背景:研究表明,股骨偏心距短缩会导致外展肌肌力下降,偏心距过大,则增加置换后股骨颈假体折断的风险及增加骨水泥型股骨柄假体骨鞘的压应力,使其易松动和下沉.目的:探讨高龄股骨颈骨折人工髋关节置换过程中偏心距调整的重要性.设计、时间及地点:观察件实验,病例来自2004-01/2005-12天津中医药大学第一附属医院骨科.对象:选择天津中医药大学第一附属医院骨科收治的股骨颈骨折患者30例,男12例,女18例,年龄62～90岁,平均73.8岁.方法:全部患者均实施了人工髋关节置换术(由同一组手术医师操作),术前利用X-Caliper仪器,仔细测量骨盆正位片中健侧股骨头旋转中心、髋关节旋转中心、颈干角、股骨的横向偏心距、外展力臂、重力力臂等,利用三角函数进行准确计算.确定截骨平面的角度,选择合适假体以及术中对于偏心距的调整,比较置换后与健侧的差异.主要观察指标:偏心距的数值及置换后关节功能.结果:30例患者术前健侧偏心距平均38.7mm(22～57mm),术后患侧偏心距平均39.2 mm(21～59 mm):健侧平均38.7 mm.术后肢体不等长范围1.8～8.7 mm,平均3.4 mm,患侧肢体长者26例,占86.7%,短者4例,占13.3%.术后随访0.5～2.5年,根据Harris评分标准,优10例,良19例,可1例,优良率达97%.结论:股骨颈骨折人工关节置换中偏心距的合适与否与置换后关节功能密切相关.%BACKGROUND:It has been demonstrated that shortening of femoral eccentricity would lead to decreased abductor muscle strength,and overlengthening eccentricity would increase the risk of femoral neck prosthesis fracture and the compressive stress of cemented femoral stem prosthesis after artificial hip replacement,which easily causes prosthetic loosening and subsidence.OBJECTIVE:To investigate the importance of eccentricity adjustment in the artificial hip replacement for treatment of femoral neck fracture in elderly patients.DESIGN,TIME AND SETTING:An observational study was performed at the Department of Orthopedics,First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine between January 2004 and December 2005.PARTICIPANTS:A total of 30 patients with femoral neck fracture,12 males and 18 females,averaging 73.8 years of age (range 62-90 years old),received treatment at the Department of Orthopedics,First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine and were recruited into this study.METHODS:All patients underwent artificial hip replacement operated by the same team of surgeons.Prior to surgery,some indices on the uninjured side were determined through the anteroposterior radiographs of pelvis using X-Caliper measurement tool,including rotation center of femoral head,rotation center of hip joint,collodiaphyseal angle,femoral transverse eccentricity,abduction moment arm,and moment arm of gravity.These indices were precisely calculated using trigonometric function.The angle of osteotomy plane was determined.Proper prosthesis was selected and eccentricity was adjusted.Following artificial hip placement,a comparison was made between uninjured and injured sides.MAIN OUTCOME MEASURES:Eccentricity and hip joint function.RESULTS:The eccentricity on uninjured side of 30 patients averaged 38.7 mm (range 22-57 mm) prior to surgery and that on the injured side averaged 39.2 mm (range 21-59 mm) after surgery.Limb discrepancy ranged 1.8-8.7 mm,with a mean of 3.4 mm,after surgery.There were 26 patients (86.7%) presenting long limbs and 4 patients (13.3%) showing short limbs after surgery.All patients were followed-up 0.5-2.5 years old.Harris hip score results were excellent in 10 patients,good in 19 patients,and fair in 1 patient,with an excellent and good rate of 97%.CONCLUSION:In treatment of femoral neck fracture,eccentricity adjustment during artificial hip replacement is closely associated with hip joint function after surgery.
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