全髋关节置换术中髋臼位置安放不良的预防

The prevention from incorrect position of the acetabular cup during the total hip arthroplasty

目的探讨自行设计的髋臼安装调节装置在全髋关节置换(THA)术中对髋臼位置安放不良的预防作用。方法将43例行THA的患者随机分为实验组(20例)和对照组(23例)。实验组在THA术中使用髋臼安装调节装置,对照组在THA术中不使用髋臼安装调节装置。记录手术时间和出血量;术后摄标准位骨盆前后位X线片及髋关节正、侧位X线片,测量髋臼假体的侧倾角和前倾角。术后6个月对患髋进行Harris髋关节评分并调查患者对手术满意度。结果患者均获得随访,时间6~24个月。手术时间:实验组为(85.00±13.86)min,对照组为(75.00±12.88)min,差异有统计学意义(P<0.05)。术中出血量:实验组为(238.5±101.17)ml,对照组为(235.65±98.85)ml,差异无统计学意义(P>0.05)。术后髋臼假体侧倾角和前倾角,实验组分别为43.97°±2.12°和16.37°±2.08°,对照组分别为45.19°±4.46°和15.58°±4.43°;术后6个月髋关节Harris评分:实验组为88.95分±6.86分,对照组为88.17分±6.13分;患者满意度:实验组与对照组均为100%;以上3项两组比较差异均无统计学意义(P>0.05),但实验组侧倾角值和前倾角值波动较小,可重复性好,对照组侧倾角值和前倾角值波动较为明显。结论在THA术中应用髋臼安装调节装置可将髋臼假体的侧倾角和前倾角有效控制在安全范围之内。

Objective To prevent from incorrect position of the acetabular cup by using the device by designed ourselves during the total hip arthroplasty（ THA）. Methods The 43 patients who underwent THA were selected. They were ramdomly divided into the experimental group（ 20 patients） and the control group（ 23 patients）. The pelvis of all patients was no deformity. In the experimental group,the self-designed new device was used in the THA. In the control group,the new device wasn＇t used in THA. During operation,the blood loss and the operativie time were recorded. On the 2nd day postoperation,all patients were taken the X-ray of the anteroposterior pelvis and hip,and were measured the inclination and anteversion of the acetabular cup according to the X-ray of the pelvis and hip. In the 6th month postoperation,all patients were asked to fill in the questionnaire about the satisfaction and the Harris hip score. Results All patients were followed up for 6 - 24 months. After the operation,all patients of the experimental group and the control group were satisfied with the THA. Operating time was respectively（ 85. 00 ± 13. 86）min and（ 75. 00 ± 12. 88） min in the experimental group and the control group（ P〉0. 05）. The blood loss during operation was respectively（ 238. 5 ± 101. 17） ml and（ 235. 65 ± 98. 85） ml in the experimental group and the control group（ P〉0. 05）. In the postoperation,the inclination angle of the acetabular cup was respectively 43. 97° ± 2. 12°and 45. 19° ± 4. 46° and the anteversion angle was respectively 16. 37° ± 2. 08° and 15. 58° ± 4. 43° in the experimental group and in the control group（ P〉0. 05）. In the 6th month postoperation,the Harris hip score was respectively 88. 95 ± 6. 86 and 88. 17 ± 6. 13 in the experimental group and in the control group（ P〉0. 05）. All patients were satisfied from the THA. There were not statistical difference in above three items between two groups（ P〉0. 05）. However,the value of the inclination and anteversion of the acetabular cup was more stable in the experimental group. Conclusions The use of the new method in THA can effectively control the inclination angle and anteversion angle of the acetabular cup in the safe range.