基于髋关节数字解剖降低THA术后下肢不等长带刻度股骨髓腔锉和相应股骨柄假体及技术的研发与应用  

Development and application of calibrated femoral canal file and corresponding femoral stem prosthesis based on the digital anatomy of the hip joint to reduce the leg length discrepancy after total hip arthroplasty

作　　者：段续东 王坤正[3] 李树锋[2] 孙华强 石志伟 顾言阁 殷鲁旭[2] 张业勇 杨佩[3] 周建生[4] 闫新峰[2] Duan Xudong;Wang Kunzheng;Li Shufeng;Sun Huaqiang;Shi Zhiwei;Gu Yange;Yin Luxu;Zhang Yeyong;Yang Pei;Zhou Jiansheng;Yan Xinfeng(Cheeloo College of Medicine,Shandong University,Jinan 250014,China;Department of Orthopedic Surgery,the First Affiliated Hospital of Shandong First Medical University(Shandong Provincial Qianfoshan Hospital),Shandong Key Laboratory of Rheumatic Disease and Translational medicine,Jinan 250014,China;Department of Orthopedics,the Second Affiliated Hospital of Xi'an Jiao Tong University Xi'an 710001,China;Department of Orthopedics,the First Affiliated Hospital of the Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]山东大学齐鲁医学院,济南250014 [2]山东第一医科大学第一附属医院(山东省千佛山医院)骨外科学,山东省风湿免疫病转化医学重点实验室,济南250014 [3]西安交通大学第二附属医院骨科,西安710001 [4]蚌埠医学院第一附属医院骨科,蚌埠233004

出　　处：《中华解剖与临床杂志》2022年第7期468-474,共7页Chinese Journal of Anatomy and Clinics

摘　　要：目的根据髋关节的数字解剖特点研发一种带刻度股骨髓腔锉和相应股骨柄假体及测量方法,探讨其在全髋关节置换手术(THA)中控制下肢长度的效果,并对影响其使用效果的原因进行分析。方法回顾性队列研究。纳入2017年6月—2020年7月山东省千佛山医院行初次单侧THA的患者300例。其中,男154例、女146例,年龄27~86(59.5±11.3)岁。按照术中控制下肢长度的方法进行分组:观察组134例,采用带刻度髓腔锉控制下肢长度;对照组166例,采用徒手方法控制下肢长度。观察指标:(1)比较2组患者性别、身高、术前下肢不等长(LLD)、手术侧别等基线资料。(2)测量和比较2组患者术后LLD的差异,以及LLD的分布情况。(3)比较2组LLD>10 mm患者的占比,分析导致患者术后LLD>10 mm的原因。结果所有患者手术过程顺利,术后切口均为一期愈合。(1)2组患者性别、身高、术前LLD、手术侧别等基线资料比较,差异均无统计学意义(P值均>0.05)。(2)观察组患者术后LLD为4.76(2.98,7.18)mm,对照组为5.85(3.78,8.38)mm,差异有统计学意义(Z=-2.84,P=0.004);观察组患者术后LLD的分布情况优于对照组,差异有统计学意义(Z=3.08,P=0.002)。(3)观察组中有8例(5.97%,8/134)患者术后LLD>10 mm,对照组有24例(14.46%,24/166),差异有统计学意义(χ^(2)=5.61,P=0.018);术后LLD>10 mm原因分析:与假体和患者不匹配有关(观察组3例、对照组4例);与髋臼下缘骨赘增生明显导致克氏针定位偏下有关(观察组5例、对照组3例)。结论在行单侧THA时,使用带刻度股骨髓腔锉相比徒手方法可以更有效地控制术后LLD。而假体不匹配以及术中对髋臼下缘及大转子顶点探查不够准确是影响该方法有效控制LLD的主要原因。Objective According to the digital anatomical characteristics of the hip joint,a calibrated femoral canal file,and corresponding femoral stem prosthesis and its measuring method are developed.To explore the effect of this technique on controlling the leg length in total hip arthroplasty(THA)and analyze the causes for the results obtained by this method.Methods Retrospective cohort study.A total of 300 patients who underwent the first unilateral THA in Qianfoshan Hospital of Shandong Province from June 2017 to July 2020 were selected.Among them,there were 154 males and 146 females,aged 27-86(59.5±11.3)years old.Patients were divided into groups according to the methods used of controlling their leg length discrepancy(LLD)during the operation:134 patients with calibrated femoral canal files to control leg length were included in the observation group,meanwhile,166 patients with unarmed methods were included in the control group.Observation indicators:(1)the baseline data of equal sex,height,preoperative LLD,and operation side were compared between the two groups.(2)the differences between LLD and the distribution of LLD were measured and compared between the two groups.(3)to compare the proportion of patients with LLD>10 mm in the two groups,and to analyze the causes of postoperative LLD>10 mm.Results All patients completed their primary wound healing.(1)There was no significant difference found in gender,height,preoperative LLD,and operation side between the two groups(all P values>0.05).(2)The postoperative LLD of the observation group was 4.76(2.98,7.18)mm,and that of the control group was 5.85(3.78,8.38)mm,the difference was statistically significant(Z=-2.84,P=0.004),and the distribution of the LLD of the observation group was better than that of the control group,and the difference was statistically significant(Z=3.078,P=0.002).(3)In the observation group,8 cases(5.97%,8/134)had postoperative LLD>10 mm,and in 24 cases in the control group(14.46%,24/166),the difference was statistically significant(χ^(2)=5.61

关 键 词：关节成形术 置换 髋 下肢不等长 带刻度股骨髓腔锉 旋转中心 股骨大转子高度 

分 类 号：R687.4[医药卫生—骨科学]