骨盆矢状面参数异常行全髋关节置换术的假体脱位分析

摘要

目的 探究骨盆矢状面参数异常患者行全髋关节置换术(THA)的假体脱位情况.方法 回顾性分析2013年1月至2016年6月骨盆矢状面参数异常(强直性脊柱炎、腰椎手术)且接受THA的40例患者(异常组)和腰部无异常行THA的120例患者(正常组)的临床资料.比较两组患者脱位率,应用Kaplan-Meier生存曲线分析假体生存率.结果 160例患者术后均获得随访,随访时间 2 ~ 45 个月,平均 26 个月.骨盆参数方面,正常组骨盆入射角(PI)为(46.32 ± 4.29)°,骨盆倾斜角(PT)为(8.31 ± 1.34)°,骶骨倾斜角(SS)为(38.01 ± 1.92)°;异常组PI为(45.15 ± 3.16)°,PT为(17.51 ± 2.31)°,SS为(27.64 ± 1.72)°.两组PI比较差异无统计学意义(P>0.05),两组PT和SS比较差异均有统计学意义(P＜0.05).正常组脱位2例,半年内假体生存率99.2%、1年98.3%、2年98.3%.异常组脱位4例,半年内假体生存率95.0%、1年92.5%、2年90.0%.结论 骨盆矢状面参数异常伴THA患者运动过程中假体脱位率明显增加.%Objective To investigate the preliminary clinical efficacy of total hip arthroplasty (THA) patients with pelvic sagittal alignment pathology. Methods The clinical data of 120 THA patients who had normal pelvic sagittal alignment and 40 THA patients who had pathology between 2013 and 2016 were retrospectively studied. Complication rate and survival rate were collected and analyzed. Results Complete case records were documented in 160 cases who were followed up for an average 26 months (range, 2—45 months). For pelvic alignment parameters: the average pelvic incidence (PI) of normal group was similar to pathology group, and no significant difference was found in two groups:(46.32 ± 4.29)°vs. (45.15 ± 3.16)°, P>0.05. There were significant differences in pelvic tilt (PT) and sacral slope (SS) between two groups: (46.32 ± 4.29)°vs. (17.51 ± 2.31)°, (38.01 ± 1.92) vs. (27.64 ± 1.72)°, P＜0.05. Two cases suffered from dislocation, half year successful rate was 99.2%, 1-year was 98.3% and 2-year was 98.3% in normal group. Four cases suffered from dislocation, half year successful rate was 95.0%, 1-year was 92.5% and 2-year was 90.0% in pathology group. Conclusions Prior lumbar-pelvic sagittal alignment pathology increases risk of complication in THA, which can obviously change hip biomechanical characteristic.