应用骨盆正位X线片测量全髋关节置换术后髋臼假体方位角的初步研究

目的通过对骨盆正位X线片的测量,归纳前倾角的变化与外展角的关系,同时检验Pettersson公式和RitenPradhan公式用于骨盆正位X线片测量的可行性和可靠性。方法模拟全髋关节置换术（total hip arthroplasty,THA）手术,将髋臼假体按照不同的外展角、前倾角放置于骨盆标本髋臼中,分别拍摄骨盆正位X线片。对图像进行测量,发现不同角度下髋臼假体投影的变化规律,应用Pettersson公式和Riten Pradhan公式计算假体前倾角,将结果与实际值进行比较。结果两组公式的计算值之间差异无统计学意义（P〉0．05）,计算值与实际值之间差异有统计学意义（P〈0．05）。结论Pettersson公式和RitenPradhan公式不适用于测量骨盆正位X线片,误差较大。RitenPradhan公式的实用性较强,计算得到的外展角和前倾角的对应比值表可用于THA后髋臼假体方位角的判断,但仍需进一步试验完善比值表。     

应用双髋关节正位X线片评估全髋关节置换术后髋臼前倾角

目的: 探讨是否可以在普通双髋关节正位X线片上评估髋臼假体前倾角。方法: 2019年3月至7月收治全髋关节置换术后患者32例(共41髋),男18例,女14例,年龄(66.2±4.1)岁,所有患者于术后完成双髋关节正位X线片及骨盆CT平扫。通过骨盆CT平扫测量髋臼前倾角,在X线片上采用Saka等测量公式进行测量。结果: 41髋X线片测量髋臼前倾角为(16.2±5.0)°,与CT测量的髋臼前倾角(31.8±9.7)°间差异有统计学意义(P=0.00)。此外,X线片测量与CT测量的髋臼前倾角具有明显相关性(Pearson相关系数r=0.84,P=0.00)。结论: CT可以较准确地测得髋臼前倾角,但是其存在辐射量大、成本较高、假体CT伪影重等明显弊端。在普通双髋关节正位X线片上采用Saka测量公式虽然无法像CT测量一样直接获得准确的髋臼前倾角,但却和CT测得的髋臼前倾角间存在高度的相关性,所以提出的方法也可以初步评估髋臼前倾角。     

全髋关节置换术中骨盆旋转对髋臼假体角度的影响

目的研究骨盆旋转对髋臼假体实际角度的影响,探讨髋臼安全区范围内可以接受的骨盆旋转角度。方法建立骨盆三维模型,确定冠状面、矢状面及髋臼轴,假设髋臼假体外展45°,前倾15°,简化成坐标图,运用解析几何原理,推导出骨盆旋转角度与实际髋臼外展角、前倾角关系的函数公式,运用函数公式计算骨盆旋转角度与实际外展角、前倾角变化趋势,在保持安全区范围内的可以接受的骨盆旋转角度。结果在假设髋臼假体外展角45°、前倾角15°不变的情况下,骨盆每前旋转5°,髋臼外展角增加0.24°~1.64°,前倾角减少3.70°~3.69°,骨盆每后旋转5°,髋臼外展角减少2.00°~3.47°,前倾角增加2.61°~3.62°。随着骨盆的前旋转,其实际外展角呈增大趋势,实际前倾角呈减小趋势;随着骨盆的后旋转,其实际外展角呈减小趋势,实际前倾角呈增大趋势,两者之间呈函数关系。如果骨盆旋转在+13.43°~-14.05°范围内,髋臼假体角度理论上保持在"安全区"范围内。结论全髋关节置换术中骨盆旋转对髋臼假体外展角、前倾角均有影响,其中对前倾角的影响更显著。骨盆在旋转+13.43°~-14.05°时,髋臼假体角度理论上仍在"安全区"范围内。     

