切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 145 -150. doi: 10.3877/cma.j.issn.1674-134X.2019.02.003

所属专题： 文献；

临床论著

髋关节发育不良全髋置换假体轻度上移放置的中长期疗效
张志奇1,†(), 朱飞1, 胡舒1, 文星钊1, 傅明1, 邬培慧1, 盛璞义1, 廖威明1   
  1. 1. 510080　广州，中山大学附属第一医院关节外科
  • 收稿日期:2018-10-10 出版日期:2019-04-01
  • 通信作者: 张志奇
  • 基金资助:
    中山大学临床研究5010计划项目(2013002)

Mild upward placement of acetabular implants has good mid and long-term outcome following total hip arthroplasty for developmental dysplasia of hip

Zhiqi Zhang1,†(), Fei Zhu1, Shu Hu1, Xingzhao Wen1, Ming Fu1, Peihui Wu1, Puyi Sheng1, Weiming Liao1   

  1. 1. Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2018-10-10 Published:2019-04-01
  • Corresponding author: Zhiqi Zhang
  • About author:
    Correspondeing author: Zhang Zhiqi, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

张志奇, 朱飞, 胡舒, 文星钊, 傅明, 邬培慧, 盛璞义, 廖威明. 髋关节发育不良全髋置换假体轻度上移放置的中长期疗效[J]. 中华关节外科杂志(电子版), 2019, 13(02): 145-150.

Zhiqi Zhang, Fei Zhu, Shu Hu, Xingzhao Wen, Ming Fu, Peihui Wu, Puyi Sheng, Weiming Liao. Mild upward placement of acetabular implants has good mid and long-term outcome following total hip arthroplasty for developmental dysplasia of hip[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(02): 145-150.

目的

探讨髋关节发育不良患者全髋关节置换术中髋臼假体真臼范围内以及适度上移放置对患者功能和假体长期生存率的影响。

方法

研究的纳入标准：髋关节发育不良继发骨关节炎，接受全髋关节置换术；使用非骨水泥型髋关节假体；手术均由同一组医生完成。排除标准：失访或随访资料不全；同期行双侧全髋关节置换术；髋关节发育不良继发骨关节炎。2008年1月至2013年12月符合入选标准的26例行全髋关节置换术的髋关节发育不良患者，其中失联及不能完成随访各1人，实际纳入随访24例，男5例，女19例；术时年龄36～80岁，平均(62±11)岁。左髋7例，右髋17例。其中Crowe I型10例、Ⅱ型8例、Ⅲ型6例。长期随访分别评估患者的Harris髋关节评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)，并行骨盆正位、患侧股骨正侧位X线片检查评估假体情况，年龄、随访时间、评分以及手术相关指标分别采用t检验或秩和检验分析。

结果

本次随访时间平均(80±23)个月。至末次随访时，Harris髋关节平均评分由术前(43±13)分提高至(91±13)分(Z＝－5.867，P＝0.000)，而WOMAC骨关节炎指数由术前(58±13)分降至(10± 4)分(Z ＝－5.957，P＝0.000)。术前患肢与对侧比较平均短缩(10±5)mm，术后患肢短缩减小至(5±4)mm(Z＝－4.525，P＝0.000)。末次随访患者未出现影像学上髋臼和股骨假体松动及下沉。髋臼假体上移距离为3～15 mm，其中髋臼假体上移0～5 mm者8例，上移6～10 mm者7例，上移11～15 mm者9例。末次随访时，3组患者Harris评分和WOMAC评分均较术前显著改善，差异均有统计学意义(Harris：Z 1＝－3.366，Z 2＝－5.355，Z 3＝－3.524；WOMAC：Z 1＝－3.602，Z 2＝－3.144，Z 3＝－3.373；均为P<0.05)；但组间比较差异无统计学意义(P>0.05)。

结论

髋关节发育不良患者在全髋关节置换术中髋臼假体采用放置在真臼范围内或者小于15 mm的适度上移放置，患者可获得满意的中长期疗效。

关键词: 髋脱位，先天性, 关节成形术，髋, 假体安装
Objective

To investigate the mid and long-term effects of selectively upward placement of acetabular implants on post-operative function and implant survival rate of cementless total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) patients.

