CAJ | 학술논문

目的探讨立体影像学分析(roentgen stereophotogrammetric analysis,RSA)对全髋关节置换术后股骨假体迁移的评估价值.方法 2009年5月至2010年4月,行组配式全髋关节置换37例,男25例,女12例；年龄58～72岁,平均(60.23±5.64)岁.退行性骨关节炎32例,股骨颈骨折3例,髋关节发育不良2例.术后3、6、12、24个月采用Harris髋关节评分评估髋关节功能及RSA评估股骨假体的早期迁移度.结果 Harris髋关节评分从术前(26.36±10.56)分提高至术后不同随访时间点的(78.24±12.72)分、(84.51±16.05)分、(86.72±9.34)分及(87.55±8.97)分,与术前比较差异均有统计学意义.无假体翻修病例,3例有轻微的大腿痛.RSA评估发现早期迁移幅度个体差异较大,术后3～6个月存在较高的初始迁移.36例于术后24个月达到临床和生物学稳定,1例表现为假体进行性迁移.股骨假体向远端迁移(1.37±0.59) mm、向后迁移(1.37±0.54) mm,与术前差异有统计学意义.术后24个月内股骨假体向远端迁移与向后迁移呈正相关(r=0.3,P=O.O1),假体在横断面和矢状面上呈现出相对宿主骨界面稳定固定的趋势,股骨假体向远端及向后的倾斜或旋转移位主要发生在术后3个月内.不同尺寸的股骨头假体和不同偏心距的组配式股骨颈假体与发生在各个方向的迁移度无相关性.结论 RSA为组配式全髋关节置换术后股骨假体迁移度的早期评估提供了客观依据,可用于评估人工关节假体的早期稳定性.
목적 탐토입체영상학분석(roentgen stereophotogrammetric analysis,RSA)대전관관절치환술후고골가체천이적평고개치.방법 2009년5월지2010년4월,행조배식전관관절치환37례,남25례,녀12례；년령58～72세,평균(60.23±5.64)세.퇴행성골관절염32례,고골경골절3례,관관절발육불량2례.술후3、6、12、24개월채용Harris관관절평분평고관관절공능급RSA평고고골가체적조기천이도.결과 Harris관관절평분종술전(26.36±10.56)분제고지술후불동수방시간점적(78.24±12.72)분、(84.51±16.05)분、(86.72±9.34)분급(87.55±8.97)분,여술전비교차이균유통계학의의.무가체번수병례,3례유경미적대퇴통.RSA평고발현조기천이폭도개체차이교대,술후3～6개월존재교고적초시천이.36례우술후24개월체도림상화생물학은정,1례표현위가체진행성천이.고골가체향원단천이(1.37±0.59) mm、향후천이(1.37±0.54) mm,여술전차이유통계학의의.술후24개월내고골가체향원단천이여향후천이정정상관(r=0.3,P=O.O1),가체재횡단면화시상면상정현출상대숙주골계면은정고정적추세,고골가체향원단급향후적경사혹선전이위주요발생재술후3개월내.불동척촌적고골두가체화불동편심거적조배식고골경가체여발생재각개방향적천이도무상관성.결론 RSA위조배식전관관절치환술후고골가체천이도적조기평고제공료객관의거,가용우평고인공관절가체적조기은정성.
Objective To investigate the value of roentgen stereophotogrammetric analysis (RSA) in assessing early migration of femoral implant after total hip arthroplasty (THA) with modular prostheses.Methods From May 2009 to April 2010,37 patients underwent THA with modular prostheses inour hospital,including 25 males and 12 females,aged from 58 to 72 years (average,60.23±5.64 years).There were 32 cases of degenerative osteoarthritis,3 cases of femoral neck fracture and 2 cases of developmental dysplasia of the hip.The Harris hip score and RSA were used to assess the clinical results and the migration of femoral implant at 3,6,12,24 months postoperatively,respectively.Results The average Harris hip score improved from preoperative 26.36 ±10.56 to 78.24±12.72,84.51±16.05,86.72±9.34,and 87.55±8.97 at 3,6,12,and 24 months after operation,respectively,and the differences between pre-and post-operative Harris score were significant.There was no prosthetic revision,and slight thigh pain occurred in 3 patients.According to RSA,the degree of initial migration of femoral implant had large individual differences,and the initial migration was higher from 3 to 6 months after operation.Clinical and biological stabilization was achieved in 36 patients,while progressive migration was found in 1 patient.There was a positive correlation between the distal migration and posterior migration within 24 months after operation (r=0.3,P=0.01).The distal migration and posterior migration/rotation mainly occurred within 3 months after operation.There was no correlation between prosthetic size/offset and degree of migration of implant.Conclusion RSA provides an objective reference for assessing the migration of femoral implant after THA with modular prostheses,which is a reliable method to evaluate early implant stability.