本文關(guān)鍵詞： 全髖關(guān)節(jié)置換術(shù) 生物型 髖臼假體 大小 影響因素 相關(guān)分析　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究全髖關(guān)節(jié)置換術(shù)中生物型髖臼假體大小選擇的影響因素,為術(shù)前及術(shù)中選擇大小合適的髖臼假體提供依據(jù)。方法:在電子病歷系統(tǒng)中,收集2013年1月至2016年6月在河北醫(yī)科大學(xué)第三醫(yī)院骨病科行初次生物型全髖關(guān)節(jié)置換術(shù)病人806例,1011側(cè)髖,剔除假體周圍骨折、假體周圍感染、假體無(wú)菌性松動(dòng)、脫位、假體磨損、骨水泥型髖臼假體、髖臼壁銼穿、髖臼打壓植骨、失訪及病歷資料不全病人74例,收集病例資料完整的病人732例918側(cè)髖(雙髖186例,單髖546例),其中男性466例592側(cè)髖,女性266例326側(cè)髖,男女比例1.75:1,年齡18-85歲,平均年齡(50.24±0.43)歲,收集病人年齡、性別、身高、體重、手術(shù)側(cè)別、臨床診斷及術(shù)中應(yīng)用的髖臼假體直徑大小,記錄于Microsoft Office Excel 2003表格中,根據(jù)最新年齡劃分標(biāo)準(zhǔn)將年齡分為45歲、45-59歲、60-74歲、75-89歲四組,性別分為男性、女性組,手術(shù)側(cè)別分為左側(cè)、右側(cè)組,參考實(shí)用骨科學(xué)臨床診斷分為股骨頸骨折、股骨頭缺血性壞死、髖關(guān)節(jié)骨關(guān)節(jié)炎、髖臼發(fā)育不良、類風(fēng)濕性關(guān)節(jié)炎、強(qiáng)直性脊柱炎伴髖關(guān)節(jié)僵直六組,使用SPSS 20.0軟件,分析性別、手術(shù)側(cè)別、年齡、臨床診斷等因素對(duì)髖臼假體直徑大小選擇的影響及身高、體重、BMI與髖臼假體大小的相關(guān)性。結(jié)果:1 918側(cè)髖臼假體大小服從正態(tài)分布;2不同性別的病人髖臼假體直徑大小差異有統(tǒng)計(jì)學(xué)意義(P0.001),男性(51.06±1.88)mm明顯大于女性(48.12±2.02)mm;(表1)3不同手術(shù)側(cè)所用髖臼假體直徑大小不同,右側(cè)使用的髖臼假體直徑(50.11±2.45)mm大于左側(cè)(49.93±2.32)mm,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.2610.05);(表2)4不同年齡組所用髖臼假體直徑大小不同,60-74歲年齡組小于其他年齡組,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.410.05);(表3)5不同髖關(guān)節(jié)病種應(yīng)用的髖臼假體直徑大小有差異,強(qiáng)直性脊柱炎伴髖關(guān)節(jié)僵直使用的髖臼假體直徑最大(51.38±1.70)mm、其次為髖關(guān)節(jié)骨關(guān)節(jié)炎(50.30±2.42)mm、股骨頭缺血性壞死(50.16±2.17)mm、股骨頸骨折(49.26±2.13)mm、類風(fēng)濕性關(guān)節(jié)炎(49.00±3.70)mm,髖臼發(fā)育不良使用的髖臼假體直徑最小(48.32±2.09)mm,其中強(qiáng)直性脊柱炎伴髖關(guān)節(jié)僵直組與其他各組差異均有統(tǒng)計(jì)學(xué)意義;(表4)6應(yīng)用的髖臼假體大小與病人身高存在直線相關(guān)關(guān)系(R2=0.364),回歸方程為:Y=16.661+0.200X;與病人體重也存在直線相關(guān)關(guān)系(R2=0.134),回歸方程為:Y=44.720+0.075X;與BMI之間無(wú)相關(guān)性(r=0.053,P=0.112);(表5、表6、表7)7髖臼假體直徑大小與身高(X1)、性別(X2)、年齡(X3)、體重(X4)及臨床診斷(X5)有線性回歸關(guān)系,且性別為選用髖臼假體直徑大小最重要的影響因素,其線性回歸方程為(表8):Y =30.277+0.119X1-1.628X2+0.301X3+0.016 X4+0.15 X5結(jié)論:1男、女性髖臼假體大小差異具有統(tǒng)計(jì)學(xué)意義,男性大于女性;2不同年齡組、不同側(cè)別髖臼假體大小無(wú)明顯統(tǒng)計(jì)學(xué)差異;3髖臼假體大小與病人身高、體重有直線相關(guān)關(guān)系;與BMI無(wú)相關(guān)性。4髖關(guān)節(jié)病種為選擇髖臼杯直徑大小的影響因素,強(qiáng)直性脊柱炎伴髖關(guān)節(jié)僵直使用的髖臼假體直徑偏大,髖臼發(fā)育不良使用的髖臼假體直徑偏小。5髖臼假體直徑大小與身高、性別、年齡及臨床診斷有線性回歸關(guān)系,性別為選用髖臼假體直徑大小最重要的影響因素。
[Abstract]:Objective: To study the effect of biological factors in total hip arthroplasty of acetabular prosthesis size selection, provide the basis for the selection of the proper size of acetabular prosthesis before and during surgery. Methods: in the electronic medical record system, from January 2013 to June 2016 in 806 cases of orthopedics, the Third Hospital of Hebei Medical University underwent primary cementless total hip replacement in 1011 patients. Hip, excluding periprosthetic fractures, periprosthetic infection, aseptic loosening, dislocation, prosthesis wear, cementless acetabular component, acetabular wall burrs wear, acetabular impaction bone grafting, lost and incomplete medical records of 74 patients, patients with complete data were collected in 732 cases (918 hip Hip 186 with a single hip in 546 cases), including 466 cases of male female 266 cases 592 hips, 326 hips, the proportion of male and female 1.75:1, aged 18-85 years old, average age (50.24 + 0.43) years old, collection of patient age, gender, height, weight, operation side, pro The clinical application of diagnosis and treatment of acetabular prosthesis size, recorded in the Microsoft Office Excel 2003 in the table, according to the division of the new standard