髋关节旋转中心位置对全髋关节置换术后Crowe Ⅳ型DDH患者关节功能的影响

Impact of hip rotation center position on joint function in Crowe type IV DDH patients after total hip arthroplasty

摘要:

目的 探讨不同髋关节旋转中心位置对全髋关节置换术后Crowe Ⅳ型发育性髋关节发育不良（DDH）患者关节功能恢复的影响。方法 选取2019年1月—2024年3月唐山市人民医院82例行全髋关节置换术的Crowe Ⅳ型DDH患者为研究对象，根据术后标准骨盆正位片测量旋转中心垂直上移距离（ΔH），将患者分为3组：ΔH1组（ΔH<5 mm，34例），ΔH2组（ΔH 5～<10 mm，29例），ΔH3组（ΔH≥10 mm，19例）。比较3组术前、术后3个月、术后6个月、术后12个月的Harris评分（HHS）、伯格平衡量表（BBS）评分、视觉模拟评分法（VAS）评分及Trendelenburg征阳性率；比较3组术后12个月患侧与健侧臼杯前倾角、外展角、偏心距的差异，以及假体松动、脱位、髂腰肌撞击等不良事件的发生情况。结果 术前、术后3个月、术后6个月、术后12个月HHS、BBS、VAS评分比较，结果 ①不同时间点的HHS、BBS、VAS评分比较，差异均有统计学意义（P <0.05）；②ΔH1组、ΔH2组和ΔH3组的HHS、BBS、VAS评分比较，差异均有统计学意义（P <0.05）；③3组的HHS评分变化趋势比较，差异有统计学意义（P <0.05）。3组术后3、6、12个月Trendelenburg征阳性率比较，差异均有统计学意义（P <0.05）；ΔH3组术后12个月Trendelenburg征阳性率均高于ΔH1组和ΔH2组，术后3个月、6个月Trendelenburg征阳性率均高于ΔH1组（P <0.05）。3组术后12个月患者患侧与健侧臼杯前倾角、臼杯外展角、偏心距的差值比较，差异均有统计学意义（P <0.05）；ΔH1组患侧与健侧臼杯前倾角的差值均小于ΔH2组和ΔH3组（P <0.05），臼杯外展角和偏心距的差值均小于ΔH3组（P <0.05）；ΔH2组患侧与健侧臼杯前倾角、臼杯外展角、偏心距的差值均小于ΔH3组（P <0.05）。ΔH3组不良事件总发生率均高于ΔH1组和ΔH2组（P <0.0125）。结论 髋关节旋转中心位置的合理调整对Crowe Ⅳ型DDH患者的全髋关节置换术后关节功能恢复具有重要影响。适度调整旋转中心位置可显著提高术后髋关节功能，且安全性较高，上移幅度<10 mm时效果更佳。这一调整策略对临床改善患者的关节功能及减少并发症具有积极作用。

Abstract:

Objective To investigate the effect of different hip rotation center positions on functional recovery in Crowe type IV developmental dysplasia of the hip (DDH) patients after total hip arthroplasty (THA).Methods A retrospective analysis was conducted on 82 Crowe type IV developmental dysplasia of the hip (DDH) patients who underwent THA at Tangshan People's Hospital from January 2019 to March 2024. Based on postoperative anteroposterior pelvic radiographs, patients were divided into three groups according to the vertical superior displacement (ΔH) of the rotation center: ΔH1 group (ΔH < 5 mm, n = 34), ΔH2 group (5 mm ≤ ΔH < 10 mm, n = 29), and ΔH3 group (ΔH ≥ 10 mm, n = 19). Hip function [Harris Hip Score (HHS) ], balance ability [Berg Balance Scale (BBS) ], pain level [Visual Analogue Scale (VAS) ], and Trendelenburg sign positivity rate were compared among the three groups preoperatively and at 3, 6, and 12 months postoperatively. Additionally, differences in cup anteversion, abduction angle, offset between the operated and healthy sides, and complications (prosthesis loosening, dislocation, iliopsoas impingement) were evaluated at 12 months postoperatively.Results Significant differences were observed in HHS, BBS, and VAS scores at preoperative, 3-month, 6-month, and 12-month postoperative intervals (P < 0.05). Comparative analysis among ΔH1, ΔH2, and ΔH3 groups revealed statistically significant differences in HHS, BBS, and VAS scores (P < 0.05), with distinct variation trends in HHS scores across groups (P < 0.05). The Trendelenburg sign positive rates demonstrated significant differences among ΔH1, ΔH2, and ΔH3 groups at 3-month, 6-month, and 12-month follow-ups (P < 0.05). Specifically, ΔH3 group exhibited higher Trendelenburg sign positivity at 12 months compared to ΔH1 and ΔH2 groups (P < 0.05), and at 3 month and 6 month intervals compared to ΔH1 group (P < 0.05). Cup orientation measurements showed significant intergroup differences in discrepancies between operated and healthy sides for anteversion angle, abduction angle, and offset at 12 months postoperation (P < 0.05). The ΔH1 group demonstrated smaller anteversion discrepancies than both ΔH2 and ΔH3 groups (P < 0.05), and smaller abduction/offset discrepancies than ΔH3 group (P < 0.05). The ΔH2 group showed significantly smaller discrepancies in all three parameters compared to ΔH3 group (P < 0.05). Adverse event analysis revealed significant differences in overall incidence among groups (P < 0.05), with ΔH3 group showing higher rates than both ΔH1 and ΔH2 groups (P < 0.0125 after Bonferroni correction).Conclusion Optimal adjustment of the hip rotation center significantly improves functional outcomes in Crowe type IV DDH patients after THA. A superior displacement of <10 mm yields better hip function and lower complication rates, supporting its clinical utility in enhancing recovery and reducing adverse events.