智能手机在人工全髋关节置换术中测量髋臼假体植入角度的应用

目的探讨利用智能手机角度测量软件在人工全髋关节置换术(total hip arthroplasty,THA)中测量髋臼假体植入角度的准确性以及应用价值。方法 2012年6月-2015年9月,在50例患者THA术中利用智能手机的角度测量软件测定髋臼假体外展角及前倾角。男24例,女26例;年龄37~83岁,平均71岁。左髋22例,右髋28例。关节置换原因:股骨颈骨折34例,股骨头缺血性坏死16例。均排除髋臼发育异常。术后1周摄骨盆正位X线片,利用PACS系统测量髋臼假体外展角及前倾角。采用组内相关系数评估观察者自身测量的可靠性,Mann-Whitney U检验比较术中手机测量及术后PACS系统测量结果差异;定义术后PACS系统测量髋臼假体角度大于手机测量值为+,反之为-,计算术中及术后角度测量误差范围。结果术中手机测量及术后PACS系统测量髋臼前倾角、外展角的组内相关系数为0.84。术中手机测量髋臼假体外展角为(44.02±1.33)°,前倾角为(17.62±2.20)°;术后PACS系统测量髋臼假体外展角为(44.74±4.05)°,前倾角为(17.22±5.57)°;两种方法测量值比较,差异无统计学意义(Z=-1.977,P=0.482;Z=-0.368,P=0.713)。术后PACS系统测量44例髋臼假体角度在安全区范围内;6例前倾角超出安全区范围1~5°,外展角超出安全区范围1~3°。髋臼假体前倾角术中及术后测量前倾角偏差为-21~+10°、外展角为-10~+9°,提示与术后PACS系统测量值比较,术中手机测量髋臼假体前倾角偏大,外展角偏小。结论 THA术中利用智能手机的角度测量软件确定髋臼假体植入前倾角及外展角方便、快捷、准确。     

下肢畸形股骨颈前倾角的X线研究

采用 X 线体层摄影方法测量了50例儿麻后遗下肢畸形患者的患侧股骨颈前倾角。在骨盆正位 X 线平片上测量了骨盆倾斜度、患侧 CE 角、髋臼角、ZM距离。将股骨前倾角作为因变量,骨盆倾斜度,CE 角、髋臼角、ZM 距离作为自变量,进行多元相关分析。结果证实,患侧股骨前倾角与骨盆倾斜度、CE 角、ZM距离之间有非常显著的线性相关关系(P<0.05)。这说明随着髋关节的不稳定性增加,股骨前倾角也随之加大,而前倾角的增大,又促进了髋关节的不稳定性。     

髋臼卵圆窝在实现术前预期髋臼杯外展角中的参考价值

  目的 探讨髋臼卵圆窝的解剖及影像学特点,评价其在实现术前预期髋臼杯外展角中的作用。方法 在16具正常成人骨盆标本上标记髋臼卵圆窝 中轴线,观察卵圆窝中轴线走行特点及其与卵圆窝顶和髋臼骨性边缘交点在标准骨盆正位X线片上的对应关系。通过模板测量观察预期外展角度的髋臼杯中轴线 与髋臼卵圆窝顶点之间的对应关系。于骨盆标本两侧髋臼施行生物髋臼杯植入术,一侧采用卵圆窝参照法,对侧采用髋臼定位器法,在标准骨盆正位X线片上比 较两侧手术前后髋臼杯外展角偏差的差异。结果 卵圆窝中轴与卵圆窝顶和髋臼骨性边缘的交点是较为恒定的解剖标志,在标准骨盆正位X线上分别对应髋臼顶部 关节面软骨下骨的内缘和外缘。髋臼卵圆窝顶点与40°±5°外展角度的髋臼杯中轴线密切相关。卵圆窝参照组手术前后髋臼杯外展角偏差为0.19° ±3.14°（-6°~5°）,髋臼定位器组为2.75°±2.89°（-2°~8°）,两组差异有统计学意义（t=－2.453,Ρ=0.027）。结论 对于患者髋臼解剖相对正常的 初次全髋关节置换,依据术前模板测量获得的预期髋臼杯位置与卵圆窝顶点的关系,可较精确地获得预期髋臼杯外展位置。     

