性别相关髋关节生物力学差异对全髋关节置换术疗效的影响

Effect of hip biomechanics of gender specific differences on outcome of total hip arthroplasty

目的探究性别相关的髋关节生物力学差异对全髋关节置换术(THA)疗效的影响。方法回顾性分析2018年1月至2018年12月解放军总医院骨科收治且由同一主刀医生完成THA手术的单侧股骨头坏死患者共76例,其中男43例,女33例,平均年龄51.24(22~80)岁。收集患者一般人口学资料,测量THA手术前后患侧和健侧的髋关节生物力学参数,对比男女两组患者手术前后各项参数的差异,以及差异与术后1年功能评分的相关性。结果术前男性组患侧髋臼、股骨和总偏距均大于女性组。术前男女两组患侧髋臼高度和偏距以及股骨高度均较健侧增大。术前男女两组患侧下肢长度较健侧平均短缩7.14 mm和7.55 mm。术后男性组患者股骨和髋臼的高度与偏距均大于女性组患者。术后男女两组的股骨和髋臼高度均较健侧增大,且男性组更明显。术后男女两组股骨偏距、髋臼偏距和总偏距的差值均较健侧减小。术后1年随访时男性组HHS评分高于女性组(96.0分比94.0分);女性组髋臼偏距增加与HHS改善值呈正相关。结论性别差异对髋关节生物力学参数有一定影响,表现为女性组患者髋臼底深度较深,因而术中倾向于臼杯内移,导致髋臼偏距减小;且女性患者术中容易选择较大号的髋臼假体,导致总高度减小,即旋转中心内移、下移,最终可能影响术后功能恢复。

Objective To explore the effect of gender specific differences of hip biomechanics on outcome of total hip arthroplasty(THA).Methods A retrospective analysis was conducted on the patients with unilateral femoral head necrosis admitted to Department of Orthopaedic,Chinese People's Liberation Army General Hospital,from January 2018 to December 2018 and received THA by the same surgeon.A total of 76 cases were included in this study,including 43 males and 33 females,aged 22-80 years with an average age of 51.24 years.General demographic data of patients were collected and the biomechanical parameters of the hip joint on the affected side and the healthy side before and after THA were measured.The differences between the parameters before and after THA of the two groups were compared,as well as the correlation between the differences and 1-year postoperative functional score.Results The preoperative acetabular,femoral and total offset were greater in the male group than in the female group.Before surgery,the acetabular height and offset,femoral height of the affected side were increased in both the male and female groups.Preoperative limb length discrepancy(LLD)of the affected side in male and female groups were shortened by 7.14 mm and 7.55 mm.The height and offset of femur and acetabulum in the male group were greater than that in the female group.After surgery,the height of femur and acetabular in both the male and female groups was larger than that on the healthy side,and the height was more significant in the male group.The difference of femoral,acetabular and total offset between the male and female groups decreased compared with that of the healthy side.The HHS score of the male group was higher than that of the female group(96.0 vs 94.0)at 1-year follow-up.The increase of acetabular offset was positively correlated with HHS improvement in the female group.Conclusions Gender differences have a certain influence on the hip biomechanical parameters,which is manifested in the following aspects:the female group has a greater acetabular floor depth,and thus reaming to the true floor results in greater loss of acetabular offset.In addition,female patients tend to choose a larger acetabular prosthesis during THA,resulting in a decrease in the total height,that is,the center of rotation moves in and down,which may eventually affect the postoperative functional recovery.