目的 测量内蒙古地区髋关节置换术后假体位置参数，了解假体位置分布及解剖重建率。 方法 纳入内蒙古地区四家三级医院179例髋关节置换术后首次X线资料（年龄30~70岁），影像资料以JEPG格式导入Mimics21.0软件，采用多人重复测量取平均值的方法测量6项参数，包括髋臼假体外展角、前倾角、髋关节旋转中心垂直位置和水平位置、股骨偏心距及双下肢长度差异；比较术侧与健侧髋关节旋转中心位置、股骨头偏心距的差异，统计以上6项参数的解剖重建率。 结果 观察者间及观察者自身的组内相关系数为0.84~0.99，可靠性较好。健侧股骨头偏心距与术侧差异无统计学意义；术侧髋关节旋转中心垂直位置、水平位置与健侧相比，向内上方偏移，差异存在统计学意义（P<0.05）。髋臼假体外展角、前倾角、髋关节旋转中心垂直位置、水平位置、股骨头偏心距及双下肢长度差异的解剖重建率分别为79.90%、77.70%、43.02%、60.34%、60.30%、79.30%。 结论 本研究统计内蒙古地区髋关节置换术假体位置的分布情况，认为术后较难达到完全的解剖重建，其中髋关节旋转中心垂直位置、水平位置及股骨偏心距的解剖重建率偏低，需改进手术方法缩小两侧的差异。
Abstract
Objective To measure the position parameters of the prosthesis after hip arthroplasty in Inner Mongolia, and to understand the position distribution and anatomical reconstruction rate of the prosthesis in Inner Mongolia. Methods The X-ray data of hip arthroplasty were collected from four tertiary hospitals in Inner Mongolia, aged 30-70 years, and 179 cases were finally. The image data was imported into the Mimics 21.0 software in JEPG format measured by multiple people’s repeated measurements and taking the average value, including acetabular prosthesis abduction angle, anteversion angle, hip rotation center position (vertical position, horizontal position), femoral offset, and leg length discrepancy, and the differences in the center of rotation of the hip joint and femoral offset between the operated side and the healthy side were compared, and the anatomical reconstruction rates of the above 6 parameters were counted. Results (1) The inter-observer and intra-observer correlation coefficients ranged from 0.84 to 0.99, showing good reliability. (2) There was no statistically significant difference in the femoral offset on the healthy side and the operated side, but there were statistically significant differences in the vertical position and horizontal position of the hip joint rotation center between the operated side and the healthy side (P<0.05), and compared with the healthy side, the center of rotation of the prosthesis on the operated side is shifted inwardly and upwardly. (3) The anatomical reconstruction rates of acetabular prosthesis abduction angle, anteversion angle, hip joint rotation center vertical position, horizontal position, femoral offset, and the leg length discrepancy were 79.90%, 77.70%, 43.02%, and 60.34%, 60.30%, 79.30%, respectively. Conclusions This study understands the distribution of prosthetic positions in hip arthroplasty in Inner Mongolia. It is difficult to achieve completely anatomical reconstruction after surgery. Among them, the anatomical reconstruction rate of the vertical position, horizontal position of the hip joint rotation center and femoral offset is low. Surgical methods need to be continuously improved to further narrow the difference between the two sides.
关键词
髋关节置换术 /
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X线 /
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假体 /
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解剖重建
Key words
Hip arthroplasty /
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X-ray /
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Prosthesis /
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Anatomical reconstruction
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参考文献
[1] 边焱焱, 程开源, 常晓, 等. 2011至2019年中国人工髋膝关节置换手术量的初步统计与分析[J]. 中华骨科杂志, 2020, 40(21): 1453-1460. DOI: 10.3760/cma.j.cn121113-20200320-00177.
[2] 陈明, 勘武生, 方真华, 等. 谁在影响着人工全髋关节置换后的中期疗效[J]? 中国组织工程研究, 2013, 17(13): 2447-2454. DOI: 10.3969/j.issn.2095-4344.2013.13.023.
[3] Mahmood SS, Mukka SS, Crnalic S, et al. Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength. A prospective cohort study of 222 patients[J]. Acta Orthop,2016, 87(1): 36-41. DOI: 10.3109/17453674. 2015.1091955.
[4] Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties[J]. J Bone Joint Surg Am, 1978, 60(2): 217-220. PMID: 641088.
[5] 路玉峰, 许鹏, 郭万首, 等. 成人正常髋关节旋转中心的X线影像测量研究[J]. 中华解剖与临床杂志, 2017, 22(2): 99-102. DOI: 10.3760/cma.j.issn.2095-7041.2017.02.003.
[6] Cassidy KA, Noticewala MS, Macaulay W, et al. Effect of femoral offset on pain and function after total hip arthroplasty[J]. J Arthroplasty, 2012, 27(10): 1863-1869. DOI: 10.1016/j.arth.2012.05.001.
