CT测量在髋关节发育不良患者初次全髋关节置换中的临床应用  

Clinical application of CT measurement in primary total hip arthroplasty of DDH patients

作　　者：莫华贵[1] 黄远翘[1] 马滚韶[1] 徐勤[1] 邬黎平[1] 方丽兰 Mo Huagui;Huang Yuanqiao;Ma Gunshao;Xu Qin;Wu Liping;Fang Lilan(Department of Orthopedics,Jiangmen Central Hospital,Jiangmen 529030,China;Department of Oncology,Jiangmen Central Hospital,Jiangmen 529030,China)

机构地区：[1]广东省江门市中心医院骨科,529030 [2]广东省江门市中心医院肿瘤内科,529030

出　　处：《中国医师杂志》2020年第1期80-83,共4页Journal of Chinese Physician

摘　　要：目的探究术前CT测量髋臼股骨颈联合前倾角在初次全髋关节置换(THA)中的临床应用效果。方法选取2016年3月至2018年5月期间本院骨科接受THA治疗的90例(90髋)髋关节发育不良(DDH)患者,48例术前通过X线和螺旋CT三维重建技术测量髋臼股骨颈联合前倾角,并拟定最佳的联合前倾角实施THA,为CT组;余42例术前不进行CT测量,为X线组。记录两组手术完成情况及手术效果,CT组术后通过三维计算机断层扫描成像(3D-CT)技术评估髋臼杯前倾角、髋臼股骨颈联合前倾角与术前拟定角度的差异。结果两组手术时间、术中失血量、术后下床活动时间及术前、术后下肢长度差值比较差异无统计学意义(P>0.05)。CT组术后2、3个月髋臼杯前倾角、髋臼股骨颈联合前倾角与术前拟定角度接近,差异无统计学意义(P>0.05)。CT组术后2、3个月Harris髋关节评分显著高于X线组(P<0.05);且术后下肢深静脉血栓发生率为6.25%,明显低于X线组的21.43%(P<0.05);脱位、感染、假体周围骨折发生率略低于X线组,但差异无统计学意义(P>0.05)。结论对于初次接受THA治疗的DDH患者,术前CT测量髋臼股骨颈联合前倾角有利于拟定最佳联合前倾角调整方案,继而可获得最大的初始稳定性,改善手术效果及减少假体脱位发生。Objective To investigate the clinical effect of preoperative computed tomography(CT)measurement of acetabulum femoral neck combined anteversion in primary total hip arthroplasty(THA).Methods From March 2016 to may 2018,48 patients(90 hips)with developmental dysplasia of the hip(DDH)who were treated with THA in the orthopaedic department of Jiangmen Central Hospital were measured by X-ray and spiral CT three-dimensional reconstruction technology before operation,and the best combined anteversion angle of acetabulum was determined before implementing THA,which was CT group;the remaining 42 patients were not measured by CT before operation,which was X-ray group.The difference of acetabulum cup anteversion angle,acetabulum femoral neck combined anteversion angle and preoperation angle were evaluated by three-dimensional computed tomography(3D-CT)in CT group.Results There was no significant difference in operative time,intraoperative blood loss,time of getting out of bed and length of lower limbs between the two groups(P>0.05).In CT group,the acetabulum cup anteversion and acetabulum femoral neck anteversion were close to the pre-operative angle at 2 and 3 months postoperatively(P>0.05).The Harris hip score of CT group was significantly higher than that of X-ray group at 2 and 3 months after operation,and the incidence of deep vein thrombosis was 6.25%,significantly lower than that of X-ray group(21.43%)(P<0.05).The incidence of dislocation,infection and periprosthetic fracture was slightly lower than that of X-ray group,but the difference was not statistically significant(P>0.05).Conclusions For DDH patients who received THA for the first time,preoperative CT measurement of acetabulum femoral neck combined with anteversion is conducive to the formulation of the best combined anteversion adjustment scheme,which can obtain the maximum initial stability,improve the surgical effect and reduce the occurrence of dislocation of prosthesis.

关 键 词：体层摄影术 X线计算机 髋臼 股骨颈 髋发育不良 关节成形术 置换 髋 

分 类 号：R687.4[医药卫生—骨科学]