中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
7期
1248-1252
,共5页
闫英杰%朱龙%程战伟%冯凯%焦雄
閆英傑%硃龍%程戰偉%馮凱%焦雄
염영걸%주룡%정전위%풍개%초웅
关节成形术,置换,髋%因素分析,统计学%旋转中心
關節成形術,置換,髖%因素分析,統計學%鏇轉中心
관절성형술,치환,관%인소분석,통계학%선전중심
Arthroplasty,replacement,hip%Factor analysis,statistical%Rotation center
目的：采用卵圆窝参照法实施初次全髋关节置换术（THR），探讨髋臼假体旋转中心变化的影响因素及临床疗效。方法回顾性分析我科2009年11月至2013年4月治疗的93例全髋关节置换患者，测量手术后双髋关节X线片髋关节旋转中心、外展角、前倾角，比较手术后髋臼假体旋转中心与解剖旋转中心符合率，对患者的Harris评分进行统计学分析。结果全部病例随访6～48个月，平均27.5个月。所有病例X线片提示，假体位置良好，无髋臼及股骨假体松动，无需要翻修病例。Harris评分由术前平均（41.45±9.74）分，增加到（91.36±3.65）分，优78例（83.87%），良8例（8.60%），可7例（7.52%），优良率92.47%。手术前后Harris评分结果比较t＝3.284，P＜0.05，差异有统计学意义。髋臼假体旋转中心O2恢复至解剖旋转中心O1者67例，符合率72.04%。未恢复者26例，未符合率27.96%。髋关节旋转中心（COR）恢复组与未恢复组外展角比较，差异有统计学意义（44.68°±5.35° vs.48.37°±4.65°，t＝2.8301，P＜0.05），COR恢复组与未恢复组前倾角比较，差异没有统计学意义（17.36°±6.65° vs.16.51°±7.25°，t＝0.5394，P＞0.05）。COR恢复组与未恢复组术前Harris评分比较，差异没有统计学意义（41.45±7.38 vs.38.85±6.65，t＝1.5657，P＞0.05）， COR恢复组与未恢复组术后Harris评分比较，差异有统计学意义（92.45±3.35 vs.81.65±5.39，t＝11.6417，P＜0.05）。结论髋臼假体旋转中心应遵循解剖重建的原则，临床关键在于确定髋臼旋转中心的位置，达到理想的臼杯外展40°，需内置、上移髋臼旋转中心。通过优化髋臼假体的倾斜角和覆盖，达到稳定关节，减少磨损，改善功能，取得良好的临床远期疗效。
目的：採用卵圓窩參照法實施初次全髖關節置換術（THR），探討髖臼假體鏇轉中心變化的影響因素及臨床療效。方法迴顧性分析我科2009年11月至2013年4月治療的93例全髖關節置換患者，測量手術後雙髖關節X線片髖關節鏇轉中心、外展角、前傾角，比較手術後髖臼假體鏇轉中心與解剖鏇轉中心符閤率，對患者的Harris評分進行統計學分析。結果全部病例隨訪6～48箇月，平均27.5箇月。所有病例X線片提示，假體位置良好，無髖臼及股骨假體鬆動，無需要翻脩病例。Harris評分由術前平均（41.45±9.74）分，增加到（91.36±3.65）分，優78例（83.87%），良8例（8.60%），可7例（7.52%），優良率92.47%。手術前後Harris評分結果比較t＝3.284，P＜0.05，差異有統計學意義。髖臼假體鏇轉中心O2恢複至解剖鏇轉中心O1者67例，符閤率72.04%。未恢複者26例，未符閤率27.96%。髖關節鏇轉中心（COR）恢複組與未恢複組外展角比較，差異有統計學意義（44.68°±5.35° vs.48.37°±4.65°，t＝2.8301，P＜0.05），COR恢複組與未恢複組前傾角比較，差異沒有統計學意義（17.36°±6.65° vs.16.51°±7.25°，t＝0.5394，P＞0.05）。COR恢複組與未恢複組術前Harris評分比較，差異沒有統計學意義（41.45±7.38 vs.38.85±6.65，t＝1.5657，P＞0.05）， COR恢複組與未恢複組術後Harris評分比較，差異有統計學意義（92.45±3.35 vs.81.65±5.39，t＝11.6417，P＜0.05）。結論髖臼假體鏇轉中心應遵循解剖重建的原則，臨床關鍵在于確定髖臼鏇轉中心的位置，達到理想的臼杯外展40°，需內置、上移髖臼鏇轉中心。通過優化髖臼假體的傾斜角和覆蓋，達到穩定關節，減少磨損，改善功能，取得良好的臨床遠期療效。
목적：채용란원와삼조법실시초차전관관절치환술（THR），탐토관구가체선전중심변화적영향인소급림상료효。방법회고성분석아과2009년11월지2013년4월치료적93례전관관절치환환자，측량수술후쌍관관절X선편관관절선전중심、외전각、전경각，비교수술후관구가체선전중심여해부선전중심부합솔，대환자적Harris평분진행통계학분석。결과전부병례수방6～48개월，평균27.5개월。소유병례X선편제시，가체위치량호，무관구급고골가체송동，무수요번수병례。Harris평분유술전평균（41.45±9.74）분，증가도（91.36±3.65）분，우78례（83.87%），량8례（8.60%），가7례（7.52%），우량솔92.47%。수술전후Harris평분결과비교t＝3.284，P＜0.05，차이유통계학의의。관구가체선전중심O2회복지해부선전중심O1자67례，부합솔72.04%。미회복자26례，미부합솔27.96%。관관절선전중심（COR）회복조여미회복조외전각비교，차이유통계학의의（44.68°±5.35° vs.48.37°±4.65°，t＝2.8301，P＜0.05），COR회복조여미회복조전경각비교，차이몰유통계학의의（17.36°±6.65° vs.16.51°±7.25°，t＝0.5394，P＞0.05）。COR회복조여미회복조술전Harris평분비교，차이몰유통계학의의（41.45±7.38 vs.38.85±6.65，t＝1.5657，P＞0.05）， COR회복조여미회복조술후Harris평분비교，차이유통계학의의（92.45±3.35 vs.81.65±5.39，t＝11.6417，P＜0.05）。결론관구가체선전중심응준순해부중건적원칙，림상관건재우학정관구선전중심적위치，체도이상적구배외전40°，수내치、상이관구선전중심。통과우화관구가체적경사각화복개，체도은정관절，감소마손，개선공능，취득량호적림상원기료효。
