脊柱骨盆参数在髋-脊柱综合征患者行全髋关节置换术后变化情况的中短期随访观察  

Short and medium term follow-up study on the changes of spine pelvic parameters in patients with hip-spine syndrome after total hip arthroplasty

作　　者：叶嘉靖 陈忠义[1] 朱忠[1] 江玲军[1] 伍海昭[1] 王守立 YE Jia-jing;CHEN Zhong-yi;ZHU Zhong;JIANG Ling-jun;WU Hai-zhao;WANG Shou-li(Department of Orthopaedics,Taizhou Hospial of Zhejiang Province,Linhai 317000,Zhejiang,Chinese)

机构地区：[1]浙江省台州医院骨科,浙江临海317000

出　　处：《中国骨伤》2020年第11期995-1000,共6页China Journal of Orthopaedics and Traumatology

基　　金：浙江省医药卫生科技计划项目(编号:2019RC307)。

摘　　要：目的:探讨髋-脊柱综合征患者行人工全髋关节置换术后对脊柱-骨盆参数变化的影响。方法:2013年1月至2014年10月对伴有股骨头坏死、髋关节骨关节炎、先天性髋关节发育不良的髋-脊柱综合征患者22例(26髋)行人工全髋关节置换术,男12例,女10例;年龄45~76岁,平均58.4岁;病程1.5~25年,平均12.8年。术前及术后常规拍摄骨盆正位、双下肢全长片、站立位胸腰椎及骨盆拼接片,测量其置换前后脊柱-骨盆冠状面及矢状面平衡参数,术前及术后患者进行视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI)及Harris评分。结果:术后所有病例获得随访,时间21~52(32±8)个月,末次随访未见感染、假体下沉、松动、假体脱位等情况。患者全髋关节置换术后矢状面偏移(sagittal vertical axis,SVA),胸椎后凸角(thoracic kyphosis,TK),腰椎前凸角(lumbar lordosis,LL),骨盆倾斜角(pelvic tilt,PT)较置换前均明显减小(P<0.05),骶骨倾斜角(sacral slope,SS)较置换前明显增大(P<0.05);骨盆入射角(pelvic incidence,PI)与置换前比较,差异无统计学意义(P>0.05);手术后骨盆倾斜、脊柱侧弯(冠状位)均明显下降,手术前后比较差异有统计学意义(P<0.05),术后腰部的VAS评分、髋关节的VAS评分、腰部的ODI评分均明显下降,手术前后比较差异有统计学意义(P<0.05);术后髋关节Harris评分明显上升,手术前后比较差异有统计学意义(P<0.05)。结论:对髋-脊柱综合征的患者行人工全髋关节置换术,术后脊柱骨盆的冠状面及史状面平衡参数均有明显改善,中短期疗效满意。Objective:To investigate the influence of total hip arthroplasty on the changes of spine pelvic parameters in patients with hip spine syndrome.Methods:From January 2013 to October 2014,22 patients(26 hips)with hip spine syndrome accompanied by necrosis of femoral head,hip osteoarthritis and congenital dysplasia of hip were treated with total hip arthroplasty.There were 12 males and 10 females with an average age of 58.4 years(range,45 to 76 years).The course of disease was 1.5 to 25 years with an average of 12.8 years.Before and after the operation,the anteroposterior,full length radiographs of both lower limbs,thoracolumbar spine and pelvis in standing position were routinely taken.The balance parameters of spine pelvis coronal plane and sagittal plane before and after the replacement were measured.Visual analogue scale(VAS),Oswestry Disability Index(ODI)and Harris score were performed before and after the operation.Results:All cases were followed up for 21 to 52(32±8)months.No infection,prosthesis subsidence,loosening,prosthesis dislocation were found in the last follow-up.After total hip arthroplasty,sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL),pelvic tilt(PT)were significantly reduced(P<0.05),sacral slope(SS)was significantly increased(P<0.05),there was no significant difference in pelvic incidence(PI)(P>0.05);PT and scoliosis(coronal position)were significantly decreased after operation(P<0.05);VAS score of waist,VAS score of hip joint and ODI score of waist were significantly decreased before and after operation(P<0.05).Harris score of hip joint increased significantly after operation,and the difference was statistically significant(P<0.05).Conclusion:After total hip arthroplasty,the coronal and historical balance parameters of spine and pelvis are significantly improved,and the short-term and medium-term effects are satisfactory.

关 键 词：关节成形术 置换 髋 腰痛 髋 骨盆 脊柱弯曲 

分 类 号：R320.2[医药卫生—人体解剖和组织胚胎学]