初次单侧全髋关节置换后骨盆倾斜转归的因素分析  

Factor analysis of pelvic tilt outcome after primary unilateral total hip arthroplasty

作　　者：卢林 陈海诚 陈楚杰[1] 周驰[2] 陈镇秋[2] Lu Lin;Chen Haicheng;Chen Chujie;Zhou Chi;Chen Zhenqiu(Guangzhou University of Chinese Medicine,Guangzhou 510005,Guangdong Province,China;Department of Femoral Head Necrosis,Bone Injury Center,First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510450,Guangdong Province,China)

机构地区：[1]广州中医药大学,广东省广州市510005 [2]广州中医药大学第一附属医院骨伤中心股骨头坏死科,广东省广州市510450

出　　处：《中国组织工程研究》2024年第36期5817-5822,共6页Chinese Journal of Tissue Engineering Research

基　　金：广州市卫生健康委员会,广州地区临床高新、重大和特色技术(2023-2025年)建设项目(2023P-TS22),项目负责人:陈镇秋。

摘　　要：背景:骨盆倾斜多见于髋关节疾病,也是全髋关节置换后常见的功能问题。目的:探讨股骨头坏死患者单侧全髋关节置换后骨盆倾斜的发生机制与恢复情况。方法:回顾性收集2021年6月至2023年2月广州中医药大学第一附属医院骨伤中心股骨头坏死科收治的100例股骨头坏死且接受单侧全髋关节置换患者的临床资料,根据术后3 d时骨盆倾斜严重程度分为3组,A组(<2°)48例,B组(2°-3°)34例,C组(>3°)18例。统计并比较3组患者术前、术后骨盆冠状面倾斜角度、双侧臀中肌长度、股骨头旋转中心高度以及双侧臀中肌长度差值、股骨头旋转中心高度差值、骨盆倾斜角度变化比值。采用皮尔逊相关系数检验术后骨盆倾斜角度与其他指标的相关性。结果与结论:①术后短期内发生骨盆倾斜加重;②术后3 d至术后1个月时段骨盆倾斜角度变化比值组间存在差异,C组>B组>A组;术后1-3个月时段C组与其他各组存在差异,C组变化比值最小;术后3 d至术后3个月时段组间变化比值无差异;③双侧臀中肌差值术后逐渐减小,术后3个月时双侧臀中肌比较无差异;④术后双侧旋转中心差值增大,术后3个月时双侧高度差值小于术前;⑤术后3 d时骨盆倾斜角度、病程与术后3个月骨盆倾斜角度呈显著相关性(均P=0.000),术前双侧臀中肌差值与术后3 d时骨盆倾斜角度呈显著相关性(P=0.006);⑥提示股骨头坏死患者全髋关节置换后发生功能性骨盆倾斜;术后骨盆倾斜的矫正是基于术后功能性骨盆倾斜角度的适应性恢复;功能性骨盆倾斜的产生是以术后短期骨性结构重建、软组织积累性损害存续为基础的机体代偿适应。BACKGROUND:Pelvic tilt,which is often seen in hip diseases,is also a common functional problem after total hip arthroplasty.OBJECTIVE:To investigate the mechanism of occurrence and recovery of pelvic tilt after unilateral total hip arthroplasty in patients with femoral head necrosis.METHODS:The clinical data of 100 patients with femoral head necrosis who underwent unilateral total hip arthroplasty in the Department of Femoral Head Necrosis,Bone Injury Center of First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected retrospectively from June 2021 to February 2023.The patients were divided into three groups,namely,groups A(<2°,n=48),B(2°-3°,n=34),and C(>3°,n=18),according to the severity of pelvic tilt on postoperative 3 day.Statistical data were collected and compared between the pre-and postoperative periods of patients of these three groups in terms of the angle of the coronal plane of the pelvis tilt,the length of the gluteus medius muscles of the bilateral sides,the heights of the rotational centers of the femoral heads,the difference in the lengths of the gluteus medius muscles of the bilateral sides and the heights of the rotational centers of the femoral heads,and the ratio of changes in the angle of the pelvic tilt.Pearson correlation coefficient was used to examine the correlation between pelvic tilt angle and other indexes.RESULTS AND CONCLUSION:(1)Pelvic tilt aggravation occurred in the short term after surgery.(2)The ratio of change in pelvic tilt angle from postoperative 3 days to postoperative 1 month time period differed between the groups,with group C>group B>group A.There was a difference between group C and the other groups in the time period from postoperative 1 to postoperative 3 months,with the ratio of change being the smallest in group C.There was no difference in the ratio of change between the groups in the time period from postoperative 3 days to postoperative 3 months.(3)The difference in bilateral gluteus medius muscles decreased gradually after surgery

关 键 词：全髋关节置换 髋关节 臀中肌 骨盆倾斜 股骨头旋转中心高度 骨盆倾斜角度变化比值 骨盆稳态 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.4