全髋关节置换术后股骨偏距减小与聚乙烯内衬磨损的关系  

Relationship between polyethylene wear and decrease of femoral offset after total hip arthroplasty

作　　者：肖瑜[1,2] 张福江[2] 马信龙[2] 任凯晶[2] 于建华[2] 高志国[2] 

机构地区：[1]天津医科大学研究生院,300070 [2]天津市天津医院关节外科

出　　处：《中华骨科杂志》2012年第9期849-854,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨全髋关节置换术后股骨偏距减小与聚乙烯内衬磨损的关系。方法选择90例单侧全髋关节置换术后即刻拍摄双髋正位x线片的病例。利用Coreldraw12．0等比例重建术后即刻双髋正位X线片，依据股骨偏距减小值（F）分为五组：F〈2mm组、2≤F≤4mm组、4〈F≤6mm组、6〈F≤8mm组、8〈F≤10mm组，每组18例；等比例重建终末随访（4～7年，平均5．6年）双髋正位x线片，测量聚乙烯内衬线性磨损量、速度和角度。结果（1）五组聚乙烯内衬线性磨损量分别为（0．72±0．13）mm、（0．78±0．11）mm、（0．87±0．09）mm、（0．99±0．09）mm、（1．17±0．15）rnm，除第l组与第2组外其余组间差异有统计学意义。（2）聚乙烯内衬线性磨损速度分别为（0．132±0．025）mm／年、（0．139±0．019）mm/年、（0．159±0．029）mm／年、（0．183±0．032）mm／年、（0．213±0．023）mm/年，除第1组与第2组外其余组间差异有统计学意义。（3）聚乙烯内衬线性磨损角度分别为5．0°±3．5°、3．2°±3．8°、-4．3°±4．9°、-8．7°±4．1°、-13．0°±4．7°，除第1组与第2组外其余组间差异有统计学意义。结论全髋关节置换术中股骨偏距的重建应尽量达到正常解剖水平，股骨头中心向外上方迁移可能会造成应力分布不均和假体磨损增加。Objective To investigate relationship between polyethylene wear and decrease of femoral offset after total hip arthroplasty （THA）. Methods Ninety patients who had undergone unilateral THA were recruited in this study. Coreldraw 12.0 software was used to measure change of femoral offset on the basis of immediate anteroposterior radiographies of bilateral hip after THA. In the light of the decreasing value of femoral offset （F）, all patients were equally into 5 groups： F〈2 mm, 2≤F≤4 ram, 4〈F≤6 ram, 6〈 F ≤ 8 mm and 8〈F ≤ 10 mm. At final follow up, some parameters about polyethylene wear were measured by using Coreldraw 12.0 software on the basis of anteroposterior radiographies of bilateral hip. Results The linear wear volume was 0.72_±0.13 mm in group F〈2 mm, 0.78±0.11 mm in group 2≤F≤4 mm, 0.87±0.09 mm in group 4〈F≤6 mm, 0.99±0.09 mm in group 6〈F≤8 ram, and 1.17±0.15 mm in group 8〈F≤10 mm. The linear wear rate was 0.132±0.025 mm/yr in group F〈2 ram, 0.139±0.019 mndyr in group 2≤F≤4 mm, 0.159±0.029 mm/yr in group 4〈F≤6 ram, 0.183±0,032 mm/yr in group 6〈F≤8 mm, and 0.213±0.023 mm/yr in group 8〈F≤ 10 ram. The linear wear angle was 5.0°±3.5° in group F〈2 mm, 3.2°±3.8° in group 2≤F≤4 mm, -4.30±4.9° in group 4〈F≤6 ram, -8,7°±4.1° in group 6〈F≤8 mm, and -13.0°±4.7° in group 8〈F≤ 10 mm. For three parameters above, there were significant differences between groups, except between group F〈 2 mm and group 2 ≤ F ≤ 4 ram. Conclusion The femoral offset should be restored to its anatomic status in THA to avoide superior lateral displacement of center of the femoral head, which could result in uneven stress distribution and increase polyethylene wear.

关 键 词：关节成形术 置换 髋 聚乙烯 放射摄影术 

分 类 号：R687.4[医药卫生—骨科学]