age will be divided into 45 years of age, 45-59 years, 60-74 years, 75-89 years of age four group, sex male, female group, the operation side is divided into left and right reference group. Practical Department of orthopedics clinical diagnosis points of femoral neck fracture, avascular necrosis of the femoral head, hip osteoarthritis, hip dysplasia, rheumatoid arthritis, ankylosing spondylitis, hip ankylosis in six groups, gender analysis using SPSS 20 software, operation, side, age, weight and other factors on the clinical diagnosis of acetabular prosthesis diameter influence of size selection and height, the correlation between BMI and acetabular prosthesis size. Results: 1918 acetabular prosthesis size obeys normal distribution; 2 different gender patients with acetabular prosthesis size difference was statistically significant (P0.001), male (51.06. 1.88) mm were significantly larger than females (48.12 + 2.02) mm; (Table 1) with acetabular prosthesis diameter 3 different surgical side, the diameter of the right to the use of the acetabular prosthesis (50.11 + 2.45) mm greater than left (49.93 + 2.32) mm, there was no statistically significant difference (P=0.2610.05); (Table 2) acetabular prosthesis the diameter of the 4 different age groups of different age group 60-74 less than other age groups, the difference was not statistically significant (P=0.410.05); (Table 3) acetabular prosthesis diameter 5 different hip joint disease application are different, ankylosing spondylitis with stiff hip with acetabular prosthesis diameter (51.38 + 1.70) mm, followed by hip osteoarthritis (50.30 + 2.42) mm, avascular necrosis of the femoral head (50.16 + 2.17) mm, femoral neck fracture (49.26 + 2.13) mm, rheumatoid arthritis (49 + 3.70) mm, acetabular dysplasia using acetabular minimum diameter (48.32 + 2.09) mm. The ankylosing spondylitis Hip joint ankylosis group with other groups, the differences were statistically significant (Table 4) with inflammation; there was a linear correlation between the 6 Application of the acetabular prosthesis size and patient height (R2=0.364), the regression equation is: Y=16.661+0.200X; also had a linear relationship with body weight (R2=0.134), the regression equation is: Y=44.720+0.075X; no correlation between BMI and (r=0.053, P=0.112); (Table 5, table 6, table 7) 7 acetabular prosthesis diameter and height (X1), gender (X2), age (X3), weight (X4) and clinical diagnosis (X5) linear regression relation, and gender factors affect the selection of the most important diameter of acetabular prosthesis and the linear regression equation (Table 8): Y =30.277+0.119X1-1.628X2+0.301X3+0.016 X4+0.15 X5 conclusion: 1 male, with significant female acetabular prosthesis size difference in male than female; 2 different age groups, different side of acetabular prosthesis size had no significant difference; 3 acetabulum The height and size of the prosthesis patients showed a linear correlation between body weight; there was no correlation between BMI.4 hip diseases affecting factors of acetabular cup diameter, ankylosing spondylitis, hip joint stiffness of acetabular prosthesis diameter using large diameter acetabular acetabular dysplasia using small.5 acetabular prosthesis diameter and height, gender age and clinical diagnosis, linear regression relation, gender factors for selection of acetabular prosthesis size is the most important.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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