Methods

Inclusion criteria: hip dysplasia followed by osteoarthritis, total hip replacement; the use of non-cemented hip prosthesis; all surgeries were performed by the same group of doctors.Exclusion criteria: missing visit or incomplete follow-up data; bilateral total hip arthroplasty was performed simultaneously; osteoarthritis secondary to hip dysplasia. Twenty-four cases were received the final follow-up in selective 26 cases of DDH received THA between January 2008 and December 2013, including five males and 19 females with an average age of (62±11) years.The left hip was involved in seven cases and the right hip in 17 cases, including 10 cases of Crowe type I, eight cases of Crowe type II, six cases of Crowe type III. The Harris score and Western Ontario and McMaster University scores(WOMAC) were analyzed at the last follow-up compared to pre-operation. The anteroposterior X-ray films of the pelvis, anteroposterior and lateral X-ray films of the femur were performed routinely before operation and follow-up. Age, follow-up time, score and surgical indicators were analyzed by t test or rank sum test, respectively.

Results

The follow-up time was (80± 23) months.The Harris score improved to(91±13)from (43±13) (Z=-5.867, P<0.01), and WOMAC score reduced from(58±13)to (10±4) (Z=-5.957, P<0.01). The leg length discrepancy was decreased to (5±4)mm from (10±5)mm after surgery (Z=-4.525, P<0.01). No loosening or subsidence of the implant was observed by X-ray during the follow-up.The upward distance of acetabular implant was 3~15 mm, among which eight cases were moved up 0~5 mm, seven cases were moved up 6~10 mm, and nine cases were moved up 11~15 mm. At the last follow-up, Harris scores and WOMAC scores of the three groups were significantly improved compared with those before surgery, and the differences were statistically significant (Harris: Z 1=-3.366, Z2=-5.355, Z 3=-3.524; WOMAC: Z 1=-3.602, Z 2= -3.144, Z3=-3.373; P< 0.05). But there was no statistical difference among these three groups (P>0.05).

Conclusion

The placement of acetabular components in an anatomic position and less than 15mm superior to the approximate femoral head center could promote middle and long-term satisfaction after cementless THA in DDH patients.

