人工全髋关节置换术后股骨柄前倾角相关因素分析  

Analysis of factors associated with the influence of femoral stem anteversion after total hip arthroplasty

作　　者：刘政 宋凯[1,2] 蒋青 徐志宏[1,2] LIU Zheng;SONG Kai;JIANG Qing;XU Zhihong(Division of Sports Medicine and Adult Reconstructive Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing Jiangsu,210008,P.R.China;Branch of National Clinical Research Center for Orthopedics,Sports Medicine and Rehabilitation,Nanjing Jiangsu,210008,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院骨科、运动医学与成人重建外科,南京210008 [2]国家骨科与运动康复临床医学研究中心分中心,南京210008

出　　处：《中国修复重建外科杂志》2023年第9期1075-1080,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81991514、82272492)。

摘　　要：目的 探讨人工全髋关节置换术(total hip arthroplasty,THA)后股骨柄前倾角(femoral stem anteversion,FSA)的相关因素,为临床术前设计FSA、降低置换术后髋关节脱位风险提供参考。方法 以2021年10月—2022年9月收治且符合选择标准的93例(103髋)THA患者作为研究对象。其中男48例,女45例;年龄25~88岁,平均58.5岁。身体质量指数18.00~37.84 kg/m2,平均24.92 kg/m2。诊断:股骨头坏死51例(57髋),骨关节炎35例(39髋),先天性髋关节发育不良7例(7髋)。基于手术前后CT图像测量以下指标:术前指标包括股骨颈前倾角(femoral neck anteversion,FNA)、股骨旋转角(femoral rotation angle,FRA)、髋臼前倾角(acetabular anteversion,AA),并计算联合前倾角(combined anteversion,CA),即术前FNA与AA之和;术后指标为FSA,并计算术后股骨前倾角变化值,即术后FSA与术前FNA的差值。基于术前X线片测量以下指标:股骨皮质厚度指数(cortical thickness index,CTI);股骨髓腔开口指数(canal flare index,CFI),并根据Noble分类法对股骨近端髓腔解剖形状分型(香槟杯型、正常型、烟囱型);股骨颈干角(neck-shaft angle,NSA);偏心距(femoral offset,FO)。应用Pearson相关分析、单因素方差分析、Point-biserial相关分析术后FSA、术后股骨前倾角变化值分别与患者诊断、股骨近端髓腔解剖类型、性别、年龄以及术前FNA、FRA、AA、CA、NSA、FO、CTI、CFI相关关系。以FSA作为因变量,纳入与其可能存在相关关系的自变量进行多重线性回归分析。结果 基于CT图像测量示,术前FNA(15.96±10.01)°、FRA(3.36±10.87)°、AA(12.94±8.83)°、CA(28.9±12.6)°,术后FSA(16.18±11.01)°,术后股骨前倾角变化值(0.22±9.98)°。基于术前X线片测量示,CTI 0.586±0.081;CFI4.135±1.125,其中股骨近端髓腔为香槟杯型23髋、正常型68髋、烟囱型12髋;NSA(132.87±7.83)°;FO(40.53±10.11)mm。患者术前FNA与术后FSA差异无统计学意义(t=-0.227,P=0.821)。Pearson相关分�Objective To explore the related factors of femoral stem anteversion(FSA)after total hip arthroplasty(THA),so as to provide reference for clinical design of FSA before operation and reduce the risk of hip dislocation after arthroplasty.Methods Ninty-three patients(103 hips)who underwent THA between October 2021 and September 2022 and met the selection criteria were selected as the study subjects.Among them,there were 48 males and 45 females with an average age of 58.5 years(range,25-88 years).Body mass index was 18.00-37.84 kg/m2,with an average of 24.92 kg/m2.There were 51 cases(57 hips)of osteonecrosis of femoral head,35 cases(39 hips)of hip osteoarthritis,and 7 cases(7 hips)of congenital hip dysplasia.Based on CT images,the following indicators were measured:preoperative femoral neck anteversion(FNA),preoperative femoral rotation angle(FRA),preoperative acetabular anteversion(AA),and preoperative combined anteversion(CA;the sum of preoperative FNA and AA);postoperative FSA and the change in femoral anteversion angle(the difference between postoperative FSA and preoperative FNA).Based on preoperative X-ray films,the following indicators were measured:femoral cortical thickness index(CTI)and canal flare index(CFI),the proximal femoral medullary cavity was classified according to Noble classification(champagne cup type,normal type,chimney type),neck-shaft angle(NSA),and femoral offset(FO).Pearson correlation analysis,one-way ANOVA,and Point-biserial correlation analysis were used to investigate the correlation between postoperative FSA,postoperative change in femoral anteversion angle,and patient diagnosis,proximal femoral medullary cavity anatomy type,gender,age,as well as preoperative FNA,FRA,AA,CA,NSA,FO,CTI,and CFI.FSA was used as the dependent variable and the independent variables that may be related to it were included for multiple linear regression analysis.Results Based on CT image measurement,preoperative FNA was(15.96±10.01)°,FRA(3.36±10.87)°,AA(12.94±8.83)°,CA(28.9±12.6)°,postoperative FSA(16.

关 键 词：人工全髋关节置换术 股骨柄前倾角 股骨颈前倾角 股骨近端形态 

分 类 号：R687.3[医药卫生—骨科学]