本文選題：髖關(guān)節(jié)　切入點(diǎn)：骨性強(qiáng)直　出處：《新疆醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:探討骨性強(qiáng)直的髖關(guān)節(jié)在全髖關(guān)節(jié)置換術(shù)(total hip arthroplasty,THA)中髖臼方位的確定方法及其術(shù)后X線的準(zhǔn)確性評價。方法:2009年1月至2015年3月期間在我院骨科中心接受初次THA(骨性及軟組織解剖標(biāo)記聯(lián)合定位)的髖關(guān)節(jié)骨性強(qiáng)直患者中篩選32例(49髖),其中男25例,女7例;單側(cè)15例,雙側(cè)17例;BMI為(25.5±3.7)kg/m2;年齡18~69歲,平均(35.8±12.7)歲。病因:強(qiáng)直性脊柱炎18例,結(jié)核6例,創(chuàng)傷5例,骨性關(guān)節(jié)炎2例,化膿性感染1例。術(shù)后運(yùn)用PACS系統(tǒng)軟件測量骨盆正位片髖臼的前傾角、外展角、股骨偏心距(femoral offset,FO)及髖臼中心(acetabular center,AC)位置。并以前傾角15°、AC偏移度為0作為參考值評價前傾角及AC偏移度的準(zhǔn)確性,同時將術(shù)后外展角及FO分別與健側(cè)比較以判斷其準(zhǔn)確性。所選病例中無骨盆及嚴(yán)重腰椎畸形改變。結(jié)果:32例患者均完成隨訪,隨訪時間13~63個月,平均(30.3±14.7)月。術(shù)后骨性強(qiáng)直髖患者的髖臼前傾角與放置目標(biāo)值(前傾角15°)相比在統(tǒng)計學(xué)上無顯著差異(P=0.630)。髖臼假體外展角、FO與健側(cè)髖臼解剖外展角、FO相比差異無統(tǒng)計學(xué)差異(P=0.233,P=0.168),髖臼假體垂直偏移度平均(2.1±3.6),水平偏移度平均(0.4±3.2),術(shù)后髖臼假體中心與髖臼解剖中心符合率73.5%(符合率:偏差在5mm以內(nèi)者認(rèn)為達(dá)到AC解剖復(fù)位)。結(jié)論:對于喪失正常解剖結(jié)構(gòu)的骨性強(qiáng)直的髖關(guān)節(jié),充分利用術(shù)中殘留的骨性及軟組織解剖標(biāo)記結(jié)構(gòu)進(jìn)行髖臼定位的策略是能夠比較準(zhǔn)確的定位髖臼。
[Abstract]:Objective: to investigate the determination of acetabular orientation in total hip arthroplasty (THAs) of hip joints with osteotonic ankylosis and to evaluate the accuracy of postoperative X-ray. Methods: from January 2009 to March 2015, the patients received initial treatment in the orthopedic center of our hospital from January 2009 to March 2015. 32 cases (25 males) with osteotropic ankylosis of hip joint were screened by THA (bone and soft tissue anatomical markers combined localization). Female 7 cases, unilateral 15 cases, bilateral 17 cases with BMI of 25.5 鹵3.7 kg / m2; age 1869 years, mean 35.8 鹵12.7 years old. Etiology: ankylosing spondylitis 18 cases, tuberculosis 6 cases, trauma 5 cases, osteoarthritis 2 cases, the etiology: ankylosing spondylitis 18 cases, tuberculosis 6 cases, trauma 5 cases, osteoarthritis 2 cases. 1 case of suppurative infection. The anteversion and abduction angle of the acetabular were measured by PACS system software after operation. The position of femoral eccentricity and acetabular center of Acetabular center-ac). The accuracy of anteversion angle and AC deviation was evaluated with the reference value of 15 擄AC deviation of 15 擄anteversion angle as the reference value. At the same time, the postoperative abduction angle and FO were compared with the healthy side to determine the accuracy. There were no pelvic or severe lumbar deformity changes in the selected cases. Results all 32 cases of the patients were followed up for 13 ~ 63 months. There was no statistical difference between the acetabular anteversion angle (15 擄) and the placement target value (15 擄). There was no statistical difference between the acetabular extension angle FO and the contralateral acetabular abduction angle (FO). The average vertical deviation and horizontal deviation of acetabular prosthesis were 2.1 鹵3.6 and 0.4 鹵3.2, respectively. The coincidence rate between acetabular prosthesis center and acetabular anatomic center was 73.5% (coincidence rate: deviation within 5mm). Conclusion: for loss of acetabular prosthesis and acetabular anatomic center, AC anatomical reduction is achieved. The bony ankylosis of the hip joint with abnormal anatomical structure, The strategy of acetabular localization is to make full use of the remaining bone and soft tissue anatomical markers to locate the acetabulum accurately.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.4

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