Key words: Hip dislocation, congenital, Arthroplasty, Hip, Prosthesis fitting
图1 某患者术前及术后骨盆正位X线片。图A　为术前骨盆正位X线片，显示符合髋关节发育不良诊断；图B　为术后第1次复查照片，显示髋臼假体上移7 mm，髋臼骨性包容好，双下肢基本等长；图C　为术后50个月骨盆正位X线片，示骨盆无明显倾斜，假体稳定，右髋病变加重；图D　为术后100个月骨盆正位X线片，示左髋假体无松动，未见骨溶解和内衬明显磨损，骨盆无明显倾斜，右髋病变较前加重明显
表1 髋臼假体不同上移距离组间功能及假体相关参数的比较(±s)
髋臼假体中心上移 例数 随访时间(月) 髋臼旋转中心上移(mm) 髋臼假体外展角(°) 髋臼假体前倾角(°)
0～5 mm 8 76.1±22.6 3.8±0.9 47.0±4.1 19.5±3.0
6～10 mm 7 80.9±30.0 6.6±0.8 49.0±5.1 14.1±6.3
11～15 mm 9 83.4±20.0 13.8±1.6 43.4±9.0 17.3±5.5
t值 ? －0.348a －3.309a －0.842a 2.152a
? －1.348b －3.536b 1.031b 0.990b
－0.207c －3.146c 1.460c －1.080c
P值 ? >0.05abc <0.01abc >0.05abc >0.05abc
表2 3组术前及末次双下肢长度差及偏心距参数的比较[mm, (±s)]
髋臼假体中心上移 例数 双下肢长度差 t值 P值 偏心距 t值 P值
术前 末次 术前 末次
0～5 mm 8 11±6 4±4 －2.43 0.029 22±4 31±6 －4.18 0.001
6～10 mm 7 10±4 5±4 －4.23 0.001 23±7 36±8 －2.63 0.009
11～15 mm 9 10±6 7±3 －2.35 0.019 20±11 32±9 －2.61 0.019
t值 ? －0.183a －1.110a ? ? －0.638a －0.877a ? ?
? －0.629b －0.871b 0.185b －0.277b
－0.220c －0.323c －0.743c 0.585c
P值 ? >0.05abc >0.05abc ? ? >0.05abc >0.05abc ? ?
表3 不同上移距离分组术前和末次评分的比较(±s)
髋臼假体中心上移 例数 Harris评分 Z值 P值
术前 末次
0～5 mm 8 43.8±11.3 92.9±7.8 －3.366 0.001
6～10 mm 7 48.5±11.3 86.9±15.2 －5.355 0.000
11～15 mm 9 38.4±15.1 92.6±14.5 －3.524 0.000
Z值 ? －0.694a －0.523a ? ?
? －1.011b －1.430b
1.483c －1.471c
P值 ? >0.05abc >0.05abc ? ?
髋臼假体中心上移 例数 WOMAC评分 Z值 P值
术前 末次
0～5mm 8 57.8±15.6 7.6±2.8 －3.602 0.000
6～10 mm 7 53.0±9.6 9.7±3.9 －3.144 0.002
11～15 mm 9 61.9±13.3 11.3±3.9 －3.373 0.001
Z值 ? －0.174a －1.191a ? ?
? －0.867b －2.024b
－1.487c －0.815c
P值 ? >0.05abc >0.05abc ? ?
[1]
Georgiades G, Babis GC, Kourlaba GA. Effect of cementless acetabular component orientation, position, and containment in total hip arthroplasty for congenital hip disease[J]. J Arthroplasty, 2010, 25(7): 1143-1150.
[2]
Karachalios T, Hartofilakidis G. Congenital hip disease in adults: terminology, classification, pre-operative planning and management[J]. J Bone Joint Surg Br, 2010, 92(7): 914-921.
[3]
Watts CD, Abdel MP, Hanssen AD, et al. Anatomic hip center decreases aseptic loosening rates after total hip arthroplasty with cement in patients with crowe Type-II dysplasia: a concise follow-up report at a mean of thirty-six years[J]. J Bone Joint Surg Am, 2016, 98(11): 910-915.
[4]
卞为伟，唐晓波，王健，等．全髋置换治疗CroweⅡ/Ⅲ型髋关节发育不良的髋臼解剖重建方法及疗效[J/CD]．中华关节外科杂志(电子版)，2018，12(4):467-471.
[5]
许杰，梁国彦，Bhandari PR, 等. 髋关节置换后双下肢不等长对功能影响的Meta分析[J]. 中国组织工程研究与临床康复，2011, 15(9): 1607-1610.
[6]
Zhang ZQ, Fu M, Kang Y, et al. Upward and inward displacements of the acetabular component increase stress on femoral head in single endoprothesis models[J]. Int Orthop, 2010, 34(4): 479-483.
