成人常见髋关节疾病双侧髋关节解剖参数的研究

Study on anatomical parameters of bilateral hip joints in common adult hip joint diseases

目的:探讨行全髋关节置换术中利用对侧相对正常髋关节的解剖参数作为模板重建患侧髋关节的准确性。方法:选取2019年9月至2020年12月于大连医科大学附属第一医院关节外科行首次单侧全髋关节置换术的患者作为研究对象。纳入标准:患侧诊断为髋关节骨关节炎、股骨头坏死或髋关节发育不良CroweⅠ型;对侧髋关节形态不影响测量。排除标准:患侧髋关节既往手术史;畸形严重影响测量;髋关节发育不良CroweⅡ型及以上。最后共纳入82例患者,其中33例男性,49例女性,年龄范围29~74岁。根据患者X线及CT影像数据,分别测量患者患侧及对侧髋臼前倾角、髋臼外展角、股骨前倾角、颈干角以及股骨偏心距,并计算其各自的联合前倾角。运用t检验、Pearson相关性分析等统计学方法分析双侧髋关节解剖参数的对称性。结果:对股骨头坏死及髋关节骨关节炎患者来说,除双侧股骨偏心距患侧小于对侧外(t=0.523,P<0.05),余双侧髋关节解剖参数包括髋臼前倾角、髋臼外展角、股骨前倾角、联合前倾角及颈干角的差异均无统计学意义(均为P>0.05)。Pearson相关性分析显示股骨头坏死及骨关节炎患者股骨偏心距的不对称性与颈干角有相关性(r=-0.519,P<0.001),颈干角的不对称性与股骨前倾角(r=0.303,P=0.041)以及股骨偏心距有相关性,联合前倾角的不对称性与髋臼外展角(r=0.311,P=0.035)、颈干角(r=0.049,P=0.032)有相关性。CroweⅠ型髋关节发育不良患者的髋臼前倾角(t=2.081,P=0.045)、股骨偏心距(t=3.934,P<0.001)患侧小于对侧,颈干角患侧大于对侧(t=3.792,P=0.001);而双侧髋臼外展角、股骨前倾角、联合前倾角差异均无统计学意义(均为P>0.05)。Pearson相关性分析发现股骨偏心距的不对称性与颈干角(r=-0.709,P<0.001)、股骨前倾角(r=-0.349,P=0.037)有相关性。CroweⅠ型髋关节发育不良患者的股骨偏心距小于股骨头坏死患者或髋关节骨关节炎患者,而髋臼前倾角、髋臼外展角、颈干角大于后者。结论:对于股骨头坏死患者及髋关节骨关节炎患者来说利用对侧肢体作为模板重建患侧髋关节是可行的。而CroweⅠ型髋关节发育不良患者双侧髋关节解剖形态差异较大,对这类患者的全髋关节置换术需个体化。

Objective To investigate the accuracy of reconstructing the affected hip joint using the anatomical parameters of the contralateral which is a relatively normal hip joint as a template in total hip arthroplasty(TH A).Methods Patients who underwent their first unilateral total hip arthroplasty at the Joint Surgery Department of the First Affiliated Hospital of Dalian Medical University from September 2019 to December 2020 were selected.Inclusion criteria:diagnosed with hip osteoarthritis(OA),osteonecrosis of the femoral head(ONFH),or developmental dysplasia of the hips(DDH)Crowe type I;the morphology of the contralateral hip joint does not affect its measurement.Exclusion criteria:surgery history on the affected side;severe deformities affecting measurement;DDH Crowe H and above.A total of 82 patients were finally included,33 males and 49 females,ranging in age from 29 to 74.According to the patient's X-ray and CT image data,the affected and contralateral acetabular anteversion angle,acetabular abduction anglefemoral anteversion angle,neck-shaft angle,and femoral offset were measured,and the combined anteversion angle was calculated respectively.The symmetry of bilateral hip anatomical parameters were analyze by t test and Pearson correlation analysis.Results For the patients with ONFH and OA,there was no statistically significant difference in acetabular anteversion angle,acetabular abduction angle,femoral anteversion angle,combined anteversion angle,or neck-shaft angle(all P>0.05),while femoral offset was smaller on the affected side than that on the contralateral side(t=0.523,P<0.05).Pearson analysis showed that asymmetry in femoral offset correlated with neck-shaft angle(r=-0.519,P<0.001),asymmetry in neckshaft angle correlated with femoral anteversion angle(t=0.303,P=0.041)and femoral offset;and asymmetry combined with anteversion angle correlated with acetabular abduction angle(t=0.311,P=0.035)and neck-shaft angle(r=0.049,P=0.032)in the patients with ONFH or OA.For the patients with DDH Crowe type I,there was no statistically significant difference in acetabular abduction angle,femoral anteversion angle,or combined anteversion angle(all P>0.05),while acetabular anteversion angle(t=2.081,P=Q.045)and femoral offset(t=3.934,P<0.001)were smaller on the affected side than that on the contralateral side,neck-shaft angle was greater on the affected side than that on the contralateral side(t=3.792,P=0.001).Pearson analysis showed that asymmetry in femoral offset correlated with neck-shaft angle(r=-0.709,P<0.001)and femoral anteversion angle(r=-0.349,P=0.037).The femoral offset in the patients with DDH Crowe type I was smaller than that in the patients with ONFH or OA,while the acetabular anteversion angle,acetabular abduction angle and neck-shaft angle were greater.Conclusions It is feasible to use the contralateral limb as a template to reconstruct the affected hip for the patients with ONFH and OA.The anatomical morphology of the bilateral hip joints in patients with DDH Crowe type I is quite different,and total hip replacement surgery for these patients need to be individualized.