[7] 周一新. 骨科标准新突破 手术技术指导规范-《人工髋、膝关节置换术》解读[J]. 中国卫生标准管理, 2011, 2(4): 22-24.
[8] 斯海波, 陈世荣, 刘淼, 等. 计算机模拟全髋关节置换术后假体位置对关节活动的影响[J]. 中国临床解剖学杂志, 2012, 30(3): 279-284. DOI: 10.13418/j.issn.1001-165x.2012.03.021.
[9] Barrack RL, Burak C, Skinner HB. Concerns about ceramics in THA[J]. Clin Orthop Relat Res, 2004, (429): 73-79. DOI: 10.1097/01.blo.0000150132.11142.d2.
[10]Bourne RB, Rorabeck CH. Soft tissue balancing: the hip[J]. J Arthroplasty, 2002,17(4 Suppl 1): 17-22. DOI: 10.1054/arth. 2002. 33263.
[11]刘玉宝, 邹瑞, 林禄攀, 等. 生物型髋关节假体位置参数与患者生命质量相关性研究[J]. 中华关节外科杂志(电子版), 2018, 12(4): 454-461. DOI: 10.3877 /cma.j.issn.1674-134X.2018.04.003.
[12]Wan Z, Boutary M, Dorr LD. The influence of acetabular component position on wear in total hip arthroplasty[J]. J Arthroplasty, 2008, 23(1): 51-56. DOI: 10.1016/j.arth.2007.06.008.
[13]Kim SC, Lim YW, Kwon SY, et al. Level of surgical experience is associated with change in hip center of rotation following cementless total hip arthroplasty: a radiographic assessment[J]. PLoS One, 2017, 12(5): e0178300. DOI: 10.1371/journal.pone.0178300.
[14]Dastane M, Dorr LD, Tarwala R, et al. Hip offset in total hip arthroplasty: quantitative measurement with navigation[J]. Clin Orthop Relat Res, 2011, 469(2): 429-436. DOI: 10.1007/s11999-010-1554-7.
[15]Bhutta MA, Arshad MS, Hassan S, et al. Trends in joint arthroplasty litigation over five years: the British experience[J]. Ann R Coll Surg Engl, 2011, 93(6): 460-464. DOI: 10.1308/003588411X587226.
[16]Whitehouse MR, Stefanovich-Lawbuary NS, Brunton LR, et al. The impact of leg length discrepancy on patient satisfaction and functional outcome following total hip arthroplasty[J]. J Arthroplasty, 2013, 28(8): 1408-1414. DOI: 10.1016/j.arth.2012.12.009.
[17]Plaass C, Clauss M, Ochsner PE, et al. Influence of leg length discrepancy on clinical results after total hip arthroplasty-a prospective clinical trial[J]. Hip Int, 2011, 21(4): 441-449. DOI: 10.5301/HIP. 2011. 8575.
[18]White TO, Dougall TW. Arthroplasty of the hip. Leg length is not important[J]. J Bone Joint Surg Br, 2002, 84(3): 335-338. DOI: 10.1302/0301-620x.84b3.12460.
[19]Meermans G, Doorn JV, Kats JJ. Restoration of the centre of rotation in primary total hip arthroplasty: the influence of acetabular floor depth and reaming technique[J]. Bone Joint J, 2016, 98-B(12): 1597-1603. DOI: 10.1302/0301-620X.98B12.BJJ-2016-0345.R1.
[20]张帅, 马明阳, 刘宇博, 等. 解剖重建理念在机器人辅助全髋关节置换术中应用的研究[J]. 中华骨与关节外科杂志, 2022, 15(8): 569-576. DOI: 10.3969/j.issn.2095-9958.2022.08.03.
[21]吴东, 刘星宇, 张逸凌, 等. 人工智能辅助全髋关节置换术三维规划系统的研发及临床应用研究[J]. 中国修复重建外科杂志, 2020, 34(9): 1077-1084. DOI: 10.7507/1002-1892.202005007.
[22]Hayakawa K, Minoda Y, Aihara M, et al. Acetabular component orientation in intra- and postoperative positions in total hip arthroplasty[J]. Arch Orthop Trauma Surg, 2009, 129(9): 1151-1156. DOI: 10.1007/s00402-008-0638-2.
[23]Scorcelletti M, Reeves ND, Rittweger J, et al. Femoral anteversion: significance and measurement[J]. J Anat, 2020, 237(5): 811-826. DOI: 10.1111/joa.13249.
基金
内蒙古自然科学基金（2020MS08124）；内蒙古自治区“草原英才”工程青年创新创业人才项目（2020）；内蒙古科技计划项目（2019GG115）；乌兰察布市基础研究项目（2021JC321）；内蒙古医科大学2021年度校级科研重点项目（YKD2021ZD001）；内蒙古自治区蒙医协同创新中心科学研究项目（MYYXTYB202104）;乌兰察布市科技创新引导项目（202201）
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