股骨偏心距重建与全髋关节置换术后关节功能的相关性

Correlation between femoral offset restoration and joint function after total hip replacement

目的:股骨偏心距的恢复和重建,在髋关节软组织张力的平衡中具有非常重要的作用,是调节软组织平衡的主要手段。分析重建股骨偏心距与人工全髋关节置换术后关节功能恢复的关系。方法:选择2004-01/2005-06北京大学人民医院骨关节科收治的单侧髋关节置换患者76例,随访资料均完整,患者对治疗方案均知情同意。随访时间16￣29个月,平均23.2个月。手术均采用髋关节外侧入路,使用Zweymüller双锥形螺旋臼及SL-PLUS矩形直柄(颈干角135°,股骨头假体的直径均为28mm)。术前和术后随访时拍摄双髋正侧位X射线片,测量股骨偏心距、髋外展肌力臂及双下肢长度;记录手术前后髋关节活动度及Harris评分,分析股骨偏心距与其他指标的相关性。结果:76例患者全部进入结果分析。①股骨偏心距与髋外展肌力臂具有正相关性(r=0.523,P<0.001)。②髋关节术后活动度、Harris评分与股骨偏心距均存在明显回归相关关系(r=0.419,0.326,P<0.001)。③股骨偏心距重建与否对下肢长度的影响存在显著性意义(χ2=4.62,P<0.01)。结论:人工全髋关节置换术中股骨偏心距重建与髋外展肌的力臂增加、髋关节的活动度、功能改善及稳定性增强呈正相关。

AIM： The recovery and reconstruction of femoral offset play important roles in the balance of hip joint soft tissue tension and is a main approach for regulating soft tissue balance. In this study, the correlation between femoral offset reconstruction and joint functional recovery after total hip replacement （THR） was analyzed. METHODS： Seventy-six patients with unilateral THR in Arthritis Clinic ＆ Research Center, Peking University People＇s Hospital from January 2004 to June 2005 were selected with complete follow-up data. They were all informed and agreed to the treatment. The mean follow-up was 23.2 months （range, 16-29 months）. Lateral approach was applied in all the procedures with Zweymuller Cementless and SL-PLUS rectangular straight shank （collodiaphyseal angle 135°, diameter of femoral prosthesis was 28 mm）. The femoral offset, the abductor lever arm and the leg length were measured from hip positive and lateral side X-ray films before and after operation. The range of motion （ROM） of hip and the Harris scores ware recorded. The correlation between femoral offset and other indexes were analyzed. RESULTS： All 76 patients were involved in the result analysis.（1）Femoral offset was correlated positively with the length of abductor lever arm （r =0,523, P 〈 0.001）. （2）Femoral offset was significantly positively related to the ROM of hip and Harris scores （r =0.419, 0.326, P 〈 0.001）. （3）Restoration of femoral offset significantly influenced the leg length （x^2=4.62, P〈 0.01）. CONCLUSION： Restoration of femoral offset in THR is positively correlated with the increase in abductor lever arm, and improvement in ROM and hip stability.