摘要
目的探究初次全髋关节置换术中后外侧入路与直接前方入路对解剖柄位置的影响及对股骨前倾角影响因素的分析。方法纳入自2015年6月至2020年6月在我院由同一名医师使用解剖柄进行初次全髋关节置换的108例共114个髋关节。患髋屈曲活动范围<60°,下肢需延长>2 cm,身体质量指数(body mass index,BMI)>30 kg/m2,患者要求后外侧入路(posterolateral approach,PLA)者采用PLA手术入路,其余采用前方入路(direct anterior approach,DAA)。DAA组共44髋,男性24髋,女性20髋;平均年龄(60.1±12.1)岁;PLA组共70髋,男性38髋,女性32髋;平均年龄(59.8±11.4)岁。患者仰卧位,CT扫描患侧(髂前上棘至胫骨结节),重建股骨三维图形,测量股骨假体柄在矢状面、冠状面及水平面的位置、前倾角,距小转子截骨距离及股骨头前后距离。结果术前DAA组股骨前倾角(23.2±10.4)°,PLA组股骨前倾角(27.7±10.9)°,两组比较差异有统计学意义(P=0.003)。术后两组股骨前倾角分别为(28.5±11.5)°、(30.7±9.2)°,差异无统计学意义(P=0.141)。术后两组前倾角变化比较,差异有统计学意义(P=0.043);两组假体柄矢状面夹角和矢状面夹角变化比较,差异均有统计学意义(P=0.008,P=0.003)。术前前倾角与术后前倾角相关,差异有统计学意义(P=0.001);DAA入路屈曲植入假体柄个数与PLA入路组相比,差异有统计学意义(P=0.043);股骨头前后距离变化在两种入路中比较差异无统计学意义(P=0.882)。结论术前股骨前倾角是影响术后前倾角变化的因素,手术入路不影响术后前倾角及股骨头前后距离的变化,而手术入路对假体柄在矢状面的位置有影响。
Objective To explore the influence of the posterolateral approach and the direct anterior approach on the position of the prosthesis stem and the analysis of the factors affecting the anteversion angle of the femur in the initial total hip arthroplasty.Methods A total of 108 cases of 114 hip joints were included in our hospital from June 2015 to June 2020 in which the same doctor used an anatomical stem for the first total hip replacement.The flexion range of the affected hip was less than 60°,the lower extremity needs to be extended more than 2 cm,the BMI was more than 30 kg/m2 and the patient requires the posterolateral approach to use the posterolateral approach approach,the rest of the patients use the posterolateral approach approach,posterolateral approach group has 44 cases of hips,male There were 24 hips and 20 female hips,with an average age of(60.1±12.1)years.There were 70 hips in the posterolateral approach group,of which 38 were male hips and 32 were female hips,with an average age of(59.8±11.4)years.The patient lies in the supine position,CT scans the affected side(anterior superior iliac spine to tibial tubercle),reconstructs the three-dimensional figure of the femur,and measures the position of the femoral prosthetic stem in the sagittal,coronal and horizontal planes,anteversion angle,and osteotomy from the lesser tuberosity Distance and the anteroposterior distance of the femoral head.Results Before the operation,the anteversion angle of the femur was(23.2±10.4)°in the posterolateral approach group and(27.7±10.9)°in the posterolateral approach group.The difference between the two groups was statistically significant(P=0.003).The postoperative femoral anteversion angles of the two groups were(28.5±11.5)°and(30.7±9.2)°,respectively,and the difference was not statistically significant(P=0.141).After the comparison of the changes in the anteversion angle between the two groups,the difference was statistically significant(P=0.043);the difference between the sagittal and sagittal angles of the prosthesis was statistically significant(P=0.008,P=0.003).The preoperative anteversion angle was related to the postoperative anteversion angle,and the difference was statistically significant(P=0.001);the difference between posterolateral approach approach flexion implantation and posterolateral approach approach implantation was statistically significant(P=0.043);femoral head There was no statistically significant difference in the changes of the front-to-back distance between the two approaches(P=0.882).Conclusion The preoperative femoral anteversion angle is a factor that affects the postoperative anteversion angle.The surgical approach does not affect the postoperative anteversion angle and the change of the femoral head's anteroposterior distance.The surgical approach affects the position of the prosthesis stem in the sagittal plane.
作者
唐宇
刘俊才
陈建
陈畅
程宇翔
李忠
陈歌
Tang Yu;Liu Juncai;Chen Jian(Department of Bone and Joint Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)
出处
《实用骨科杂志》
2021年第2期97-102,共6页
Journal of Practical Orthopaedics
关键词
全髋关节置换术
后外侧入路
直接前方入路
解剖柄
股骨前倾角
total hip arthroplasty
posterolateral approach
direct anterior approach
anatomic stems
femoral anteversion
