摘要
目的 探讨人工全髋关节置换术(total hip arthroplasty,THA)后股骨柄前倾角(femoral stem anteversion,FSA)的相关因素,为临床术前设计FSA、降低置换术后髋关节脱位风险提供参考。方法 以2021年10月—2022年9月收治且符合选择标准的93例(103髋)THA患者作为研究对象。其中男48例,女45例;年龄25~88岁,平均58.5岁。身体质量指数18.00~37.84 kg/m2,平均24.92 kg/m2。诊断:股骨头坏死51例(57髋),骨关节炎35例(39髋),先天性髋关节发育不良7例(7髋)。基于手术前后CT图像测量以下指标:术前指标包括股骨颈前倾角(femoral neck anteversion,FNA)、股骨旋转角(femoral rotation angle,FRA)、髋臼前倾角(acetabular anteversion,AA),并计算联合前倾角(combined anteversion,CA),即术前FNA与AA之和;术后指标为FSA,并计算术后股骨前倾角变化值,即术后FSA与术前FNA的差值。基于术前X线片测量以下指标:股骨皮质厚度指数(cortical thickness index,CTI);股骨髓腔开口指数(canal flare index,CFI),并根据Noble分类法对股骨近端髓腔解剖形状分型(香槟杯型、正常型、烟囱型);股骨颈干角(neck-shaft angle,NSA);偏心距(femoral offset,FO)。应用Pearson相关分析、单因素方差分析、Point-biserial相关分析术后FSA、术后股骨前倾角变化值分别与患者诊断、股骨近端髓腔解剖类型、性别、年龄以及术前FNA、FRA、AA、CA、NSA、FO、CTI、CFI相关关系。以FSA作为因变量,纳入与其可能存在相关关系的自变量进行多重线性回归分析。结果 基于CT图像测量示,术前FNA(15.96±10.01)°、FRA(3.36±10.87)°、AA(12.94±8.83)°、CA(28.9±12.6)°,术后FSA(16.18±11.01)°,术后股骨前倾角变化值(0.22±9.98)°。基于术前X线片测量示,CTI 0.586±0.081;CFI4.135±1.125,其中股骨近端髓腔为香槟杯型23髋、正常型68髋、烟囱型12髋;NSA(132.87±7.83)°;FO(40.53±10.11)mm。患者术前FNA与术后FSA差异无统计学意义(t=-0.227,P=0.821)。Pearson相关分析示术后FSA与术前FNA及CA、术后股骨前倾变化值、年龄成正相关(P<0.05),与术前FRA成负相关(P<0.05);而术后股骨前倾角变化值与术前FRA及术后FSA成正相关(P<0.05),与术前CA、FNA成负相关(P<0.05)。单因素方差分析示上述两指标与诊断和股骨近端髓腔解剖类型无相关(P>0.05)。多重线性回归分析示FSA与FNA、CA、年龄、FRA存在线性相关(F=10.998,P<0.001),最佳拟合优度模型为FSA=0.48×FNA–2.551。结论 与THA术后FSA相关的因素包括患者年龄以及术前FNA、CA、FRA和术后股骨前倾变化值,其中术前FNA与之关系最密切。术前设计手术方案时应注意患者FNA,必要时扫描髋关节周围CT以详细了解股骨近端解剖结构。
Objective To explore the related factors of femoral stem anteversion(FSA)after total hip arthroplasty(THA),so as to provide reference for clinical design of FSA before operation and reduce the risk of hip dislocation after arthroplasty.Methods Ninty-three patients(103 hips)who underwent THA between October 2021 and September 2022 and met the selection criteria were selected as the study subjects.Among them,there were 48 males and 45 females with an average age of 58.5 years(range,25-88 years).Body mass index was 18.00-37.84 kg/m2,with an average of 24.92 kg/m2.There were 51 cases(57 hips)of osteonecrosis of femoral head,35 cases(39 hips)of hip osteoarthritis,and 7 cases(7 hips)of congenital hip dysplasia.Based on CT images,the following indicators were measured:preoperative femoral neck anteversion(FNA),preoperative femoral rotation angle(FRA),preoperative acetabular anteversion(AA),and preoperative combined anteversion(CA;the sum of preoperative FNA and AA);postoperative FSA and the change in femoral anteversion angle(the difference between postoperative FSA and preoperative FNA).Based on preoperative X-ray films,the following indicators were measured:femoral cortical thickness index(CTI)and canal flare index(CFI),the proximal femoral medullary cavity was classified according to Noble classification(champagne cup type,normal type,chimney type),neck-shaft angle(NSA),and femoral offset(FO).Pearson correlation analysis,one-way ANOVA,and Point-biserial correlation analysis were used to investigate the correlation between postoperative FSA,postoperative change in femoral anteversion angle,and patient diagnosis,proximal femoral medullary cavity anatomy type,gender,age,as well as preoperative FNA,FRA,AA,CA,NSA,FO,CTI,and CFI.FSA was used as the dependent variable and the independent variables that may be related to it were included for multiple linear regression analysis.Results Based on CT image measurement,preoperative FNA was(15.96±10.01)°,FRA(3.36±10.87)°,AA(12.94±8.83)°,CA(28.9±12.6)°,postoperative FSA(16.18±11.01)°,and postoperative change in femoral anteversion angle was(0.22±9.98)°.Based on preoperative X-ray films measurements,the CTI was 0.586±0.081;the CFI was 4.135±1.125,with 23 hips classified as champagne cup type,68 hips as normal type,and 12 hips as chimney type in the proximal femoral medullary cavity anatomy;NSA was(132.87±7.83)°;FO was(40.53±10.11)mm.There was no significant difference between preoperative FNA and postoperative FSA(t=−0.227,P=0.821).Pearson correlation analysis showed that postoperative FSA was positively correlated with preoperative FNA,preoperative CA,postoperative change in femoral anteversion angle,and age(P<0.05),while negatively correlated with preoperative FRA(P<0.05).The postoperative change in femoral anteversion angle were positively correlated with preoperative FRA and postoperative FSA(P<0.05),and negatively correlated with preoperative CA and FNA(P<0.05).One-way ANOVA analysis showed that the above two indicators were not correlated with diagnosis and the proximal femoral medullary cavity anatomy type(P>0.05).Multiple linear regression analysis showed a linear correlation between FSA and FNA,CA,age,and FRA(F=10.998,P<0.001),and the best fit model was FSA=0.48×FNA–2.551.Conclusion The factors related to FSA after THA include patient’s age,preoperative FNA,CA,FRA and postoperative femoral anteversion,of which preoperative FNA is the most closely related.When designing a surgical plan before surgery,attention should be paid to the patient’s preoperative FNA,and if necessary,CT around the hip joint should be scanned to gain a detailed understanding of the proximal femoral anatomical structure.
作者
刘政
宋凯
蒋青
徐志宏
LIU Zheng;SONG Kai;JIANG Qing;XU Zhihong(Division of Sports Medicine and Adult Reconstructive Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing Jiangsu,210008,P.R.China;Branch of National Clinical Research Center for Orthopedics,Sports Medicine and Rehabilitation,Nanjing Jiangsu,210008,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2023年第9期1075-1080,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(81991514、82272492)。
关键词
人工全髋关节置换术
股骨柄前倾角
股骨颈前倾角
股骨近端形态
Total hip arthroplasty
femoral stem anteversion
femoral neck anteversion
proximal femoral morphology
