截骨形态评估股骨前倾角的准确性  

Estimation of femoral version based on broach geometry after femoral-neck osteotomy

作　　者：柳剑[1] 吕明[1] 吴坚[1] 郭盛杰[1] 韩娜[2] 周一新[1] 

机构地区：[1]北京积水潭医院矫形骨科,北京100035 [2]北京大学人民医院创伤骨科,北京100044

出　　处：《北京大学学报（医学版）》2016年第2期279-282,共4页Journal of Peking University:Health Sciences

摘　　要：目的:研究应用CT扫描模拟的股骨颈截骨面形态判别股骨假体前倾角的准确性。方法:采用前瞻性自身对照研究,于髋关节置换术前及术后分别对32例患者行CT扫描。应用术前CT选取股骨小粗隆水平及小粗隆上方5 mm、10 mm、15 mm四个可能的截骨平面,根据股骨后髁连线分别计算这四个截面的前倾角;应用术后CT计算股骨假体前倾角。分别比较术前四个截面前倾角以及股骨前倾角与术后假体前倾角的关系。结果:小粗隆及小粗隆上方5 mm水平的截面前倾角分别为37.0°±11.0°和34.3°±10.6°,明显大于术后假体前倾角(26.1°±11.0°,P<0.001);小粗隆上方10 mm及15 mm水平的截面前倾角分别为28.1°±10.9°和22.4°±13.7°,与术后假体前倾角差异无统计学意义(P>0.05);术前股骨前倾角(12.9°±13.8°)小于术后假体前倾角(P<0.001)。结论:根据股骨截骨的开口形态来判断股骨假体前倾角要根据截骨平面来决定:截骨平面低于小粗隆上方5 mm时,截面前倾角大于假体前倾角;截骨平面高于小粗隆上方10 mm时,截面前倾角与假体前倾角无显著差异。Objective： To find out whether it is accurate to estimate femoral version based on femoral broach after femoral neck osteotomy using computed tomography scans. Methods： In 32 total hip arthroplasty（ THA）,we performed CT scans before and after operation. Four possible levels（ lesser trochanter,5 mm above,10 mm above and 15 mm above the lesser trochanter） of broach version were calculated based on the pre-operative CT scan. Stem versions were measured on the post-operative CT scan. We determined the difference between the preoperative broach version and the postoperative stem version using the Student＇s t-test for paired samples assuming equal variance. Results： For the operated hips,preoperative hip version differed according to the level of measurement. Our findings showed that the average femoral version was 37. 0° ± 11. 0° at the level of the lesser trochanter（ section 1）,34. 3° ± 10. 6° at 5mm above the lesser trochanter（ section 2）,28. 1° ± 10. 9° at 10 mm above the lesser trochanter（ section 3）,and 22. 4° ± 13. 7° at 15 mm above the lesser trochanter（ section 4）,and that the average version for the femoral neck（ FNV） was 12. 9° ± 13. 8°. The postoperative hip version was the stem version（ FSV）,which we found to be an average of 26. 1° ± 11. 0°. The mean femoral version for section 1 and2 was larger than the mean postoperative stem version（ P〈0. 01）; the mean version for sections 3 and 4did not differ from the mean postoperative stem version（ P〉0. 05）. The mean femoral neck version was less than the mean postoperative stem version（ P〈0. 01）; the difference was 13. 2° ± 11. 1° of the increased anteversion on average for the FSV compared with FNV. Conclusion： The accuracy of estimated femoral version after arthroplasty depends on broach level. When it is 10 mm above the lesser trochanter,stem version estimation is accurate,but below that level,there is a tendency to overestimate.

关 键 词：假体设计 股骨颈 髋臼 关节成形术 置换 髋 体层摄影术 X线计算机 

分 类 号：R687.3[医药卫生—骨科学]