初次全髖關(guān)節(jié)置換髖臼旋轉(zhuǎn)中心重建與術(shù)后功能恢復(fù)
發(fā)布時(shí)間：2018-07-17 00:41
【摘要】：背景:隨著經(jīng)濟(jì)的高速發(fā)展,人們生活方式的改變及人口老齡化程度加快,股骨頭壞死、髖關(guān)節(jié)骨性關(guān)節(jié)炎及股骨頸骨折等髖關(guān)節(jié)病變的發(fā)生率也逐年上升。全髖關(guān)節(jié)置換術(shù)可以截去引起病人疼痛和活動受限的病變關(guān)節(jié),用耐磨的人工關(guān)節(jié)替換發(fā)生病變的髖關(guān)節(jié),很好的減輕病人的疼痛,重建了髖關(guān)節(jié)活動功能,受到廣大臨床醫(yī)生的推崇。對成功的全髖關(guān)節(jié)置換術(shù)來說,重建髖臼的旋轉(zhuǎn)中心是十分重要的[1],而且隨著全髖關(guān)節(jié)置換術(shù)開展的越來越多,也越來越引起業(yè)內(nèi)同行的關(guān)注。本文就非骨水泥假體行初次全髖關(guān)節(jié)置換術(shù),術(shù)中旋轉(zhuǎn)中心的重建對病人術(shù)后髖關(guān)節(jié)功能恢復(fù)的影響進(jìn)行驗(yàn)證及討論。方法:本課題為回顧性研究,選擇的研究對象均為大連醫(yī)科大學(xué)附屬第二醫(yī)院關(guān)節(jié)外科的住院病人,所有病人均在住院期間接受了單側(cè)的全髖關(guān)節(jié)置換,所有病人都是2014年1月到2016年1月期間在我院住院的病人,總共有87個(gè)病人被納入本次課題,其中有72個(gè)病人患有嚴(yán)重的股骨頭壞死,還有15個(gè)病人患有嚴(yán)重的髖關(guān)節(jié)骨性關(guān)節(jié)炎,本課題主要想探討全髖關(guān)節(jié)置換術(shù)后旋轉(zhuǎn)中心發(fā)生較小的偏移是否會對術(shù)后髖關(guān)節(jié)的功能恢復(fù)產(chǎn)生影響,因此所有病人按術(shù)后髖臼旋轉(zhuǎn)中心是否重建分為髖臼重建組A(62例)和髖臼未重建組B(25例)。所有的病人均有較重的疼痛伴不同程度的活動受限,生活質(zhì)量均明顯下降,均有明確的全髖關(guān)節(jié)置換術(shù)的適應(yīng)癥。所有病人查無明顯禁忌癥后,向患者及家屬交代手術(shù)風(fēng)險(xiǎn)并簽署手術(shù)同意書。由我院關(guān)節(jié)外科全髖關(guān)節(jié)置換經(jīng)驗(yàn)豐富的主任醫(yī)師主刀進(jìn)行手術(shù),所有病人使用的假體均為非骨水泥假體,都為初次人工全髖關(guān)節(jié)置換。患者術(shù)前、術(shù)后均攝標(biāo)準(zhǔn)骨盆正位片來確定旋轉(zhuǎn)中心是否得到重建(假體旋轉(zhuǎn)中心在解剖旋轉(zhuǎn)中心5mm內(nèi)即視為重建),患者隨訪時(shí)間為6--30個(gè)月,平均為18個(gè)月。通過對患者術(shù)前及末次隨訪時(shí)的Harris評分來評定患者髖關(guān)節(jié)功能恢復(fù)情況。比較兩組患者術(shù)前及末次隨訪時(shí)Harris髖關(guān)節(jié)功能評分,并通過SPSS軟件對數(shù)據(jù)進(jìn)行分析,得出結(jié)論。結(jié)果:經(jīng)過SPSS軟件分析,末次隨訪時(shí)兩組患者的Harris髖關(guān)節(jié)評分均較術(shù)前有顯著的提高,且髖臼旋轉(zhuǎn)中心重建者較未重建者更高,且差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論:有嚴(yán)重疼痛伴活動受限的股骨頭壞死病人及髖關(guān)節(jié)骨性關(guān)節(jié)炎病人,經(jīng)過全髖關(guān)節(jié)置換術(shù)后,病人的疼痛得到了極大的減輕甚至完全消失,髖關(guān)節(jié)的伸曲旋轉(zhuǎn)等各方向的活動范圍得到了明顯的提高,經(jīng)過一段時(shí)間的康復(fù),行走步態(tài)也接近甚至達(dá)到正常人水平,病人的生活質(zhì)量得到了顯著的提高。所以,全髖關(guān)節(jié)置換術(shù)是一種卓有成效的手術(shù)方式[2],是髖關(guān)節(jié)中晚期病變患者的福音。成功的全髖關(guān)節(jié)置換術(shù)應(yīng)包括充足的術(shù)前準(zhǔn)備和精準(zhǔn)的手術(shù)操作,其中準(zhǔn)確的重建髖關(guān)節(jié)的旋轉(zhuǎn)中心對成功的全髖關(guān)節(jié)置換術(shù)中有重要意義[3],因?yàn)樾D(zhuǎn)中心的解剖重建可以產(chǎn)生較小的關(guān)節(jié)應(yīng)力[4],有利于恢復(fù)髖關(guān)節(jié)周圍的力學(xué)環(huán)境,可以得到較穩(wěn)定的髖關(guān)節(jié),因此術(shù)后經(jīng)過相同康復(fù)訓(xùn)練可以獲得更好的髖關(guān)節(jié)功能改善,患者滿意度也更高,因此旋轉(zhuǎn)中心的重建在全髖關(guān)節(jié)置換術(shù)中占有越來越重要的地位,如果其他因素不變的情況下,髖關(guān)節(jié)的功能恢復(fù)將從解剖重建的旋轉(zhuǎn)中心中得到較大的收益。那么如何對旋轉(zhuǎn)中心進(jìn)行精準(zhǔn)的重建,為了達(dá)到這個(gè)目的,需要醫(yī)生術(shù)前對旋轉(zhuǎn)中心進(jìn)行精準(zhǔn)的定位、手術(shù)計(jì)劃盡可能詳盡完善、術(shù)中仔細(xì)定位與認(rèn)真的操作。由于本研究為回顧性研究,且樣本量較小,組間人數(shù)差距較大,說服力不如前瞻性大樣本試驗(yàn),并且隨訪時(shí)間相對較短,只能對近期結(jié)果進(jìn)行研究。缺乏遠(yuǎn)期的數(shù)據(jù)例如:晚期髖關(guān)節(jié)功能、人工髖關(guān)節(jié)的磨損率、松動率、假體壽命等數(shù)據(jù)未能納入本試驗(yàn)。只能對早期的關(guān)節(jié)功能進(jìn)行評價(jià),后續(xù)的工作需要更長時(shí)間的隨訪以及更多的患者來進(jìn)行進(jìn)一步臨床研究。
[Abstract]:Background: with the rapid development of economy, people's lifestyle changes and population aging, femoral head necrosis, hip osteoarthritis and femoral neck fracture and other hip joint lesions have increased year by year. Total hip arthroplasty can cut off the pain and limited movement of the joint, with wear-resistant artificial prosthesis. Joint replacement of the diseased hip joint is a good way to relieve the pain of the patient and rebuild the function of the hip joint. It is highly respected by the clinicians. For the successful total hip replacement, the reconstruction of the rotation center of the acetabulum is a very important [1], and as more and more hip arthroplasty has been carried out, it is becoming more and more important. In this paper, the effect of the primary total hip replacement on the non bone cement prosthesis and the effect of the reconstruction of the rotation center on the postoperative recovery of the hip joint were verified and discussed. Methods: the subject was a retrospective study, and the selected subjects were all hospitalized patients in the Second Affiliated Hospital of Dalian Medical University. All patients received