金属对金属髋关节表面置换术两种不同手术入路中假体位置的X线测量比较

Comparison of radiographic measurements of metal-on-metal hip resurfacing arthroplasty in two different approaches

[目的]了解外侧入路和后外侧入路两种不同入路中髋关节表面置换中假体位置的差异。[方法]72个关节中,分为两组:A组21例病人,共26个髋关节,采用Hardinge的外侧入路。B组44例,共46个髋关节,采用改良的Gibson入路,股骨头由关节后方脱出。测量的指标包括:(1)术前颈干角和术后股骨假体柄干角;(2)髋臼假体的外展角;(3)股骨假体的中心偏移距;(4)术前髋臼前倾角和术后髋臼假体前倾角;(5)股骨假体侧方中心偏移距;(6)股骨假体的侧方偏移角。[结果]股骨假体的柄干角A组为139.5°,B组为140.5°,2种入路间的柄干角无显著性差异;髋臼假体的外展角A组为37.7°,B组为44.4°;前倾角A组为21.6°,B组为15.2°。[结论]髋关节表面置换可以采用外侧入路和后外侧入路,股骨假体安放位置在两种入路中差别不大,但在髋臼假体安放时,相差显著。与后外侧入路比较,外侧入路中,髋臼假体的外展角较小,但前倾角较大。

[ Objective ] Measuring the preoperative and postoperative radiography of the patients with hip resurfacing arthroplasty to see if there are any differences in the orientation of acetabular and femoral components when two different approaches were adopted. [ Method] According to the approaches adopted, 72 hips resurfaced were divided into two groups. 26 hips of 21 patients with Harding lateral approaches were in Group AIn group B, 46 hips of 44 patients were operated using modified Gibson approach, which the femoral head were dislocated posteriorly. The radiographic measurements included： （1） preoperative femoral neck-shaft angle and postoperative femoral component stem-shaft angle of; （2） abduction angle of acetabular component; （3） femoral component offset; （4） preoperative acetabular anteversion angle and postoperative acetabular component anteversion angle; （5） femoral component lateral offset; （6） femoral component lateral deviation angle. [Result] The mean abduction angle ofacetabular component was 37.7° in Group Aand 44. 4° in Group B. The mean anteversion angle of acetabular component was 21.6° in Group A and 152° in Group B. The femoral component stem-shaft angle was 139. 5° in Group A and 140. 5°in Group B. [ Conclusion] There were some statistical differences in the acetabular component orientation of hip resurfacing arthroplasty when two different approaches were adoptedComparing with Group B, Group A was located less abductedly and more antevetedly in the orientation of acetabular component.