高位髋关节旋转中心对髋臼发育不良髋关节置换术后外展肌力及早期康复的影响

Effect of high hip rotation center on abduction muscle strength and early rehabilitation after DDH arthroplasty

目的探讨高位髋关节旋转中心对髋臼发育不良(DDH)患者人工全髋关节置换术(THA)后髋关节外展肌力恢复及早期康复的影响。方法选取我院2010年1月至2020年12月接受初次单侧THA手术治疗的CroweⅠ~Ⅳ型DDH病例142例,回顾分析其术前及术后3、6、12个月时Harris评分和Trendelenburg征;记录相关并发症;检测双侧髋关节外展肌力矩比(HAMMR);采用Adobe illustrator CC 201822.0软件在标准骨盆正位片上测量外展肌力臂、股骨头水平旋转中心距(HRC)、股骨头垂直旋转中心距(VRC)、股骨头垂直移位(V-shift)。结果142例患者DDH-THA术前双下肢长度短缩差为(31.2±20.1)mm,术后为(3.6±3.5)mm;髋关节Harris评分术前为(43.4±13.4)分,术后为(79.8±21.7)分;CroweⅠ~Ⅲ型DDH的136例患者术后HRC较术前显著改善(P<0.05);DDH-THA术后6个月HAMMR为(85.5±8.6)%,而术后12个月为(94.3±4.8)%,均较手术前显著升高(P<0.05);V-shift>4~8 mm患者DDH-THA术后获得HAMMR的明显改善,术后6~12个月患者的髋关节外展肌力恢复明显;而V-shift>12 mm患者HAMMR的恢复有延迟现象(P<0.05)。结论DDH伴髋关节骨性关节炎患者THA术后髋关节旋转中心的有限高位(V-shift≤12 mm)不影响髋关节外展肌力的的恢复,配合THA手术后早期的康复训练,可有效改善DDH-THA患者的髋关节功能。

Objective To clarify the effect of high hip rotation center in total hip arthroplasty(THA)on postoperative recovery of the abductor muscle strength and the early rehabilitation in patients with developmental dysplasia of the hip(DDH)(CroweⅠtoⅣ).Methods The Harris scores and Trendelenburg characteristics of 142 patients with DDH-THA were examined,and the related complications were recorded.The bilateral hip abductor muscle torque ratio(HAMMR)was examined.The force extension arm,horizontal rotation center distance of femoral head(HRC),vertical rotation center distance of femoral head(VRC),and vertical displacement of femoral head(V-shift)were measured on standard pelvic orthotopic tablets.Results In the 142 cases of this study,the hip Harris score was 43.4±13.4 preoperatively and 79.8±21.7 postoperatively.The HRC of 136 patients with Crowe typeⅠtoⅢDDH was significantly improved after operation(P<0.05).The HAMMR of 6 months after DDH-THA was 85.5%±8.6%,compared with 12 months of 94.3%±4.8%,which was significantly higher than before the surgery(P<0.05).The V-shift of>4 to 8 mm obtained a significant improvement in HAMMR after DDH-THA,and the patient’s hip abduction muscle strength recovered significantly at 6 to 12 months after the surgery.However,the recovery of the HAMMR in patients with a V-shift greater than 12 mm was delayed(P<0.05).Conclusion Limited high position of hip rotation center(vertical displacement of the femoral head≤12 mm)after THA may not significantly affect the recovery of the hip abductor muscle strength.The hip function in DDH-THA patients can be effectively improved,along with early rehabilitation training after THA surgery.