Objective The implementation of primary total hip arthroplasty (total hip replacement, THR) by adopt the method of fossa ovalis reference to investigate the factors affecting acetabular center of rotation changes and clinical efficacy. Methods A retrospective analysis of 93 cases of patients treated in our department in November 2009-April 2013 with total hip arthroplasty, Measuring the compliance rate with double hip surgery after X-ray of the hip joint center of rotation, abduction angle, anteversion, comparing the surgical center of rotation of the acetabular prosthesis with anatomic center of rotation. Harris scores for the patients were statistically analyzed. Results All patients were followed up for 6 to 48 months, average 27.5 months. All cases X-ray prompt prosthesis position well, no acetabular and femoral prosthesis loosening, no need to overhaul cases. Harris score was (41.45±9.74) points from the preoperative to (91.36±3.65) points, excellent 78 cases (83.87%), good in 8 cases (8.60%), 7 cases (7.52%), good rate of 92.47%. Harris scores before and after surgery results compare t=3.284, P<0.05, the difference was statistically significant. Acetabular center of rotation O2 restored to 67 cases by anatomic center of rotation O1, 72.04% compliance rate. Not recovered in 26 cases, do not meet the rate of 27.96%. Hip rotation center (center of rotation, COR), COR recovery group and the group does not restore the abduction angle, the difference was statistically significant (44.68°±5.35° vs. 48.37°±4.65°, t=2.830 1, P<0.05), COR recovery group and did not resume before the inclination comparison group, the difference was not statistically significant (17.36°±6.65° vs. 16.51°±7.25°, t=0.539 4, P>0.05). COR recovery group and did not resume before the comparison group preoperative Harris hip score, the difference was not statistically significant (41.45±7.38 vs. 38.85±6.65, t=1.565 7, P>0.05), COR recovery group and the group did not recover after Harris scores, the difference was statistically significant (92.45±3.35 vs. 81.65±5.39, t=11.641 7, P<0.05). Conclusions Acetabular prosthesis should follow the principle of rotation center anatomical reconstruction, the key is to determine the location of the clinical acetabular center of rotation, to achieve the desired cup abduction angle of 40°, to be built-in, move acetabular center of rotation. By optimizing the tilt angle and the acetabular prosthesis coverage, stabilize joints, reduce wear, improve function, and achieved good clinical long-term effect.
