股骨假体颈干角、前倾角变化对全髋关节置换术后预后的影响

Effect of post-operative changes of neck-shaft angle and femoral component anteversion on clinical outcome following uncemented total hip arthroplasty

摘要:

目的 研究全髋关节置换手术前后股骨解剖改变，测量颈干角、股骨前倾角等解剖参数，对比 上述参数差异对关节置换术后的功能预后、疼痛及患者满意度的影响。方法 选取2011 ～ 2014 年55 例患 者行全髋关节置换术并随访1 年，收集患者基本资料，手术前后行CT 检查以及常规X 射线检查，利用三维 重建软件构建髋关节三维模型，测量股骨颈干角、前倾角、股骨偏心距及髋关节旋转中心的解剖参数，利用 Harris 关节评分评估患者关节功能，利用视觉模拟评分评估术后关节疼痛程度，评估患者满意度，通过亚组分 析上述解剖参数变化与术后预后的相关性。结果 共有44 例患者完成随访，平均年龄为（65.3±7.0）岁，术 后颈干角为（131.6±2.1）°，手术前后颈干角比较有差异（P <0.05），术后平均颈干角较术前大。术前股骨 前倾角为（24.9±8.0）°，术后前倾角为（7.4±7.3）°，手术前后股骨前倾角比较有差异（P <0.05）。亚组 患者Harris 关节评分、视觉模拟评分及患者满意度评分均无差异（P >0.05）。结论 患者对手术前后的颈干 角以及前倾角差异耐受能力较强，上述解剖参数改变对术后关节功能、疼痛以及患者满意度无显著影响。

Abstract:

Objective To compare the pre- and post-operative changes in femoral anatomy: neckshaft angle, femoral anteversion, and femoral offset after insertion of a nonmodular femoral component and the influence of the postoperative changes in hip anatomy on functional outcome and pain. Methods Fiftyfive patients with total hip arthroplasty (THA) from 2011 to 2014 were recruited in the study and followed up for one year. The basic data of the patients were collected. All patients underwent pre- and post-operative three dimensional CT scanning of the hip. The pre- and post-operative neck–shaft angle, offset, hip centre of rotation, femoral anteversion, and stem alignment were measured. Functional assessment (Harris hip score) and pain score (visual analogical score) were evaluated before surgery and 1 year after operation. The relationships of the post-operative anatomical changes with postoperative outcome were evaluated by sub-group analysis. All data were analyzed by SPSS 20.0. Results A total of 44 patients were followed up with the mean age of (65.3 ± 7.0) years. They all underwent pre- and post-operative three dimensional CT scanning of the hip.The mean post-operative neck–shaft angle [(131.0 ± 2.1)°] was significantly larger than the pre-operative one [(128.8 ± 6.2)°, P < 0.05]. The mean pre-operative anteversion was (24.9 ± 8.0)° and reduced to (7.4 ± 7.3)° after operation (P < 0.05). The post-operative changes had no influence on hip function and pain. Conclusions Using a standard uncemented femoral component, high pre- and post-operative variability of femoral anteversion and neck-shaft angles is found with a significant decrease of the post-operative anteversion and a slight increase of the neck-shaft angle, which have no impact on clinical outcome.