髋臼旋转截骨术时髋臼后上方植骨前后髋关节生物力学的改变及其对比  

The biomechanical changes of the hip in rotation acetabular osteotomy before and after posterosuperior bone grafting

作　　者：向珊珊[1] 陈艺[2] 傅明[1] 张志奇[1] 杨子波[1] 白波[2] 廖威明[1] 

机构地区：[1]中山大学附属第一医院关节外科,广州510080 [2]广州医学院第一附属医院骨科,510120

出　　处：《中华关节外科杂志（电子版）》2012年第3期68-71,共4页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：国家自然科学基金(81171759);广东省科技计划项目(2011B031300012;2009A030200013;2007B031002003)

摘　　要：目的探讨在偏心性髋臼旋转截骨术时于髋臼后上缘旋出部分上方进行植骨并检测植骨前、后髋关节生物力学的变化,为临床进行该类手术时髋臼后上方是否需要植骨提供必要的理论依据。方法将7具人体防腐骨盆标本建立成髋关节发育不良模型,测定每具标本模型髋关节所受应力的初始应变值α,在每具标本的同一侧做偏心性髋臼旋转截骨术,再测定应变值β,然后,于旋转截骨后的髋臼后上缘旋出部分上方加骨块进行植骨,再测定应变值β’。应用配对资料的t检验比较植骨前后髋关节间应力的改变程度在不同压力负荷时有无差别。结果植骨前后组的对比中,当压力负荷为100N时,t=0.254,P>0.05;200N时,t=-0.542,P>0.05,可以认为植骨前后两组间数值差异无统计学意义;但植骨组多数标本的绝对数值要优于非植骨组。结论髋臼旋转截骨后,在髋臼旋出部分后上方进行植骨,能使股骨头所受的应力更趋于合理分布,而且,待植骨块与宿主骨完全愈合后,能较好地增加髋臼后上方骨的储备量。Objective To investigate the biomechanical changes of eccentric rotational acetabular osteotomy before and after bone grafting at the outer part of posterosuperior acetabulum. Methods Seven human cadaver specimens were reconstructed to establish hip dysplasia models by imaging and biomechanical test. The initial strain value ct of each dysplasia model hip joint was measured by the strain gages, and on the same side of each specimen, the eccentric rotational acetabular osteotomy was conducted and the strain value β was measured. The strain valueβ＇ of the same hip joint with bone graft at the outer part of posterosuperior acetabulum after rotational acetabular osteotomy was then measured. Paired t-test was performed to identify the significant difference before and after posterosuperior bone grafting. Results According to the comparison of two surgical methods, when the pressure load was 100N （ t = 0. 254, P 〉 0. 05 ）, and the pressure load was 200N （ t = - 0. 542, P 〉 0. 05 ）, there was no significant difference in biomechanical changes between the two groups. However, the absolute value was better after bone grafting in most of the human cadaver specimens. Conclusions Bone graft at the outer part of posterosuperior acetabulum after rotational acetabular osteotomy may be valuable for the reasonable stress distribution in femoral head, and could also increase the bone reserve in the posterosuperior acetabulum after total healing between grafts and bost.

关 键 词：髋关节 发育不良 髋臼旋转截骨术 生物力学 骨移植 

分 类 号：R687.4[医药卫生—骨科学]