自制髋臼假体角度安放导向器的研制与临床应用

[目的]验证在初次人工全髋关节置换时,使用自制髋臼假体角度导向器辅助安装,对提高髋臼假体置入角度准确率的影响和临床疗效。[方法]90例(98髋)进行全髋关节置换术,设定髋臼最佳置入外展角为40°,前倾角为20°。患者随机分导向器组(50髋)和对照组(48髋),其中导向器组手术中采用自制金属髋臼假体安装导向器辅助下进行髋臼假体的安放,对照组则采用传统手术,没有借助任何定位导向安装设备,完全靠徒手安装。术后拍骨盆前后位X线片测量髋臼假体角度,并将测量的外展角与前倾角数据进行分析,评估两种方法安放髋臼假体的准确性。[结果]导向器组:手术中安装导向器时间为40 s~1 min 30 s,髋臼前倾角为14.54°±5.25°,外展角为41.82°±3.61°;对照组前倾角为17.49°±8.47°,外展角为39.26°±7.19°。将外展角、前倾角均值分别进行比较,差异具有统计学意义(P0.05)。[结论]髋臼角度导向器可以提高置入髋臼假体的准确性,术中操作方便,安装导向器耗时短,可以反复使用,具有重要的临床价值。     

计算机辅助全髋关节表面置换11例(16髋)随访报告

[目的]探讨非影像手术导航系统下进行全髋关节表面置换的方法和疗效.[方法]11例(16髋)在导航系统下进行全髋关节表面置换术,设定髋臼假体最佳植入角度为外展角45°,前倾角15°,股骨假体柄颈角为O°,柄干角140°.术后测定假体植入的角度情况,统计手术时间、出血量.[结果]术后手术导航系统植入髋臼假体的前倾角为(15.6±1.2)°、外展角为(45.3±1.5)°,股骨假体柄颈角为(2.2±1.8)°,柄干角为(140.5±2.0)°.平均随访2.5年(40～15个月),术前平均Harris评分35分(25～35分),术后为X线片发现1例髋臼假体周围出现透亮线,而无松动迹象.[结论]非影像手术导航系统下可以精确地植入假体,减少假体松动的发生,具有重要的临床价值.     

髋臼前倾角研究进展

髋臼前倾角和外展角为全髋关节置换术(THA)中评估髋臼假体位置,术后随访假体位置的两个重要参数。髋臼前倾角的测量目前仍无统一标准。该文就近期文献中髋臼前倾角的定义、测量时骨盆参考平面、各种测量方法、髋臼角安全范围等作一综述。     

髋臼外展角和前倾角的动态测量及其临床意义

作者通过对１１２个正常髋臼外展角和前倾角随骨盆前倾度改变而变化的动态测量研究，制作出髋臼两角与骨盆倾度之间的相关变化曲线。根据结果和曲线分析而知：（１）正常成人站立和行走时的髋臼外展角约为４０°～４７°，前倾角为４°～２０°，男性与女性之间无显著性差异（Ｐ＞０．０５）；（２）髋臼前倾角的存在使外展角在屈髋活动时减小比较缓慢，保证了髋臼对股骨头较好的覆盖；（３）骨盆倾度的改变对髋臼前倾角的大小影响较大，骨盆倾度每增大１０°，前倾角即减小６°。该结果为临床全髋置换术前判断髋臼位相，术中正确放置人工臼杯，术后指导髋关节功能锻炼，提供了可靠的解剖依据。     

Acetabular dysplasia in the adolescent and young adult

Hip dysplasia is a major cause of osteoarthrosis in adults. Early aggressive osteotomy has the potential of preventing the development of arthritis, but carries with it significant risks. The problem is further complicated because the surgeon has no means of quantifying the dysplastic deformity or of predicting what a particular combination of osteotomies would do to correct the deformity. This study describes methods of quantifying hip-joint geometry in three dimensions based on computed tomography and magnetic resonance studies, and of simulating pelvic osteotomy to correct the deformities. The study analyzes 49 normal hip joints and 20 dysplastic hip joints. The results show that the normal acetabulum is nearly a full hemisphere, which is anteverted 20 degrees and abducted 53 degrees. The normal lateral center-edge angle is 37 degrees. The dysplastic acetabulum is not anterolaterally maldirected, as has been assumed, but is globally dysplastic. Analysis of the individual dysplastic hip joints showed a wide variability. Some patients were deficient globally, some anterolaterally, and some posterolaterally. Methods of analyzing a patient's hip joint, quantifying abnormalities, simulating surgery, and predicting results are demonstrated in a case example.     

