本文選題：聯(lián)合前傾角　切入點：垂直偏距　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:隨著進(jìn)入社會老齡化,我國全髖關(guān)節(jié)置換術(shù)(THA)逐年增多,髖關(guān)節(jié)翻修術(shù)數(shù)量也呈逐年增多趨勢。有效重建恢復(fù)髖關(guān)節(jié)功能、降低并發(fā)癥是髖關(guān)節(jié)翻修術(shù)的最終目的。在初次全髖關(guān)節(jié)置換術(shù)中,因可利用髖臼橫韌帶、髖臼緣等解剖標(biāo)志輔助定位髖臼杯的外展角和前傾角,故可較容易獲得滿意的假體位置及角度。而對于髖關(guān)節(jié)翻修病例,往往存在解剖標(biāo)志的破壞,髖臼及股骨近端結(jié)構(gòu)異常,這使得髖關(guān)節(jié)翻修術(shù)的困難明顯增加。因諸多因素存在,難以獲得理想的假體“安全區(qū)”,難以獲得正常的旋轉(zhuǎn)中心。聯(lián)合前傾角被用于髖關(guān)節(jié)發(fā)育不良的全髖關(guān)節(jié)置換術(shù),根據(jù)該技術(shù),髖關(guān)節(jié)假體可被安裝在較為理想的位置和方向。而未見其在髖關(guān)節(jié)翻修術(shù)中應(yīng)用的報道。本文回顧性研究聯(lián)合前傾角在髖關(guān)節(jié)翻修術(shù)中旋轉(zhuǎn)中心的意義,以及預(yù)防術(shù)后脫位、撞擊及松動等的作用。方法:本文回顧性研究自2010,02-2016,02我院行采用聯(lián)合前傾角技術(shù)成功實施髖關(guān)節(jié)翻修手術(shù)15例15髖,年齡38-72歲,平均61.40±8.45歲,其中男性15例10髖,年齡38-72歲,平均年齡60.54±8.78歲;女性2例2髖,年齡分別是66歲和68歲,平均年齡67歲。所有病例均采用聯(lián)合前傾角技術(shù),根據(jù)股骨前傾角調(diào)整髖臼前傾角及外展角。術(shù)后行CT檢查髖臼假體的外展角度、前傾角及聯(lián)合前傾角。根據(jù)骨盆X線平片測量垂直偏距、水平偏距及其與對側(cè)差值。結(jié)果:所有患者均得到隨訪,隨訪時間1-5年,平均3年。術(shù)后CT片檢查測得的髖臼外展角度為:27.27±7.81°(20-35°),髖臼前傾角為:16.93±3.63°(13-21°),聯(lián)合前傾角為:42.87±7.08°(35-50°)。手術(shù)組垂直偏距為:3.89±0.42cm,水平偏距為:4.10±0.28cm。對側(cè)或健側(cè)垂直偏距為:4.10±0.44cm,水平偏距為:3.90±0.36cm。術(shù)前Harris評分為:41.07±4.65分(37-45分),術(shù)后Harris評分為:88.33±2.99分(85-91分)。髖關(guān)節(jié)功能評分明顯改善。其中2例聯(lián)合前傾角超出安全區(qū),但患者無髖關(guān)節(jié)明顯疼痛,自我感覺手術(shù)滿意。所有患者均未出現(xiàn)脫位、假體松動及感染。結(jié)論:聯(lián)合前傾角測量技術(shù)對髖關(guān)節(jié)翻修手術(shù)有著指導(dǎo)意義。良好的髖臼假體及股骨假體植入角度決定良好的髖關(guān)節(jié)旋轉(zhuǎn)中心,對髖臼穩(wěn)定性、降低磨損、防止脫位有著重要意義。但由于該研究納入的病例數(shù)量有限,統(tǒng)計結(jié)果有一定的局限性,需要增加病例數(shù),以進(jìn)一步提高其臨床指導(dǎo)作用。
[Abstract]:Objective: with the aging of the society, the total hip replacement (THA) is increasing year by year, and the number of hip revision is increasing year by year.Effective reconstruction and recovery of hip function and reduction of complications are the ultimate goals of hip revision.In the primary total hip arthroplasty, the position and angle of the prosthesis can be easily obtained by using the anatomical markers such as transverse acetabular ligament and acetabular edge to assist in locating the abduction angle and the antegrade angle of the acetabular cup.However, for the revision of the hip, the destruction of anatomic markers and the abnormal structure of the acetabular and proximal femur make the revision of the hip more difficult.Because of many factors, it is difficult to obtain the ideal prosthesis "safe area" and the normal rotation center.Combined anteversion is used in total hip arthroplasty with dysplasia of hip, according to which hip prosthesis can be installed in ideal position and direction.There was no report of its application in hip revision surgery.In this paper, the significance of combined antegrade angle in the rotation center of hip revision and the role of preventing dislocation, impact and loosening after operation were studied retrospectively.Methods: a retrospective study was conducted on 15 hips of 15 patients (38-72 years old, mean 61.40 鹵8.45 years old) who underwent revision hip arthroplasty with combined anteversion technique in our hospital from February to February 2012.There were 15 males (10 hips, 38-72 years old) with an average age of 60.54 鹵8.78 years.Two hips (66 and 68 years old, mean age 67 years) were found in 2 female patients.The acetabular anteversion and abduction angle were adjusted according to the femoral anteversion.The abduction angle, anteversion angle and combined anteversion angle of acetabular prosthesis were examined by CT.The vertical deviation, horizontal deviation and their difference with the opposite side were measured according to the pelvic X-ray plain film.Results: all patients were followed up for 1-5 years with an average of 3 years.After operation, the acetabular abduction angle measured by CT film was 1: 27.27 鹵7.81 擄/ 20 ~ 35 擄/ L, the acetabular anteversion angle was: 1 / 16.93 鹵3.63 擄/ 13-21 擄/ m, and the combined anteversion angle was: 1 / 42.87 鹵7.08 擄/ v 35-50 擄/ m.In the operation group, the vertical deviation was 3.89 鹵0.42 cm and the horizontal deviation was 4.10 鹵0.28 cm.The vertical deviation of the contralateral side and the normal side was: 1: 4.10 鹵0.44 cm, and the horizontal deviation was: 3. 90 鹵0. 36 cm.The preoperative Harris score was 1: 41.07 鹵4.65 min, 37-45 min, and the postoperative Harris score was 8% 88.33 鹵2.99 min (85-91 min).The score of hip joint function was improved obviously.Two of them had combined antegrade angle beyond the safety zone, but the patients had no obvious pain in hip joint and were satisfied with self-sensory surgery.No dislocation, loose prosthesis and infection were found in all patients.Conclusion: combined antegrade measurement technique is of guiding significance for hip revision surgery.The good angle of acetabular prosthesis and femoral prosthesis determines the rotation center of hip joint, which is of great significance to the stability of acetabular, the reduction of wear and the prevention of dislocation.However, due to the limited number of cases included in the study, the statistical results have some limitations, so it is necessary to increase the number of cases in order to further improve its clinical guidance.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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本文編號：1710424