股骨头坏死及髋关节置换后髋关节解剖参数变化的10年跟踪

背景：目前国内对股骨近端解剖参数特点的研究仅局限于普通国人，而对某些特殊群体关于此方面的研究较少。 目的：对1例因右侧股骨头坏死而行人工髋关节置换的运动员进行为期10年的跟踪调查，进行健侧与患侧，健侧与普通国人的髋关节参数对比。 方法：2001至2011年在医院对观察对象进行骨盆平片的X射线片拍摄。拍摄时患者仰卧于摄影台上，双下肢标准中立位，紧贴X射线片，摄影距离100 cm，以小转子水平为中心拍摄骨盆平片。要求股骨内旋，使股骨颈处在冠状面，于股骨颈纵轴平行位摄片。对X射线片上髋关节的各解剖参数进行测量，将数据导入SPSS 16.0软件，进行方差分析、相关分析以及主成分贡献率分析。 结果与结论：长期职业训练使受试者髋关节负荷严重增加，其股骨头所承受的压缩应力也远超普通人。患侧偏心距偏小，使关节周围软组织收缩乏力。应注意维持和恢复这些变形的部位。髋关节置换后的牵引使中心边缘角(CE角)有所恢复，但由于长期拄拐行走，患侧受压小于常人，患侧下肢重力自然牵引所致，要注意对患侧髋臼相对位置的恢复。由于患侧股骨头坏死，超载负荷区出现股骨头塌陷，关节腔隙减小，骨盆高度明显下降，手术后健侧股骨头与髋臼相对位置有所恢复，但患侧相对位置差异更为明显。

Changes in anatomical parameters of the hip following femoral head necrosis and hip replacement: A 10-year follow-up survery

BACKGROUND:At present, research on the anatomy parameters of the proximal femur is only confined to ordinary Chinese people, and the studies on some special groups are less. OBJECTIVE:To perform a 10-year follow-up in one athlete treated with artificial hip replacement due to right femoral head necrosis, and to compare the hip parameters between healthy side and affected side and between healthy side and ordinary Chinese people. METHODS:Pelvis X-ray plain films were taken from 2001 to 2011. The subject supine on photography table while shooting with double lower limbs in neutral position and closed to the X-ray films, the photographic distance was 100 cm, with the small rotor level as the center. Internal rotation of the femur was required to make the femoral neck in the coronal plane, then parallel to the longitudinal axis of the femoral neck for radiography. The various hip anatomy parameters were measured on the X-ray film, and then the data were imported into the SPSS 16.0 software for variance analysis, correlation analysis and principal component analysis of the contribution rate. RESULTS AND CONCLUSION:Long-term training led to a serious increase in hip load, and the stress on femoral head was far beyond the ordinary people. The eccentricity on the healthy side was smaller which leading to the periarticular soft tissue contraction asthenia. Attention should be paid to maintaining and restoring the deformed parts. The traction after hip replacement recovered the center edge angle somewhat. As a result of long-term curtch walking, the compression on the healthy side was less than that of the ordinary people. A natural form of gravity-assisted traction was shown in the lower limbs. We should pay attention to the recovery of relative acetabular position on the healthy side. As a result of femoral head necrosis, femoral head collapse was observed in the overload area, joint cavity and pelvic height was decreased obviously. After operation, the femoral head and relative acetabular position on the healthy side were restored somewhat, but relative ipsilateral position difference was more obvious.