立体影像学分析对组配式全髋关节置换术后股骨假体迁移的早期评估  

The role of roentgen stereophotogrammetric analysis in assessing early migration of femoral implant after total hip arthroplasty with modular prostheses

作　　者：周军杰[1,2] 曹成福[1] 庞金辉[1] 高文武[1] 陈贤奇[1] 

机构地区：[1]上海中医药大学附属普陀医院骨科,200062 [2]加拿大戴尔豪斯大学附属医学中心骨科

出　　处：《中华骨科杂志》2013年第9期881-887,共7页Chinese Journal of Orthopaedics

基　　金：国家教育部暨上海市教委重点学科建设项目（T0303）;国家中医药管理局重点学科项目（2013QK20）;上海市教委科研项目（2011JW60）

摘　　要：目的探讨立体影像学分析（roentgen stereophotogrammetric analysis，RSA）对全髋关节置换术后股骨假体迁移的评估价值。方法2009年5月至2010年4月，行组配式全髋关节置换37例，男25例，女12例；年龄58±72岁，平均（60．23±5．64）岁。退行性骨关节炎32例，股骨颈骨折3例，髋关节发育不良2例。术后3、6、12、24个月采用Harris髋关节评分评估髋关节功能及RSA评估股骨假体的早期迁移度。结果Harris髋关节评分从术前（26．36±10．56）分提高至术后不同随访时间点的（78．24±12．72）分、（84．51±16．05）分、（86．72±9．34）分及（87．55±8．97）分，与术前比较差异均有统计学意义。无假体翻修病例，3例有轻微的大腿痛。RSA评估发现早期迁移幅度个体差异较大，术后3～6个月存在较高的初始迁移。36例于术后24个月达到临床和生物学稳定，1例表现为假体进行性迁移。股骨假体向远端迁移（1．37±0．59）mm、向后迁移（1．37±0．54）mm，与术前差异有统计学意义。术后24个月内股骨假体向远端迁移与向后迁移呈正相关（r=0．3，P=O．01），假体在横断面和矢状面上呈现出相对宿主骨界面稳定固定的趋势，股骨假体向远端及向后的倾斜或旋转移位主要发生在术后3个月内。不同尺寸的股骨头假体和不同偏心距的组配式股骨颈假体与发生在各个方向的迁移度无相关性。结论RSA为组配式全髋关节置换术后股骨假体迁移度的早期评估提供了客观依据，可用于评估人工关节假体的早期稳定性。Objective To investigate the value of roentgen stereophotogrammetric analysis （RSA） in assessing early migration of femoral implant after total hip arthroplasty （THA） with modular prostheses. Methods From May 2009 to April 2010, 37 patients underwent THA with modular prostheses in our hospital, including 25 males and 12 females, aged from 58 to 72 years （average, 60.23±5.64 years）. There were 32 cases of degenerative osteoarthritis, 3 cases of femoral neck fracture and 2 cases of developmental dysplasia of the hip. The Harris hip score and RSA were used to assess the clinical results and the migration of femoral implant at 3, 6, 12, 24 months postoperatively, respectively. Results The average Harris hip score improved from preoperative 26.36 ±10.56 to 78.24±12.72, 84.51±16.05, 86.72±9.34, and 87.55±8.97 at 3, 6, 12, and 24 months after operation, respectively, and the differences between pre- and post-operative Harris score were significant. There was no prosthetic revision, and slight thigh pain occurred in 3 patients. According to RSA, the degree of initial migration of femoral implant had large individual differences, and the initial migration was higher from 3 to 6 months after operation. Clinical and biological stabilization was achieved in 36 patients, while progressive migration was found in 1 patient. There was a positive correlation between the distal migration and posterior migration within 24 months after operation （r=0.3, P=-0.01 ）. The distal migration and posterior migration/rotation mainly occurred within 3 months after operation. There was no correlation between prosthetic size/offset and degree of migration of implant. Conclusion RSA provides an objective reference for assessing the migration of femoral implant after THA with modular prostheses, which is a reliable method to evaluate early implant stability.

关 键 词：关节成形术 置换 髋 摄影测量法 髋假体 诊断技术和方法 

分 类 号：R687.4[医药卫生—骨科学]