全髋关节置换术中解剖柄股骨假体周围骨折的影像学分析  

Imaging reasons for periprosthetic femoral fractures during the operation of total hip arthroplasty with anatomic prosthesis

作　　者：张道俭[1] 朱天岳[1] 柴卫兵[1] 卢宏章[1] 李军[1] 刘震宁[1] 叶一林[1] 

机构地区：[1]北京大学第一医院骨科,北京100034

出　　处：《中华医学杂志》2013年第9期690-692,共3页National Medical Journal of China

摘　　要：目的 分析全髋关节置换术中解剖柄引起股骨假体周围骨折的影像学测量的意义.方法 回顾性分析2001年1月至2011年1月北京大学第一医院骨科144例使用解剖柄初次全髋关节置换中7例术中发生股骨假体周围骨折的骨折组病例及21例未发生骨折的非骨折组病例,测量术前髋关节X线片的髋臼Sharp＇s角、CE角、股骨颈干角、前倾角、股骨干近段的前弓角度、股骨近段最窄髓腔直径,查阅病历,记录患者身高、体重,并了解手术细节.对测量结果用SPSS 17.0进行独立样本t检验统计学分析.结果 骨折组与非骨折组一般情况及髋臼Sharp＇s角、CE角差异无统计学意义,测量比较股骨颈前倾角（25.7±8.7）°比（14.9±3.2）°,（P =0.040）、颈干角（138.9±7.1）°比（134.4±4.0）°,（P=0.026）、股骨干前弓角（173.6±3.5）°比（171.2±1.4）°,（P=0.024）、峡部髓腔直径（11.5±1.9）°比（12.2±1.0）°,（P =0.021）,差异有统计学意义.结论 股骨近段发育异常是导致全髋关节置换术中使用解剖柄股骨假体周围骨折的主要原因.Objective To explore the imaging reasons for periprosthetic femoral fractures during the operation of total hip arthroplasty with anatomic prosthesis.Methods The fracture group consisted of 7 cases with periprosthetic femoral fracture （PPFF） and the non-fracture group 21 cases without PPFF during the operation of total hip arthoplasty （THA） among the 144 cases of primary THA with anatomic prosthesis.The preoperative plain films of hip joint were taken to calibrate the Sharp＇s angle,centre edge （CE） angle,femoral neck shaft angle,femoral anteversion angle of neck,bowing angle of proximal femoral shaft part,width of narrowest part in proximal femoral shaft.For each case,surgical details,age,height and weight were recorded.The results were analyzed with independent sample t test by software SPSS 17.0.Results No significant difference existed in general situation,Sharp＇s angle and CE＇s angle between two groups.And there were significant differences in femoral neck shaft angle （P =0.040）,femoral anteversion angle of neck （P =0.026）,bowing angle of proximal femoral shaft part （P =0.024）,width of narrowest part in proximal femoral shaft （P =0.021）.Conclusion Dysplasia of proximal femur is a major cause of periprosthetic femoral fracture during the operation of total hip arthroplasty with anatomic prosthesis.

关 键 词：关节成形术 置换 髋 髋假体 骨折 

分 类 号：R687.3[医药卫生—骨科学]