穿桌侧位片及骨盆正位片测量髋臼杯前倾角的对比  

Comparative study of cross-table and anteroposterior radiographs in measurement of acetabular cup anteversion after total hip arthroplasty

作　　者：张文辉 许杰[1] 李登[1] 孙浩 蔡志清[1] 陈镁仪 马若凡[1] Zhang Wenhui;Xu Jie;Li Deng;Sun Hao;Cai Zhiqing;Chen Meiyi;Ma Ruofan(Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China)

机构地区：[1]中山大学孙逸仙纪念医院关节外科,广州510120

出　　处：《中华关节外科杂志（电子版）》2021年第2期151-156,共6页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：广州市科技计划项目(201803010011);广东省自然科学基金项目(2018A030310231);中央高校基本科研业务费专项资金(18zxxt61);广东省基础与应用基础研究基金(2019A1515011647)。

摘　　要：目的分析穿桌侧位片(CL)与骨盆正位片(AP)测量髋臼假体前倾角的一致性及可靠性差异。方法回顾性分析2014年5月至2017年7月期间于中山大学孙逸仙纪念医院接受单侧初次全髋关节置换术并于术后第1天进行了CL及AP拍摄的患者,排除有脊柱或骨盆相关疾病或手术史及一期行双侧髋关节置换术的患者,共纳入100例,其中男46例,女54例,平均年龄(54±13)岁。3名独立的对患者资料不知情的测量者分别在CL及AP上进行髋臼杯前倾角测量,使用组内相关系数(ICC)和95%置信区间(CI)评估AP和CL测量值的可靠性,均值、标准差和95%置信区间(CI)用于对两组测量值进行统计描述。结果CL与AP均具有较高的组内和组间ICC,但CL相对更高。CL平均髋臼假体前倾为(17.5±5.3)°,AP为(15.9±9.7)°;CL与AP均值的ICC=0.723[95%CI(0.588,0.813)],差值几乎均在95%一致性界限内(-15.9~12.7),平均差值为-1.6。差值较大的26例中有17例术后30 d AP上闭孔高度及髋臼前倾角较术后1 d及术前发生较大变化。另外发现一例AP显示倾斜方向不明,而CL显示倾斜方向与CT一致。结论CL与AP测量髋臼杯前倾角具有良好的一致性,CL在测量可靠性、臼杯倾斜方向判定上更具有优势。两种方法测量时均需考虑到骨盆前倾角的影响。Objective To determine the consistency and reliability between cross-table lateral radiograph(CL)and anteroposterior radiograph(AP)in measuring acetabular cup anteversion.Methods Patients undergoing primary total hip arthroplasty and examinations of CL and AP one day after the surgery in Sun Yat Sen Memorial Hospital from May 2014 to July 2017 were eligible for inclusion in this study.Those who had spinal or pelvic diseases or surgical history and received bilateral hip arthroplasty were excluded.A total of 100 patients were evaluated.The patients comprised 46 men and 54 women with a mean age of(54±13)years.Acetabular cup anteversion was measured on CL and AP by three independent blind observers.The consistency and reliability of AP and CL measurements were evaluated using mean value,standard deviation,intra-class correlation coefficient(ICC)and 95%confidence interval(CI).Results Both CL and AP had high intra-and inter-observer ICC,but relatively higher CL.The acetabular cup anteversion of the CL group was(17.5±5.3)°,and was(15.9±9.7)°of the AP group.There was good agreement[ICC=0.723,95%CI(0.588,0.813)]between CL and AP,with an average difference of-1.6 and 95%limits of agreement was-15.9 to 12.7.Among 17 of 26 cases with large difference,the obturator height and acetabular anteversion on AP taken at 30 days after operation were significantly different from those at one day after operation and before operation.In another case,the version direction of the acetabular cup shown on AP was unknown,while the one shown on CL was clear and consistent with CT.Conclusion There is a good agreement between CL and AP in measuring the anteversion of acetabular cup,and CL has more advantages in the reliability of measurement and the ability to distinguish anteversion and retroversion,but the effect of pelvic tilt should be taken into account in both methods.

关 键 词：关节成形术 置换 髋 髋臼 假体和植入物 放射摄影术 

分 类 号：R68[医药卫生—骨科学]