骨盆倾斜对人工全髋关节置换术股骨偏心距影响的前瞻性研究

摘要

目的：研究盆下型骨盆倾斜（ infrapelvic obliquity ，IPO）对全髋关节置换术中股骨偏心距的影响，以进行临床分析。方法通过收集在上海第六人民医院2013年4～6月期间行全髋关节置换（ THA）患者共计98例，术前、术后骨盆前后位X线片，使用Image Pro Plus6．0测量术前及术后骨盆倾斜角、健侧及患侧股骨偏心距（ femoral offset， FO）、内侧偏心距（ medial offset， MO）、垂直偏心距（vertical offset， VO），以分析THA术中骨盆倾斜角对股骨偏心距的影响。结果 THA术后术侧FO为28．50±7．74mm，健侧FO为29．36±9．51mm，术后术侧与健侧相比，患侧FO得到了重建（ t＝0．80，P＝0．420）。股骨偏心距接近29（28.50±7．74）mm，ⅠC 型骨盆倾斜所对应的 FO明显较其他类型低（23．07±8．96mm）（P ＜0．05），较 FO平均值减小约5.43mm。 MO接近60（60．27±8．83） mm，ⅠC型所对应的MO较平均值小约6．16mm，ⅠC型与ⅠA、ⅡB、ⅡC相比较，MO显著偏小（54．11±8．97mm）（P＜0．05），而ⅠC型同ⅠB型相比较，差异无统计学意义（P＝0．590）。各亚型之间VO（32．63±9.24mm）差异无统计学意义（P＞0．05）。结论对于ⅠC型骨盆倾斜患者THA术中股骨偏心距需增加约5mm才得以重建，内侧偏心距增加约6mm，其他各亚型骨盆倾斜THA术中股骨偏心距及内侧偏心距无需额外矫正。无需处理垂直偏心距。%Objective To study the effect of infrapelvic obliquity ( IPO) on the femoral offset in the total hip arthroplasty.Methods The standing preoperative and postoperative AP pelvic and hip radiographs of patients who underwent total hip arthroplasty ( THA) dur-ing April to Jun 2014 in Department of Orthopaedics of Shanghai Sixth People′s Hospital were were studied.Image Pro Plus 6.0 were ap-plied to measure pre-and post-operative pelvic obliquity( PO) ,femoral offset( FO) of both hip joint,medial offset( MO) and vertical off-set( VO) .The effect of infrapelvic obliquity on the FO, MO, VO were analysed.Results After THA , the operative lateral FO were 28.50 ±7.74mm,and the healthy lateral FO were 29.36 ±9.51mm,and FO of operative lateral were reconstructed(t=0.80,P=0.420). Mean value of FO was about 29(28.50 ±7.74)mm, FO of typeⅠC was 5.43mm lower than other types(23.07 ±8.96mm)(P<0.05). Mean value of MO was about 60(60.27 ±8.83)mm.Decreased MO (mean,6.16mm) was also observed in typeⅠC.There was no signifi-cant difference of VO between all types.Conclusion A correction of the FO by 5mm and MO by 6mm is required in typeⅠC.Adjust-ment of FO and MO among all other types of PO is needless.There is no need to correct VO.