股骨偏心距重建对人工全髋关节置换术后髋关节功能的影响

Influence of restoring femoral offset on the function of hip joint after total hip arthroplasty

目的探讨重建股骨偏心距对人工全髋关节置换术后髋关节功能的影响。方法回顾性分析2016年1月至2017年6月新乡医学院第一附属医院76例行单侧人工全髋关节置换术患者的临床资料,根据股骨偏心距是否得到重建将患者分为重建组(n=54)和非重建组(n=22)。比较2组患者髋外展肌力臂、髋关节Harris评分、髋关节活动度、髋臼外展角及前倾角、双下肢长度的差异,并分析影响重建股骨偏心距的因素。结果术前2组患者健侧和术侧股骨偏心距比较差异无统计学意义(P>0.05),术后1 d重建组患者股骨偏心距与未重建组比较差异有统计学意义(P<0.05)。术前2组患者髋外展肌力臂、髋关节Harris评分及髋关节活动度比较差异均无统计学意义(P>0.05);与术前比较,术后1、2、3、6个月2组患者髋外展肌力臂长(P<0.05),髋关节Harris评分高(P<0.05),髋关节活动度大(P<0.05);与未重建组比较,术后1、2、3、6个月重建组患者髋外展肌力臂长(P<0.05),髋关节Harris评分高(P<0.05),髋关节活动度大(P<0.05)。术前2组患者髋臼外展角、前倾角比较差异均无统计学意义(P>0.05);术后6个月2组患者髋臼外展角、前倾角与术前比较差异均无统计学意义(P>0.05);术后6个月2组患者髋臼外展角、前倾角比较差异均无统计学意义(P>0.05)。术后6个月,重建组和未重建组双下肢等长患者比例分别为88.89%(48/54)和45.45%(10/22);重建组患者双下肢等长患者比例高于未重建组(χ~2=16.319,P<0.05)。在一定范围内,股骨偏心距与髋外展肌力臂、髋关节Harris评分及髋关节活动度呈正相关(r=0.549、0.341、0.427,P<0.001)。结论人工全髋关节置换术中重建股骨偏心距可增加髋关节外展肌力臂和髋关节的稳定性,恢复患肢长度,明显改善髋关节功能。

Objective To investigate the influence of restoring femoral offset on the function of hip joint after total hip joint arthroplasty（THA）.Methods The clinical data of seventy-six patients who underwent unilateral THA in the First Affiliated Hospital of Xinxiang Medical University from January 2016 to June 2017 were retrospectively analyzed.According to the reconstruction of the femoral offset,the patients were divided into reconstruction group（ n =54） and non-reconstruction group（ n =22）.The abductor lever arm,Harris scores of hip joint,the range of motion of hip joint,acetabular abduction and acetabular anteversion,the length of the two legs were compared between the two groups,and the factors of affecting restoration of femoral offset were analyzed.Results There was no significant difference in the femoral offset both the operative side and the uninjured side between the two groups before surgery（ P 〉0.05）;there was significant difference in the femoral offset between the two groups at one day after operation（ P 〈0.05）.There was no significant difference in the abductor lever arm,Harris scores of hip joint,the range of motion of hip joint between the two groups before operation（ P 〉0.05）.Compared with that before operation,the abductor lever arm was longer,Harris scores of hip joint was higher and the range of motion of hip joint was larger in the two groups at 1,2,3,6 months after operation（ P 〈0.05）.Compared with the non-reconstruction group,the abductor lever arm was longer,Harris scores of hip joint was higher and the range of motion of hip joint was larger in the reconstruction group at 1,2,3,6 months after operation（ P 〈0.05）.There was no significant difference in the acetabular abduction and acetabular anteversion between the two groups before operation（ P 〉0.05）.Compared with that before operation,there was no significant difference in the acetabular abduction and acetabular anteversion in the two groups after operation（ P 〉0.05）.There was no significant difference in the acetabular abduction and acetabular anteversion between the two groups at 6 months after operation（ P 〉0.05）.At 6 months after operation,the percentage of the patients with equal length of the two legs in the reconstruction group and the non-reconstruction group was 88.89%（48/54） and 45.45%（10/22）,respectively.The percentage of the patients with equal length of the two legs in the reconstruction group was significantly higher than that in the non-reconstruction group（ χ^2=16.319, P 〈0.05）.There was a significantly positive correlation between femoral offset and the abductor lever arm,Harris scores of hip joint and the range of motion of hip joint within a certain range（ r =0.549,0.341,0.427; P 〈0.001）.Conclusion Restoration of femoral offset in THA can enhance the abductor lever arm,increase the stability of hip joint,restore the length of the two legs and improve the function of hip joint obviously.