重建股骨偏心距对人工全髋关节置换术后骨盆稳定性的影响

EFFECT OF FEMORAL OFFSET RECONSTRUCTION ON PELVIC STABILITY DURING GAIT AFTER TOTAL HIP ARTHROPLASTY

目的探讨人工全髋关节置换术后股骨偏心距对行走过程中骨盆稳定性的影响。方法 2000年1月-2005年12月,29例患者行单侧人工全髋关节置换术。男10例,女19例;年龄33～75岁,平均64.3岁。左髋15例,右髋14例。随访时间5～10年,平均7.7年。末次随访时Harris评分为90～100分,平均97分。末次随访时行标准骨盆正位X线片检查,测量双侧股骨偏心距,计算股骨偏心距比(femoral offset ratio,FOR);根据测量结果将患者分为两组,A组:术侧股骨偏心距小于健侧,10例;B组:术侧股骨偏心距大于健侧,19例。行三维步态分析,采集行走时骨盆在冠状面的倾斜角度;并对FOR与倾斜角度进行Pearson相关分析。结果 A组FOR为0.81±0.08,B组FOR为1.27±0.15。A组患肢单腿支撑相骨盆在冠状面的倾斜角度为(—0.42±0.91)°,B组为(1.02±0.94)°,健侧为(1.15±0.85)°。A组骨盆在冠状面的倾斜角度与B组、健侧比较,差异均有统计学意义(P<0.05);B组与健侧比较,差异无统计学意义(P>0.05)。骨盆在冠状面的倾斜角度与FOR成正相关(r=0.534,P=0.003),回归方程为:y=—2.551+2.781x。结论重建股骨偏心距是避免人工全髋关节置换术后臀中肌无力及改善步态的重要因素。

Objective To investigate the effect of femoral offset reconstruction on pelvic stability during gait after total hip arthroplasty.Methods According to the inclusion criteria,29 patients undergoing unilateral total hip arthroplasty between January 2000 and December 2005 were selected.There were 10 males and 19 females with an average age of 64.3 years（range,33-75 years）.The affected hips included 15 left hips and 14 right hips.The follow-up time was from 5 to 10 years（mean,7.7 years）.The Harris score was 90 to 100（mean,97） at last follow-up.The femoral offset ratio（FOR） was calculated by measuring the femoral offset of the bilateral hips on radiograph,and then the patients were divided into 2 groups： group A（the femoral offset of diseased hip was less than that of normal hip,n=10） and group B（the femoral offset of diseased hip was greater than that of normal hip,n=19）.The pelvis kinematic variables were measured by three-dimensional gait analysis to collect the magnitude of pelvic oblique angle（POA）.Results In group A,the FOR was 0.81±0.08 and the POA was（—0.42±0.91）°.In group B,the FOR was 1.27±0.15 and the POA was（1.02±0.94）°.For the normal hip,the POA was（1.15±0.85）°.The POA was significantly less in group A than in group B and the normal limb（P0.05）.The difference in POA had no signifi cance between group B and the normal hip（P0.05）.The POA was positive relative with FOR（r=0.534,P=0.003）,and the regression equation was y=— 2.551＋ 2.781x.Conclusion The femoral offset reconstruction is crucial to improve hip abductor function and gait.