全髋置换是否重建偏心距对髋关节功能的影响

背景：股骨偏心距的重建对于恢复外展肌力和髋关节周围软组织张力平衡，维持关节稳定，恢复关节功能，减少置换后跛行，降低假体磨损、人工关节脱位等并发症的发生率具有重要意义。目的：探讨全髋置换的重建偏心距对髋关节功能恢复的影响。方法：对比分析采用组配式假体(S-ROM)行全髋置换20例20髋患者及采用普通假体(Corail)行全髋置换19例20髋患者的相关资料，通过临床(Harris评分)和X射线测量，对两组患者置换后髋关节功能和偏心距重建率进行对比研究。结果与结论：纳入患者均无感染、骨折、脱位，无深静脉血栓及神经损伤等并发症。临床随访：在组配式假体和普通假体两组中，股骨偏心距重建组与未重建组置换前Harris评分差异无显著性意义(P > 0.05)；置换后12个月及末次随访偏心距重建患者Harris评分高于未重建者(P < 0.05)。髋关节外展活动度大于未重建患者(P < 0.05)。X射线随访：组配式假体和普通假体两组中股骨偏心距重建率差异有显著性意义  (χ²=3.956，P < 0.05)，39髋(98%)股骨假体位于中立位，1髋(2.5%)轻度外翻位，两组中股骨偏心距得到重建与未得到重建患者的髋臼假体外展角及前倾角差异均无显著性意义(P > 0.05)。说明组配式假体和普通假体两组中股骨偏心距得到重建患者的髋关节功能和髋关节外展活动度优于未得到重建者，组配式假体偏心距重建率高。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：

Effects of femoral offset reconstruction or non-reconstruction on hip joint function in total hip arthroplasty

BACKGROUND: Femoral offset reconstruction is significant for recovering strength of abductor and the balance of soft tissue tension surrounding hip joint, maintaining joint stabilization, restoring joint function, reducing limping after replacement, decreasing prosthetic abrasion, and the incidence of joint prosthesis dislocation. OBJECTIVE: To discuss effect of femoral offset reconstruction on hip joint function in total hip arthroplasty.METHODS: We comparatively analyzed 20 patients (20 hips) undergoing the modular prosthesis (S-ROM) total hip arthroplasty and 19 patients (20 hips) undergoing the one modular prosthesis (Corail) total hip arthroplasty at the same time. According to Harris hip score and radiography results, hip joint function and femoral offset reconstruction rate were comparatively studied in both groups. RESULTS AND CONCLUSION: No infection, fracture, dislocation, deep venous thrombosis or neurovascular injury occurred in either group. Clinical follow-up results: In the modular prosthesis and one modular prosthesis  groups, there was no significant difference in preoperative Harris hip score between the femoral offset reconstruction and non-reconstruction groups (P > 0.05). At 12 months and the latest follow-up, the Harris hip score was higher in the patients with femoral offset reconstruction than those with femoral offset non-reconstruction (P < 0.05). The range of abduction of hip joint was larger in patients with femoral offset reconstruction than those with femoral offset non-reconstruction (P < 0.05). Radiographic follow-up results: significant differences in the rate of femoral offset reconstruction were detected between the modular prosthesis and one modular prosthesis groups (χ² = 3.956, P < 0.05). 39 (98%) femoral stems were in neutral position and one (2.5%) was in mild valgus. There was no significant difference in the abduction angle and the anteversion angle between patients with and without femoral offset reconstruction (P > 0.05). These results indicated that functional recovery and the range of abduction were better in patients with femoral offset reconstruction than those without femoral offset reconstruction. Modular prosthesis has a high rate of femoral offset reconstruction.