骨盆倾斜角和骶骨倾斜角在合并脊柱疾病的患者行初次全髋关节置换术中的作用

目的总结对合并脊柱疾病患者行人工全髋关节置换术(THA)髋臼假体位置与骨盆矢状面解剖参数的相关性。方法 2004年4月至2011年12月,对收治的27例(38髋)合并脊柱疾病的患者采用THA治疗,其中强直性脊柱炎24例(33髋),既往脊柱内固定史3例(5髋),左侧19髋,右侧19髋;双髋11例,单髋16例。患者25男2女;年龄21～61岁,平均40.33岁,病程0.5～20年,平均12.1年。术前Harris评分为(37.76±15.9)分。结果所有患者术后效果满意,髋关节功能均得到显著改善,术后末次随访未见下沉、松动等现象,末次随访时Harris评分为(89.54±7.64)分,与术前比较差异有统计学意义(t=-9.096,P<0.01)。所有患者矢状面解剖参数的三者之间的关系为PI=SS+PT。SS>PT组术后Harris评分为(93.31±6.37)分,而SSPT组有着较好的临床疗效,差异有统计学意义(t=-4.242,P<0.05)。术后Harris评分与SS/PI成正相关,Pearson相关性为0.682(P<0.05)。髋臼外展角和前倾角与PT成正相关,Pearson相关性分别为0.866(P<0.01)、0.82(P<0.01),与SS成负相关,Pearson相关性分别为-0.254(P>0.05)、-0.412(P>0.05)。结论对于合并脊柱疾病的患者进行THA,因为患者骨盆和脊柱对病变或内固定的代偿性改变,术前进行矢状面参数的评估,对髋臼假体最佳位置的安放及避免术后撞击、脱位有着相当重要的意义。

Effects of pelvic tilt and sacral slope in total hip arthroplasty of spinal diseases

Objective To investigate the relationship between pelvic sagittal indexes and acetabular prothesis position in total hip arthroplasty （ THA ） for patients with spinal diseases. Methods From April 2004 to December 2011, 38 hips （27 patients） with spinal diseases received THA, including 33 hips with ankylosing spondylitis and five hips with spinal internal fixation, 19 left hips and 19 fight hips, 25 males and two females, aged 21 -61 years with an average of 40. 33 years. The course of disease was 0. 5 -20 years with an average of 12. 1 years. Harris hip score was （37. 76 ± 15.9） points before operation. Results All the patients were satisfied, and the function of suffered hips were significantly improved. Harris hip score at final follow-up was （ 89. 54 ± 7.64） points, indicating a significant difference compared with preoperation score （ t = - 9. 096 ,P 〈0. 01 ）. In all patients, pelvic incidence （PI） = pelvic tilt （PT） ＋ sacral slope （SS）. Harris hip score of group （SS 〉 FF） was （93.31 ± 6. 37 ） points, and that of group （ SS 〈 PT） was （ 82 ±1.73 ） points, indicating a significant difference between group （ SS 〉 PT） and group （ SS 〈 PT ） （ t = - 4. 242, P 〈 0. 05 ）. The post-operation Harris hip score was positivelycorrelated with SS/PI, and the Pearson correlation coefficient was 0. 682 （ P 〈 0. 05 ）. PT was positively correlated with acetabular abduction and anteversion, and the Pearson correlation coefficients were 0. 866 （P 〈 0. 01 ） and 0.82 （ P 〈 O. 011 ） respectively ; SS was negative correlated with acetabular abduction and anteversion, and the Pearson correlation coefficients were - 0. 254 （ P 〉 0. 05 ） and - 0. 412 （ P 〉 0.05 ） respectively. Conclusions Because of the compensatory changes in spine and pevis, it is important to evaluate the the pelvic sagittal indexes before surgery and adjust the acetabular prothesis during THA for the patient with spinal diseases.