计算机辅助的EBRA—FCA法分析半髋表面置换治疗股骨头缺血性坏死假体生物力学变化

背景：对于中晚期（FicatⅢ．Ⅳ期）股骨头缺血性坏死且髋臼基本完好的患者，单纯股骨头表面置换是一种较好的治疗方法。股骨假体位置、下沉影响全髋关节置换术的治疗效果．但假体位置、下沉对半髋表面置换术疗效的影响尚需进一步研究。目的：观察钻铬合金半髋表面置换对中晚期（FicatⅢ，Ⅳ期）股骨头缺血性坏死且髋臼基本完好患者髋关节功能的影响．并分析疗效与股骨假体柄干角、下沉的关系．评估计算机辅助X射平片分析对假体失败的预测价值.设计：病例分析.单位：广西医科大学第一附属医院脊柱骨病科。对象：选择1997—06／2002—07广西医科大学第一附属医院脊柱骨病科收治的中晚期（FicatⅢ，Ⅳ期）股骨头缺血性坏死行半髋表面置换患者41例（48髋），患者手术时的年龄29-49岁，平均（37±9）岁，其中男30例．女11例：其中FloatⅢ期35髋．FicatⅣ期13髋．髋臼均相对正常。所有患者病变部位病理检查均为股骨头缺血性坏死；且均签署知情同意书.方法：①于术前和随访时采用UCLA（University of California Los Angeles）髋关节功能评分标准对患者手术前后疼痛、步行、功能、活动进行评分，每一项记分为1～10分．10分为最佳。优．35～40分．好29～34分，一般22-28分．差〈22分。术后评分为随访时评分平均值。②运用计算机辅助的EBRA—FCA法，在术后骨盆的X射线平片上测量股骨假体的柄干角、下沉．并对半髋表面置换术治疗股骨头缺血性坏死的疗效与股骨假体的柄干角、下沉的关系进行分析。③采用复诊的方式进行随访，于术后2个月开始第1次随访．每年随访1次，共随访8年。④两组样本间均数比较采用独立样本t检验（并做方差齐性检验）。在对临床结果的析因分析（post hoc analysis）基础上，比值比（odds ratio）分析用来确定假

Biomechanical changes of the prostheses for the surface hemi-arthroplasty of the hip in the treatment of femoral head avascularnecrosis by using computer-assisted Einzel-Bild-Rontgen-Analyse-femoral component analysis

BACKGROUND： For patients with osteonecrosis and collapse of the femoral head but with preservation of some acetabular articular cartilage at Ficat stage Ⅲ or stage Ⅳ, the hemisurface replacement of the femoral head has emerged as the treatment of choice. Although the orientation and the migration of the femoral component have been shown to influence the outcome of total hip replacement, to the best of our knowledge, their effect on the clinical outcome of surface arthroplasty and the relationship between the outcome and the femoral component positioning and the migration of an implant have not been studied.
OBJECTIVE： To observe the effect of cobalt-chrome alloy surface hemiarthroplasty of the hip on hip joint function of patients with osteoneerosis of the femoral head but with preservation of some acetabular articular cartiiage at Ficat stage Ⅲ or stage Ⅳ, and to analyze the relationship between the clinical outcome and the femoral component positioning; meanwhile, to evaluate the advantage of computer-assisted Einzel-Bild-Rontgen-Analyse- femoral component analysis （EBRA-FCA） to prognosticate the results of prostheses implant.
DESIGN： Case analysis.
PARTICIPANTS： Between June 1997 and July 2002, of the forty-eight patients with precision-fit surface hemiarthroplasties of the hips performed at the first Affiliated Hospital of Guangxi Medical University, forty-one patients were forty years old or younger at the time of the operation including 30 males and 11 females; with an average age of （37±9） years. There were thirty-five hips at Ficat stage Ⅲ and thirteen at stage Ⅳ with relatively normal acetabula. Fourteen prostheses were implanted in the female and thirty-four in the male. The histopathological observation showed femoral head necrosis in all patients and informed consent was obtained.
METHODS： （1）All hips were evaluated with the University of California at Los Angeles （UCLA） hip score before and after operation.UCLA scoring consists of pain, walking, function