生物型髋关节假体位置参数与患者生命质量相关性研究  

Relationship between life quality and prosthesis position parameters after cementless total hip arthroplasty

作　　者：刘玉宝 邹瑞 林禄攀 赵清华 温传阳 郭玉祥 林福庆 Liu Yubao;Zou Rui;Lin Lupan;Zhao Qinghua;Wen Chuanyang;Guo Yuxiang;Lin Fuqing(Department of Orthopaedic Trauma,Luhe Hospital Affiliated to Medical School of Yangzhou University,Nanjing 211500,China)

机构地区：[1]南京市六合区人民医院骨二科,211500

出　　处：《中华关节外科杂志（电子版）》2018年第4期454-461,共8页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：南京市科技发展计划项目(201605072)

摘　　要：目的分析初次生物型全髋关节置换术(THA)后假体位置重建情况,探讨假体位置参数与患者生命质量的相关性,总结假体位相参数的安全范围。方法对南京市六合区人民医院骨科2013年3月至2015年3月52例因股骨颈骨折行初次生物型全髋关节置换术的患者进行2年的前瞻性研究。术后第3天未负重前首次拍摄患侧髋关节正侧位及骨盆正位X线片,分析髋臼及股骨柄假体的位置参数,包括髋臼外展角、髋臼前倾角、股骨头旋转中心、股骨垂直偏距、股骨偏心距、外展肌力臂、重力力臂、股骨柄内外翻、颈干角。术前和术后24个月对患者进行评估健康相关生命质量的SF-36简明健康状况调查量表(SF-36)评分。采用SPSS 17. 0软件对量表进行Cronbach's (系数同质性分析、Pearson相关分析、因子分析及t检验以评价其信效度,并评价假体位置参数与SF-36各项评分提高值之间的相关性。结果 52名患者(52髋)均完成了随访,根据THA术后首次X线片获取假体位置参数。除情感职能外,手术前后的SF-36量表内部一致性显示Cronbach'sα系数> 0. 7;重测信度显示相关系数(CC)ICC> 0. 8;分半信度显示Pearson相关系数> 0. 874;反应度显示SF-36量表能较好地反应THA患者手术前后的生命质量变化状况;结构效应单因子分析结果示全部36个条目在各自维度上的因子载荷为0. 23～0. 87(P <0. 05),其中3个条目的载荷小于0. 30。多因子分析结果2/df=3. 16,拟合优度指数(GFI)=0. 892,近似误差均方根(RMSEA)=0. 089,表明SF-36的各拟舍指数均在可被接受水平;证明SF-36的内部结构与其理论架构有很高的一致性。假体位置参数与SF-36各维度的相关系数都为正数,除GH外SF-36各维度与髋臼假体位相参数间相关系数均大于0. 6,SF-36各维度与髋关节旋转中心体位相参数间高度相关,SF-36中活力(VT)、社会功能(SF)、情感职能(RE)及精神健康(MH)与股骨垂直偏距�Objective To analyze the conditions of hip prosthesis reconstruction and to probe into the relationship of the life quality and the safe range of the prosthesis position parameters.Methods Based on a prospective study design,from March 2013 to March 2015,52 eligible patients(52 hips)who had had total hip arthroplasty were interviewed and measured by the short form 36-item health survey(SF-36)before and two years after the operation.The anteroposterior pelvis,anteroposterior and lateral hip joint X-rays were taken at the third day after the operation to analyze the prosthesis position parameters of acetabulum and the femoral prosthesis,including acetabulum abducent and anteversion angles,femoral head rotation center position,femoral eccentricity,femoral vertical setover,length of abductor and gravity lever arm,femoral prosthesis varus and valgus,neck shaft angle.SF-36 was used to evaluate the patient′s quality of life before and two years after the operation.SPSS 17.0 was applied to analyze the reliability and validity of SF-36 and evaluate the relationship between quality of life and prosthesis position parameters after cementless total hip arthroplasty by Pearson analysis and t test.Results All the patients(52 hips)completed the follow-up,and prosthesis position parameters were obtained from X-ray after THA.Except role emotional(RE),the internal consistency of before and after opration of SF-36 determined by Cronbach s alpha coefficient were greater than 0.7.Test-retest reliability of SF-36 expressed by intraclass corre-lation coefficient(ICC)were greater than 0.80.The half-split reliability expressed by Pearson correlation coefficient(CC)was greater than 0.874.The validity was good at showing the life quality changes of patients before and after the surgery.Except vitality(VT),content validity evaluated by Pearson CC were higher than 0.7 between most dimensions and items of SF-36.CC between the prosthesis position parameters and the items of SF-36 were positive value.Except general health(GH),CC between th

关 键 词：生物假体 关节成形术 置换 髋 生活质量 

分 类 号：R687.4[医药卫生—骨科学]