Friction of ceramic and metal hip hemi-endoprostheses against cadaveric acetabula

Introduction Studies of hip arthroplasty have dealt mainly with total endoprosthesis, while tribology measurement values of hemi-endoprosthetic implants are rare. The small amount of experimental tribological data concerning materials of hemi-endoprosthetic implants in the form of pendulum trials, animal experiments, in vivo measurements on human hip joints and pin on disc studies report friction coefficients between 0.014 and 0.57; the friction coefficients measured in fresh human cadaver hip joints were determined between 0.001 and 0.08.Materials and methods The HEPFlEx-hip simulator was constructed to test the friction coefficients of unipolar femur head hemi-endoprostheses made of metal or ceramic against fresh cadaveric acetabula. Its plane of movement is uniaxial with a flexion-extension movement of +30/–18°. The force is produced pneumatically dynamic with amounts of 2.5 kN. Newborn calf serum serves as a lubricant. We mounted 20 fresh porcine acetabula and 10 fresh human cadaver acetabula in the HEPFlEx-hip simulator and compared the two unipolar femur head hemi-endoprostheses (metal vs. ceramic).Results The mean friction coefficients against porcine acetabula were µ=0.017–0.082 for ceramic and µ=0.020–0.101 for metal; against human cadaver acetabula µ=0.017–0.083 for ceramic and µ=0.019–0.118 for metal. The frictional coefficient deltas (metal-ceramic) values of all measurements were µ=0.004 for porcine acetabula and µ=0.001 for cadaver acetabula. Box-plots graphics document significantly lower frictional coefficients of the ceramics.Conclusions The lower frictional coefficients of ceramic compared to metal against fresh cadaveric acetabula may have a clinical impact on the process of the protrusion of the corresponding femoral head through the acetabulum.     

Heterotopic ossification as a complication of total hip replacement]

Heterotopic ossification is the most common complication after THR. The authors present the distribution of frequency of ectopic ossification after cementless THR using Mittelmeier and Parhofer-M?nch prosthesis and it's influence on THR outcome. 151 hip joints were evaluated with a follow-up period of more than 2 years. All procedures were performed by a lateral approach. The ectopic ossification was verified according to the Brooker classification. Clinical evaluation was performed according to the d'Aubigne-Postel method in Charnley's modification. The 3rd degree ectopic ossification was found in 14 hip joint and 4th degree ectopic ossification in 2 hip joints (together 10.6%). The positive correlation between the degree of ossification (3rd and 4th) and the decrease of range of motion of the hip joint along with an increase in pain after THR was found.     

Bilateral synchronous total hip arthroplasty for ankylosed hips

Purpose  

We investigated the effect of bilateral total hip replacement (THR) for patients with ankylosed hip joints caused by late ankylosing spondylitis (AS) and to discuss its related pre- and postoperative problems.     

Rehabilitation und Sport nach H��fttotalendoprothese

The number of total hip replacement (THR) surgeries has increased significantly over the last few years and patients undergoing surgery are of decreasing age. In consequence the question of the influencing factors for the survival of artificial hip joints becomes more and more urgent. The expected survival time of an implant is nowadays 15-20 years and it seems that factors for a shorter lifetime are female gender, overweight, younger age and certain indications which led to surgery, such as rheumatoid arthritis or fractures. In the early phase of rehabilitation, measures against dislocation including training of the abductor muscles are most important. Starting rehabilitation programs early after surgery has positive effects on outcome, especially when strengthening programs are included. There are different opinions concerning the question how the lifetime of a THR is influenced by sports activities. However, it seems to have been demonstrated that suitable sports activities have a positive effect and do not necessarily correlate with higher loosening rates after THR. In general, high-impact sports should be avoided. Recommended activities are cycling, swimming, aquajogging, hiking, rowing and dancing.     