[7]
张志奇，廖威明，侯昌禾，等．变异髋臼人工全髋关节置换中髋臼假体选择性上移安置的初步疗效分析[J]．中国修复重建外科杂志，2014，28(5):566-570.
[8]
黄志宇，张志奇，傅明，等．髋臼假体上移放置对髋关节发育不良全髋关节置换术后下肢长度及功能的影响[J]．中华骨科杂志，2014，34(12):1225-1230.
[9]
Zhang Z, Wu P, Huang Z, et al. Cementless acetabular component with or without upward placement in dysplasia hip：Early results from a prospective, randomisedstudy[J]. J Orthop, 2017, 14(3): 370-376.
[10]
康焱，邬培慧，张紫机，等. 初次全髋关节置换术后5年以上随访结果与分析[J/CD]. 中华关节外科杂志(电子版), 2011, 5(5): 546-554.
[11]
傅明，廖威明，何爱珊，等. 全髋关节翻修术中髋臼假体的选择和髋臼骨缺损的处理[J/CD]. 中华关节外科杂志(电子版), 2008, 2(5): 497-504.
[12]
Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusioacetabuli of rheumatoid arthritis[J]. J Bone Joint Surg Am, 1980, 62(7): 1059-1065.
[13]
Pagnano W, Hanssen AD, Lewallen DG, et al. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty[J]. J Bone Joint Surg Am, 1996, 78(7): 1004-1014.
[14]
Flecher X, Parratte S, Brassart N, et al. Evaluation of the hip center in total hip arthroplasty for old developmental dysplasia[J]. J Arthroplasty, 2008, 23(8): 1189-1196.
[15]
Takao M, Ohzono K, Nishii T, et al. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia[J]. J Bone Joint Surg Am, 2011, 93(6): 548-555.
[16]
Hirakawa K, Mitsugi N, Koshino T, et al. Effect of acetabular cup position and orientation in cemented total hip arthroplasty[J]. Clin Orthop Relat Res, 2001, (388): 135-142.
[17]
Murayama T, Ohnishi H, Okabe S, et al. 15-year comparison of cementless total hip arthroplasty with anatomical or high cup placement for crowe I to III hip dysplasia[J]. Orthopedics, 2012, 35(3): E313-E318.
[18]
孙红，方淑莺，杨子波，等．成人发育性髋关节发育不良人工全髋关节置换术后臼杯位置的影像学分析[J]．中国修复重建外科杂志，2016，30(11):1349-1353.
[19]
Morag G, Zalzal P, Liberman B, et al. Outcome of revision hip arthroplasty in patients with a previous total hip replacement for developmental dysplasia of the hip[J]. J Bone Joint Surg Br, 2005, 87B(8): 1068-1072.
[20]
沈彬，裴福兴，杨静．髋关节发育不良的髋臼重建[J]．中华外科杂志，2004，42(16):44-48.
[1] 顾言阁, 石志伟, 段续东, 殷鲁旭, 张业勇, 孙华强, 李树锋, 闫新峰. Bernese髋臼周围截骨术早期手术效果的影响因素分析[J]. 中华关节外科杂志(电子版), 2022, 16(01): 8-15.
[2] 李朋, 唐向阳, 吴同岭, 于志滨, 朱智奇. 髋臼螺钉对非骨水泥全髋置换术中假体稳定性的影响[J]. 中华关节外科杂志(电子版), 2019, 13(03): 284-289.
[3] 杨育晖, 李钊, 董航, 刘潼, 高忠礼. 成人发育性髋关节发育不良真臼三维形态研究及髋臼重建的处理策略[J]. 中华关节外科杂志(电子版), 2018, 12(02): 256-260.
[4] 王加宽, 王玉欢. 髋关节发育不良的早期筛查现状与筛查网络体系[J]. 中华妇幼临床医学杂志(电子版), 2018, 14(01): 113-115.
[5] 牛文杰, 周新, 杨彦飞, 梁浩然, 宋文杰, 刘洋, 王薛丁, 任智远, 段王平. 中年患者髋关节表面置换与全髋关节置换疗效差异的Meta分析[J]. 中华老年骨科与康复电子杂志, 2021, 07(05): 304-313.
[6] 沈先月, 刘潼, 杨育晖, 肖建林, 陈尚钧, 左建林, 高忠礼. CT三维重建应用于成人发育性髋关节发育不良股骨近端形态学研究的进展及意义[J]. 中华老年骨科与康复电子杂志, 2018, 04(06): 369-373.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号