全髋人工关节置换术中股骨偏心距的重建

Restoration of femoral offset in total hip arthroplasty

目的 探讨全髋人工关节置换术 (THA)中影响股骨偏心距的因素及股骨偏心距和髋关节外展肌力的关系。方法 对 1998年 3月至 2 0 0 2年 1月间施行的 81例 ( 99髋 )全髋人工关节置换术进行了随访。其中男 2 8例 ,女 5 3例 ;年龄平均 5 7 0岁 ( 2 9～ 80岁 )。右侧 2 8例 ,左侧 35例 ,双侧 18例。随访时间 19～ 6 6个月 (平均 36 8个月 )。手术均采用髋关节后外侧入路。X线片上测量股骨偏心距、髋外展肌力臂及股骨矩保留部分的长度 ,使用Cybex测量髋外展肌力量。统计学软件(SPSS10 0 )对X线片测量数据进行统计学处理。结果 股骨偏心距与股骨外展肌力臂具有正相关性 (r =0 6 13,P <0 0 0 1)。术后股骨矩保留部分的长度与股骨偏心距存在正相关性 (r =0 4 5 1,P =0 0 0 1) ,术后股骨颈干角与股骨偏心距存在明显相关性 (r =0 5 6 7,P <0 0 0 1) ,髋关节的外展肌力与股骨偏心距和外展肌力臂存在正相关性 (r =0 5 0 0 ,P =0 0 0 9;r =0 4 77,P =0 0 14 )。结论 全髋人工关节置换术中欲重建股骨偏心距 ,术前细致的模板测量至关重要 ,选用接近解剖颈干角的股骨柄假体 。

Objective To explore the factors effecting restoring femoral offset and the relation between femoral offset and hip abductor strength during total hip arthroplasty(THA) Methods Ninty nine THA for 81 patients were performed from March 1998 to January 2002. And follow up was finished There were 53 women and 28 men and the average age was 57 years(29 to 80) The right hip had been replaced in 28 cases,the left in 35 cases and the bilateral in 18 cases The mean duration of clinical and roentgenographic follow up was 36 8 months (range,19～66 months) A posterolateral approach was used in all THA The femoral offset and the abductor lever arm were measured from each radiograph The measurement of the hip abduction strength was made for some THA by the Cybex machine Statistical data analysis was performed by SPSS10 0 software Results Femoral offset correlated positively with the length of the abductor lever arm ( r =0 613; P <0 001) Simple regression analysis showed that femoral offset was significantly and positively related to the length of femoral neck and neck shaft angle ( r =0 451, P =0 001; r =0 567, P <0 001) There was a highly significant and positive correlation between femoral offset (and consequently abductor lever arm) and hip abductor strength ( r =0 500, P =0 009; r =0 477, P =0 014) Conclusions It is very important to template both sides of hip preoperatively for restoring femoral offset in THA Femoral component with more anatomical neck shaft angle will be used with the increase in the femoral neck length