A comparison of a less invasive piriformis-sparing approach versus the standard posterior approach to the hip: A randomised controlled trial

We undertook a randomised controlled trial to compare the piriformis-sparing approach with the standard posterior approach used for total hip replacement (THR). We recruited 100?patients awaiting THR and randomly allocated them to either the piriformis-sparing approach or the standard posterior approach. Pre- and post-operative care programmes and rehabilitation regimes were identical for both groups. Observers were blinded to the allocation throughout; patients were blinded until the two-week assessment. Follow-up was at six weeks, three months, one year and two years. In all 11 patients died or were lost to follow-up. There was no significant difference between groups for any of the functional outcomes. However, for patients in the piriformis-sparing group there was a trend towards a better six-minute walk test at two weeks and greater patient satisfaction at six weeks. The acetabular components were less anteverted (p = 0.005) and had a lower mean inclination angle (p?=?0.02) in the piriformis-sparing group. However, in both groups the mean component positions were within Lewinnek's safe zone. Surgeons perceived the piriformis-sparing approach to be significantly more difficult than the standard approach (p = 0.03), particularly in obese patients. In conclusion, performing THR through a shorter incision involving sparing piriformis is more difficult and only provides short-term benefits compared with the standard posterior approach.     

全髋关节置换术治疗先天性髋关节发育不良

目的: 探讨全髋关节置换治疗成人先天性髋关节发育不良的手术方法和疗效。方法: 对 25例 28髋成人先天性髋关节发育不良继发骨性关节炎患者行全髋关节置换术。结果:刀口均Ⅰ期愈合。经 13个月~6年, 平均 27个月随访, Harris评分 87分 (术前 46分 ), 优 5髋、良 19髋、中 4髋,优良率为 85. 7%。结论: 全髋关节置换术是治疗成人先天性髋关节发育不良继发骨性关节炎的有效方法。     

Total hip replacement in younger patientsSurvival rate after avascular necrosis of the femoral head

Background?A high risk of loosening has been reported in replacements performed because of avascular necrosis.Patients and methods?To study cementless total hip replacement (THR) in younger patients with avascular necrosis (AVN), we analyzed retrospectively the outcome in 129 cases: 46 Mittelmeier monobloc ceramic hips (22 cases with AVN), and 83 Zweymüller total hip systems (35 cases with AVN) clinically and radiographically.Results?At follow-up, 17 Mittelmeier prostheses (10 AVN) and 4 Zweymüller prostheses (none with AVN) had been revised. The diagnosis did not affect the implant survival, but the Zweymüller THR fared better than the Mittelmeier system. The main reason for revision of Mittelmeier implants was aseptic loosening, 3 of 4 Zweymüller revisions were necessary due to polyethylene wear. This difference was confirmed by the radiographic evaluation of the still intact implants: Zweymüller THR showed better values for signs of osseointegration, radiolucent lines around the implants and migration, but more acetabular wear. None of these differences was affected by the AVN diagnosis.Interpretation?We could not confirm that AVN is a risk factor in total hip replacement.     

人工全髋关节置换28例临床应用体会

目的　探讨人工全髋关节置换术的适应证、手术方法、疗效及并发症。方法　行人工全髋关节置换术 2 8例 ,30髋。结果　Harris评分 ,术前平均 44分 ,术后平均 93分 ,优良率 94%。结论　全髋关节置换术是治疗髋部疾患的有效方法     

The effectiveness of the proximal femoral stem centraliser on the stem alignment in total hip replacement

We studied a new polymethylmethacrylate proximal femoral centraliser designed for use along with the distal femoral centraliser. Using cadaver femora we conducted an in vitro study to measure the influence of the proximal centraliser on the cement mantle and femoral stem alignment in a total hip replacement (THR). The cadaver femora were randomised into two groups. The Royal National Orthopaedic Hospital (RNOH) femoral stems were inserted to each femur using third-generation cementing technique .The first group was inserted using proximal and distal centralisers. The second group was inserted using distal centralisers only. All the hip specimens were X-rayed using high-tech scanner and computer software. The stem alignment and cement mantle were measured. We concluded that the proximal femoral centraliser improved the cement mantle distribution and femoral stem alignment in THR. This improvement will reflect on the long-term survival of the THR. We also showed an excellent and accurate way of measuring the femoral stem alignment in THR.