under CT three-dimensional reconstruction in predicting the joint function recovery of patients with THA were 0.931,0.772 and 0.903,and the cut-off values were 10.43°,130.41°and 41.86 mm,respectively,and there were statistically significant differences in the AUC values of ROC curves of femoral anteversion angle,collodiaphyseal angle and femoral offset compared to the reference line(P<0.05).Conclusion Harris score of patients with THA is significantly correlated with femoral anteversion angle,collodiaphyseal angle and femoral offset under CT three-dimensional reconstruction.The latter three can provide an early reference for clinical prediction of recovery of joint function in such patients.