unilateral total hip replacement during hospitalization. All patients were hospitalized in our hospital from January 2014 to January 2016. A total of 87 patients were included in the subject, of which 72 were suffering from severe femoral head necrosis and 15 patients suffered severe hip osteoarthritis. The main purpose of the study was to investigate whether the minor deviation of the rotation center after total hip replacement would affect the functional recovery of the hip joint, so all patients were divided into the acetabular reconstruction group A (62 cases) and the acetabular non reconstruction group B (25 cases) according to the reconstruction of the acetabular rotation center after the operation. All patients had heavier pain and different degrees. There was a clear reduction in the quality of life and a clear indication of total hip arthroplasty. After all patients without contraindications, the patients and their families were presented with the operation risk and signed the operation consent. All prostheses were non bone cement prostheses for the first time artificial total hip replacement. Before surgery, a standard pelvis was taken to determine whether the center of rotation was rebuilt (the center of the rotation of the prosthesis was rebuilt in the anatomical rotation center 5mm). The patient was followed up for a period of 6--30 months, averaging 18 months. The Harris score was used to evaluate the recovery of hip joint function. The Harris hip joint function score was compared between the two groups before and after the last follow-up, and the data were analyzed by the SPSS software. Results: after the SPSS software analysis, the Harris hip scores of the two groups were significantly higher than those before the operation. High, and the reconstruction of acetabular rotation center is higher than that of the non rebuilt, and the difference is statistically significant. Conclusion: the patients with severe pain with limited activity of the femoral head and hip osteoarthritis, after total hip replacement, the patient's pain has been greatly reduced or even completely disappeared, the hip joint extension rotation and so on. The range of activities in all directions has been obviously improved. After a period of rehabilitation, the walking gait is close to even the normal level. The quality of life of the patient has been significantly improved. Therefore, total hip arthroplasty is an effective surgical method, [2], the gospel of the patients with middle and late hip lesions. Joint replacement should include adequate preoperative preparation and accurate operation, in which accurate reconstruction of the hip rotation center is important for successful total hip replacement ([3]), because the anatomical reconstruction of the rotation center can produce a smaller joint stress [4], which is beneficial to the recovery of the mechanical environment around the hip joint and can be obtained. A more stable hip joint, so after the same rehabilitation training, can achieve better hip function improvement and higher patient satisfaction. Therefore, the reconstruction of the center of rotation plays an increasingly important role in total hip replacement. If other factors are constant, the recovery of the hip joint function will be rotated from the anatomical reconstruction. In order to achieve this goal, it is necessary for the doctor to accurately locate the center of rotation, the operation plan is as detailed as possible, the operation is carefully positioned and the operation is careful. Because this research is a retrospective study, the sample size is small and the number of groups is poor. Greater distance, less persuasive force than prospective large sample trials and relatively short follow-up, only a relatively short follow-up time, only a study of recent results. Data such as late hip joint function, artificial hip wear rate, loosening rate, and prosthesis life were not included in this test. Work requires longer follow-up and more patients for further clinical studies.
