人工全髋关节置换术中髋臼杯尺寸评估方法研究  

Study on assessment methods for acetabular cup size in total hip arthroplasty

作　　者：王金子 常文举 张培 李想 张勇 张硕硕 丁海 WANG Jinzi;CHANG Wenju;ZHANG Pei;LI Xiang;ZHANG Yong;ZHANG Shuoshuo;DING Hai(Department of Orthopedics,the First Affiliated Hospital of Bengbu Medical University,Bengbu Anhui,233000,P.R.China;Anhui Key Laboratory of Tissue Transplantation,Bengbu Anhui,233000,P.R.China)

机构地区：[1]蚌埠医科大学第一附属医院骨科,安徽蚌埠233000 [2]组织移植安徽省重点实验室,安徽蚌埠233000

出　　处：《中国修复重建外科杂志》2025年第2期163-167,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：安徽省高等学校自然科学基金重点研究项目(KJ2020A0579);安徽省高等学校科学研究项目(2023AH051987);安徽省新时代育人质量工程项目(2022qywsysfkc033)。

摘　　要：目的探讨准确评估人工全髋关节置换术(total hip arthroplasty,THA)中髋臼杯尺寸的方法。方法以2022年12月—2024年7月接受初次THA患者作为研究对象,其中73例(80髋)患者符合选择标准纳入研究。男39例,女34例;年龄56~78岁,平均66.3岁。单髋置换66例,双髋置换7例。其中,骨关节炎29例(34髋),股骨颈骨折35例(35髋),股骨头坏死9例(11髋)。基于X线片,采用术前模板规划法、影像学股骨头直径(diameter of the femoral head,FHD)评估法以及术中实测FHD评估法选择最适配髋臼杯尺寸,并与术中实际植入髋臼杯尺寸进行比较。结果术前模板规划法、影像学FHD评估法及术中实测FHD评估法、实际植入臼杯尺寸分别为(51.25±2.81)、(49.72±3.11)、(49.90±2.74)、(50.57±2.74)mm。前三种评估结果与术中实际植入髋臼杯尺寸相比,差异均无统计学意义(P>0.05)。与术中实际植入髋臼杯相比,术前模板规划法尺寸一致35髋(43.75%),相差1个型号41髋(51.25%),相差2个型号4髋(5%);影像学FHD评估法分别为12髋(15%)、57髋(71.25%)、11髋(13.75%);术中实测FHD评估法分别为26髋(32.5%)、52髋(65%)、2髋(2.5%)。术前模板规划法、影像学FHD评估法及术中实测FHD评估法与实际植入型号一致性分布差异有统计学意义(H=18.579,P<0.001)。结论术中实测FHD评估法作为一种简单、经济且准确的评估方法,可有效指导髋臼杯选择,减少假体磨损风险,提高术后关节稳定性。Objective To evaluate precise assessment methods for predicting the optimal acetabular cup size in total hip arthroplasty(THA).Methods A clinical data of 73 patients(80 hips)who underwent primary THA between December 2022 and July 2024 and met the inclusion criteria was analyzed.There were 39 males and 34 females with an average age of 66.3 years(range,56-78 years).Among them,66 cases were unilateral THA and 7 were bilateral THAs.There were 29 patients(34 hips)of osteoarthritis,35 patients(35 hips)of femoral neck fractures,and 9 patients(11 hips)of osteonecrosis of the femoral head.Based on anteroposterior pelvic X-ray films,three methods were employed to predict acetabular cup size,including preoperative template planning,radiographic femoral head diameter(FHD)measurement,and intraoperative FHD measurement.The predicted acetabular cup sizes from these methods were compared with the actual implanted sizes.Results The predicted acetabular cup sizes using the preoperative template planning,radiographic FHD measurement,and intraoperative FHD measurement were(51.25±2.81),(49.72±3.11),and(49.90±2.74)mm,respectively,compared to the actual implanted cup size of(50.57±2.74)mm,with no significant difference(P>0.05).Regarding agreement with the actual implanted cup size,the preoperative template planning achieved exact matches in 35 hips(43.75%),one-size deviation in 41 hips(51.25%),and two-size deviations in 4 hips(5%);the radiographic FHD measurement achieved exact matches in 12 hips(15%),one-size deviation in 57 hips(71.25%),and two-size deviations in 11 hips(13.75%);and the intraoperative FHD measurement achieved exact matches in 26 hips(32.5%),one-size deviation in 52 hips(65%),and two-size deviations in 2 hips(2.5%).There were significant differences in agreement distributions between the three methods and the actual implanted cup sizes(H=18.579,P<0.001).Conclusion The intraoperative FHD measurement,as a simple,cost-effective,and accurate method,effectively guides acetabular cup selection,reduces the risk of pros

关 键 词：人工全髋关节置换术 髋臼杯 假体 术前评估 

分 类 号：R687.4[医药卫生—骨科学]