髋臼卵圆窝参照法在THR中髋臼假体旋转中心的疗效分析

目的采用卵圆窝参照法实施初次全髋关节置换术(THR),探讨髋臼假体旋转中心变化的影响因素及临床疗效。方法回顾性分析我科2009年11月至2013年4月治疗的93例全髋关节置换患者,测量手术后双髋关节X线片髋关节旋转中心、外展角、前倾角,比较手术后髋臼假体旋转中心与解剖旋转中心符合率,对患者的Harris评分进行统计学分析。结果全部病例随访6⁴8个月,平均27.5个月。所有病例X线片提示,假体位置良好,无髋臼及股骨假体松动,无需要翻修病例。Harris评分由术前平均(41.45±9.74)分,增加到(91.36±3.65)分,优78例(83.87%),良8例(8.60%),可7例(7.52%),优良率92.47%。手术前后Harris评分结果比较t=3.284,P<0.05,差异有统计学意义。髋臼假体旋转中心O2恢复至解剖旋转中心O1者67例,符合率72.04%。未恢复者26例,未符合率27.96%。髋关节旋转中心(COR)恢复组与未恢复组外展角比较,差异有统计学意义(44.68°±5.35°vs.48.37°±4.65°,t=2.830 1,P<0.05),COR恢复组与未恢复组前倾角比较,差异没有统计学意义(17.36°±6.65°vs.16.51°±7.25°,t=0.539 4,P>0.05)。COR恢复组与未恢复组术前Harris评分比较,差异没有统计学意义(41.45±7.38 vs.38.85±6.65,t=1.565 7,P>0.05),COR恢复组与未恢复组术后Harris评分比较,差异有统计学意义(92.45±3.35 vs.81.65±5.39,t=11.641 7,P<0.05)。结论髋臼假体旋转中心应遵循解剖重建的原则,临床关键在于确定髋臼旋转中心的位置,达到理想的臼杯外展40°,需内置、上移髋臼旋转中心。通过优化髋臼假体的倾斜角和覆盖,达到稳定关节,减少磨损,改善功能,取得良好的临床远期疗效。

Analysis of curative effect of acetabular fossa ovalis reference method in the THR acetabular rotation center

Objective The implementation of primary total hip arthroplasty（total hip replacement, THR） by adopt the method of fossa ovalis reference to investigate the factors affecting acetabular center of rotation changes and clinical efficacy. Methods A retrospective analysis of 93 cases of patients treated in our department in November 2009-April 2013 with total hip arthroplasty, Measuring the compliance rate with double hip surgery after X-ray of the hip joint center of rotation, abduction angle, anteversion, comparing the surgical center of rotation of the acetabular prosthesis with anatomic center of rotation. Harris scores for the patients were statistically analyzed. Results All patients were followed up for 6 to 48 months, average 27.5 months. All cases X-ray prompt prosthesis position well, no acetabular and femoral prosthesis loosening, no need to overhaul cases. Harris score was（41.45±9.74） points from the preoperative to（91.36±3.65） points, excellent 78 cases（83.87%）, good in 8 cases（8.60%）, 7 cases（7.52%）, good rate of 92.47%. Harris scores before and after surgery results compare t=3.284, P〈0.05, the difference was statistically significant. Acetabular center of rotation O2 restored to 67 cases by anatomic center of rotation O1, 72.04% compliance rate. Not recovered in 26 cases, do not meet the rate of 27.96%. Hip rotation center（center of rotation, COR）, COR recovery group and the group does not restore the abduction angle, the difference was statistically significant（44.68°±5.35° vs. 48.37°±4.65°, t=2.830 1, P〈0.05）, COR recovery group and did not resume before the inclination comparison group, the difference was not statistically significant（17.36°±6.65° vs. 16.51°±7.25°, t=0.539 4, P〉0.05）. COR recovery group and did not resume before the comparison group preoperative Harris hip score, the difference was not statistically significant（41.45±7.38 vs. 38.85±6.65, t=1.565 7, P〉0.05）, COR recovery group and the group did not recover after Harris s