全髋关节置换术中髋关节偏心距重建对临床效果的影响

Clinical effect of the reconstruction of eccentric distance of hip joint in total hip arthroplasty

目的探讨全髋关节置换（THA）术中偏心距的恢复和重建在髋关节软组织张力平衡中的作用,分析重建髋关节偏心距与术后双下肢不等长以及髋关节功能恢复的关系。方法随机选择2008年1月~2012年5月收治的单侧THA患者98例,采用髋关节后外侧入路。全部使用Depuy（强生）公司（Pinnacle Acetabular System）髋系统和Corail人工关节柄。手术前后影像学检查：骨盆前后位X线片,髋关节三维CT扫描,双下肢全长X线片;测量双下肢全长、股骨偏心距的长度、髋臼偏心距的长度、髋关节外展肌力矩关节偏心距和其他指标的相关性。结果 （1）髋关节偏心距与髋关节外展肌力矩有正相关性（r=0.558,P〈0.001）;（2）髋关节术后的活动度Harris评分与髋关节偏心距具有明显的回归相关关系（r=0.439,P〈0.001）;（3）髋关节偏心距的重建对双下肢长度的影响存在着显著的意义（χ^2=4.83,P〈0.01）。结论 THA术中偏心距的重建,可增加髋关节外展肌力矩和髋关节的活动度,与功能的改善及稳定性增加呈正相关。

Objective To investigate the recovery and reconstruction of the eccentric distance in total hip arthroplasty （ THA） ,and to analyze the relationship between the eccentric distance and the hip joint function recover -y.Methods Ninety-eight patients treated with unilateral THA from Jan .2008 to May.2012 were randomly selected in our hospital .Posterior lateral approach of hip joint was used .Depuy （ Pinnacle Acetabular System ） and Corail were applied in all patients .Imaging examinations were taken before and after surgery：X ray film of the front and rear pelvis,the three-dimensional CT scan of the hip joint ,X ray film of the double lower limbs .The full length of the two legs,the length of the femoral eccentricity ,the length of the white space ,the eccentricity and the other inde-xes of the eccentric distance and their relationship was analyzed .Results All 98 patients were involved in the re-sult analysis.（1）The hip joint eccentricity and the hip abduction torque was positively correlated （r=0.558,P〈0.001）.（2）The eccentric distance and Harris hip score had obvious regression correlation （r=0.439,P〈0.001）. （3）The reconstruction of the hip joint eccentricity had a significant effect on the length of the two legs （χ^2 =4.83, P〈0.01）.Conclusion The reconstruction of the eccentric distance of THA can increase the torque of the hip joint and the activity of the hip joint ,which is positively related with the function improvement and increased stability .