伴腰椎退变性后凸畸形的人工全髋关节置换安放髋臼假体前倾角的策略

目的：探讨伴腰椎退变性后凸畸形患者行人工全髋关节置换时如何更合理地安放髋臼假体的前倾角。方法：纳入2017年12月至2019年10月行人工全髋关节置换术的患者122例，均伴腰椎退变性后凸畸形，分为试验组和对照组，各61例。试验组男25例，女36例；年龄中位数67.0岁；病程中位数46.0个月；术中根据骨盆前平面支架，按不同类型，设置安装髋臼前倾角的功能性骨盆平面。对照组男27例，女34例；年龄中位数67.0岁；病程中位数42.0个月；对照组以传统的方法设定前倾角。术后随访3个月，记录两组患者手术时间、术中出血量，统计3个月内感染脱位发生，记录手术前和术后3个月Harris评分，测量术后3个月患者站立位功能性前倾角。结果：试验组和对照组手术时间、术中出血量比较差异无统计学意义（P=0.918，0.381）；术后3个月内两组均无感染；对照组1例髋关节脱位，试验组无脱位。手术前后Harris评分比较差异无统计学意义（P>0.05）。3个月后复查骨盆站立位X线片示：髋臼假体功能性前倾角在安全区外的患者数量试验组比对照组少（P=0.048）；并且试验组在15°~20°范围内更集中（P<0.001）。。结论：伴有腰椎退变性后凸畸形的人工髋关节置换，根据术前对患者的评估分类，可以借助骨盆前平面参考支架，获得更佳的髋臼假体功能性前倾角。

Strategy of acetabular anteversion in total hip arthroplasty with lumbar degenerative kyphosis

Objective: To investigate how to place the anteversion of acetabular prosthesis more reasonably in patients with lumbar degenerative kyphosis. Methods: A total of 122 patients with degenerative kyphosis of lumbar spine who underwent total hip arthroplasty from December 2017 to October 2019 were included and divided into experimental group and control group,61 cases in each group. In experimental group,there were 25 males and 36 females,with a median age of 67.0 years;the median course of disease was 46.0 months;the functional pelvic plane with acetabular anteversion was set according to different types of pelvic anterior plane bracket. In control group,there were 27 males and 34 females,with a median age of 67.0 years;the median course was 42.0 months;in control group,the anteversion was set by the traditional method. The patients were followed up for 3 months. The operation time and blood loss were recorded. The incidence of infection and dislocation within 3 months was counted. Harris score before and 3 months after operation was recorded. Functional anteversion angle of standing position was measured 3 months after operation. Results: Compared with control group,there was no difference in operation time and blood loss between the two groups(P=0.918,0.381);there was no infection between two groups within 3 months after operation;there was 1 case of hip joint dislocation in the control group and no dislocation in experimental group. There was no significant difference in Harris score before and after operation. Three months later,reexamination of pelvic standing radiographs showed that the number of patients with functional anteversion of acetabular prosthesis outside the safe area was less in experimental group than in control group(P=0.048),and the functional anteversion angle of acetabular prosthesis was more concentrated in the range of 15 ° to 20 ° in experimental group(P<0.001). Conclusion: According to the preoperative evaluation and classification of patients,better functional anteversion of acetabular prosthesis can be obtained with the help of pelvic anterior plane reference bracket in hip arthroplasty with lumbar degenerative kyphosis.