股骨侧优先和联合前倾角技术行全髋关节置换术的疗效分析

A therapeutic effect analysis of femur first principle and combined anteversion technique during total hip arthroplasty

目的探讨应用＂股骨侧优先＂和＂联合前倾角技术＂行全髋关节置换术的临床效果。方法回顾性分析2014年6月至2016年6月在山东省立医院骨关节外科行全髋关节置换术的104例（133髋）髋关节疾病患者的临床资料，假体全部为生物型。男性65例，女性39例；年龄46.6岁（范围：23-76岁）。双侧29例，单侧75例。晚期股骨头无菌性坏死76例，髋关节发育不良并骨性关节炎28例。手术入路：Hardinge入路103髋，后外侧入路30髋。术中先行股骨扩髓，测量髓腔锉的前倾角，然后计算臼杯的前倾角（37°－髓腔锉的前倾角），按照该角度安装臼杯。记录本组患者假体的联合前倾角、关节活动度、手术时间、术中出血量及并发症的发生情况。术后1、3、6个月进行门诊复查，拍摄髋关节正侧位X线片。采用髋关节Harris评分评定术前和术后6个月的髋关节功能。通过LSD-t检验进行组间两两比较。 结果所有患者均顺利完成手术，手术时间为（57.6±14.5）min（范围：36-115 min），术中出血量为（336.5±50.8）ml（范围：180-620 ml）。术中发现用＂股骨侧优先＂和＂联合前倾角＂技术假体的联合前倾角为（36.6±6.8）°，患者髋关节活动度均达到D′Lima标准，所有患者均未发生脱位及其他严重并发症。随访截至2017年8月，本组中88例（119髋）获得随访，随访12.2个月（范围：6-18个月）。术后6个月患侧髋关节Harris评分为94.6分（范围：86-100分），与术前的29.8分（范围：12-43分）相比，差异有统计学意义（t＝12.82，P＝0.003）。结论全髋关节置换术中根据＂股骨侧优先＂的原则进行髋关节置换的效果较满意，能够满足日常活动的需要。

Objective To investigate the situation of hip dislocation with the application of ＂femur first＂ principle and ＂ combined anteversion technique＂ during total hip arthroplasty. Methods A retrospective analysis has been done on the clinical data about 104 patients （ 133 hips）who were diagnosed as hip disease and were treated with total hip arthroplasty by the doctors from the Department of Joint Orthorpaedics of Shandong Provincial Hospital Affiliated to Shandong University from June 2014 to June 2016,and all the prostheses applied in the operation were cementless ones. Among them,65 patients were males, 39 females and their age was 46. 6 years （ ranging from 23 to 76 years） . And 29 of them underwent bilateral hip operations and 75 unilateral ones. Seventy-six cases of aseptic necrosis of the femoral head in the terminal stage ,28 cases of hip dysplasia and osteoarthritis. Surgical approach：of all the operations, 103 hips were operated on with hardinge approach, 30 with posterolateral approach. During the operation, first of all, the femoral medullary cavity was broached and then the anteversion of intramedullary broacher was measured. After that, the anteversion of the acetabular cup was calculated as 37° minus the anteversion of the broacher, and the acetabular cup was implanted at that angle. The patients＇ prosthesis combined anteversion, range of motion of the hip joint, operation time, hemorrhage amount, and complications had been kept record. One, three, and six months respectively after the operation, all the patients received outpatient review, and took anteroposterior and lateral position X-ray examination. Harris hip score had been applied to evaluate their hip function before the operation and six months after the operation. Results All the patients had been operated on smoothly, with the operation time of （ 57.6±14.5 ） minutes （ 36 - 115 minutes ） arid hemorrhage amount of （ 336. 5±50. 8 ） ml （ 180- 620 ml ） . The operation finding showed that the combined anteversion by employing ＂femur firsl＂ principle and combined anteversion techniqueis was （36. 6±6.8）o Also,range of motion of the patients＇ hip conforms to the D＇Lima criterion and no patients had experienced dislocation and stone other serious complications. The follow-up ended at August 2017, whieb lasted tor 12.2 months（6-18 months）,and 88 cases（ 119 hips） were interviewed. The Harris hip score for the affected sides of the hip joints 6 mnnths after the surgery was 94. 6（ 86- 100）. Compared with the seore of 29. 8（ 12 - 43 ） before surgery, the t-test halt proven its statistical siguificance （ t = 12.82, P = 0. 003 ）. Conclusion Based upon the ＂femoral first＂ principle and ＂combined anteversion technique＂ during total hip arthroplasty,these operations has been carried out well enough to meet the patients＇ needs of performing normal daily activities.