【學(xué)位授予單位】：大連醫(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
本文編號：2128264
[Abstract]:Background: with the rapid development of economy, people's lifestyle changes and population aging, femoral head necrosis, hip osteoarthritis and femoral neck fracture and other hip joint lesions have increased year by year. Total hip arthroplasty can cut off the pain and limited movement of the joint, with wear-resistant artificial prosthesis. Joint replacement of the diseased hip joint is a good way to relieve the pain of the patient and rebuild the function of the hip joint. It is highly respected by the clinicians. For the successful total hip replacement, the reconstruction of the rotation center of the acetabulum is a very important [1], and as more and more hip arthroplasty has been carried out, it is becoming more and more important. In this paper, the effect of the primary total hip replacement on the non bone cement prosthesis and the effect of the reconstruction of the rotation center on the postoperative recovery of the hip joint were verified and discussed. Methods: the subject was a retrospective study, and the selected subjects were all hospitalized patients in the Second Affiliated Hospital of Dalian Medical University. All patients received unilateral total hip replacement during hospitalization. All patients were hospitalized in our hospital from January 2014 to January 2016. A total of 87 patients were included in the subject, of which 72 were suffering from severe femoral head necrosis and 15 patients suffered severe hip osteoarthritis. The main purpose of the study was to investigate whether the minor deviation of the rotation center after total hip replacement would affect the functional recovery of the hip joint, so all patients were divided into the acetabular reconstruction group A (62 cases) and the acetabular non reconstruction group B (25 cases) according to the reconstruction of the acetabular rotation center after the operation. All patients had heavier pain and different degrees. There was a clear reduction in the quality of life and a clear indication of total hip arthroplasty. After all patients without contraindications, the patients and their families were presented with the operation risk and signed the operation consent. All prostheses were non bone cement prostheses for the first time artificial total hip replacement. Before surgery, a standard pelvis was taken to determine whether the center of rotation was rebuilt (the center of the rotation of the prosthesis was rebuilt in the anatomical rotation center 5mm). The patient was followed up for a period of 6--30 months, averaging 18 months. The Harris score was used to evaluate the recovery of hip joint function. The Harris hip joint function score was compared between the two groups before and after the last follow-up, and the data were analyzed by the SPSS software. Results: after the SPSS software analysis, the Harris hip scores of the two groups were significantly higher than those before the operation. High, and the reconstruction of acetabular rotation center is higher than that of the non rebuilt, and the difference is statistically significant. Conclusion: the patients with severe pain with limited activity of the femoral head and hip osteoarthritis, after total hip replacement, the patient's pain has been greatly reduced or even completely disappeared, the hip joint extension rotation and so on. The range of activities in all directions has been obviously improved. After a period of rehabilitation, the walking gait is close to even the normal level. The quality of life of the patient has been significantly improved. Therefore, total hip arthroplasty is an effective surgical method, [2], the gospel of the patients with middle and late hip lesions. Joint replacement should include adequate preoperative preparation and accurate operation, in which accurate reconstruction of the hip rotation center is important for successful total hip replacement ([3]), because the anatomical reconstruction of the rotation center can produce a smaller joint stress [4], which is beneficial to the recovery of the mechanical environment around the hip joint and can be obtained. A more stable hip joint, so after the same rehabilitation training, can achieve better hip function improvement and higher patient satisfaction. Therefore, the reconstruction of the center of rotation plays an increasingly important role in total hip replacement. If other factors are constant, the recovery of the hip joint function will be rotated from the anatomical reconstruction. In order to achieve this goal, it is necessary for the doctor to accurately locate the center of rotation, the operation plan is as detailed as possible, the operation is carefully positioned and the operation is careful. Because this research is a retrospective study, the sample size is small and the number of groups is poor. Greater distance, less persuasive force than prospective large sample trials and relatively short follow-up, only a relatively short follow-up time, only a study of recent results. Data such as late hip joint function, artificial hip wear rate, loosening rate, and prosthesis life were not included in this test. Work requires longer follow-up and more patients for further clinical studies.
【學(xué)位授予單位】：大連醫(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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