中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (27): 4339-4343.doi: 10.12307/2021.193

• 人工假体 artificial prosthesis • 上一篇    下一篇

首次全髋关节置换后股骨柄尖端与股骨远端皮质撞击的危险因素

张  扬,王大赛,王  强   

  1. 1皖南医学院附属弋矶山医院,安徽省芜湖市   241000 ;2皖南医学院第一附属医院关节骨科,安徽省芜湖市   241000
  • 收稿日期:2020-10-14 修回日期:2020-10-17 接受日期:2020-11-26 出版日期:2021-09-28 发布日期:2021-04-10
  • 通讯作者: 王强,博士,主任医师,皖南医学院第一附属医院关节骨科,安徽省芜湖市 241000
  • 作者简介:张扬,男,1995年生,浙江省绍兴市人,汉族,皖南医学院在读硕士,主要从事关节骨科方面的研究。

Risk factors for impingement between the femoral stem tip and the distal femoral cortex after first total hip arthroplasty

Zhang Yang, Wang Dasai, Wang Qiang   

  1. 1Yijishan Hospital Affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China; 2Department of Orthopedics, the First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
  • Received:2020-10-14 Revised:2020-10-17 Accepted:2020-11-26 Online:2021-09-28 Published:2021-04-10
  • Contact: Wang Qiang, MD, Chief physician, Department of Orthopedics, the First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
  • About author:Zhang Yang, Master candidate, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China

摘要:

文题释义:
股骨柄:是一种髋关节置换假体,分为骨水泥型和非骨水泥型,此次研究运用的是非骨水泥柄,是一种钛合金,表面覆有致密的生物涂层,耐磨损且适合骨长入,为术后提供较好的稳定性。
皮质撞击:皮质撞击即皮质骨与植入物接触或者被击穿的现象,临床工作中较为常见,是一种严重的术后并发症,如诊断或处理不及时,常易引起术后疼痛甚至假体周围骨折等问题。

背景:随着全髋关节置换的不断开展,医患双方也不断追求着更高质量的修复效果,然而高质量的全髋关节置换不仅需要医者熟练的技术,患者本身股骨构型也存在一定的影响。
目的:分析股骨柄尖端与股骨皮质远端撞击的危险因素,为初次全髋关节置换术前计划提供有效参考。
方法:回顾性分析2018年1月至2020年1月初次行全髋关节置换的160例患者资料,所有手术是由同一位经验丰富的骨科主任医生采用经臀后外侧入路进行的,由2位骨科医生通过医学影像存档与通信系统或Mimics 20.0观察术后髋关节正侧位X射线片或者CT,将股骨柄尖端与股骨远端皮质接触或穿透定义为撞击。其中符合纳入标准的患者139例,男56例,女83例;年龄 26-92 岁,平均(68.1±12.3) 岁。记录患者性别、年龄、身高、体质量、体质量指数、股骨柄长度(全部是LK.LCU型柄)、股骨柄置入角度(股骨柄长轴与股骨干长轴线的夹角)、股骨前弓角度、股骨外侧弓角度及股骨髓腔类型,并对上述数据进行差异分析和逻辑回归(Logistics regression)分析。
结果与结论:①139例初次全髋关节置换患者中,32例出现撞击(撞击率23%),其中男6例,女26例;年龄46-85岁,平均(68.13±10.90)岁;体质量指数(22.48±3.39) kg/m2;②回归分析提示与股骨远端皮质撞击有关的因素包括性别(P=0.036)、身高(P=0.018)、假体置入角度(P=0.047)、股骨前弓角度(P=0.000)及股骨外侧弓角度(P=0.003);③提示身材较矮、股骨前弓角度及股骨外侧弓角度较大的女性患者或者股骨假体置入角度过大者,容易导致股骨柄尖端与股骨皮质撞击。
https://orcid.org/0000-0001-9618-9781 (张扬) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 全髋关节置换, 股骨柄, 股骨弓角度, 假体置入角度, 撞击

Abstract: BACKGROUND: With the continuous development of total hip arthroplasty, both doctors and patients are constantly pursuing higher quality surgical results. However, high-quality total hip arthroplasty not only requires the skilled skills of the doctor, but also has a certain impact on the femoral configuration of the patient.  
OBJECTIVE: To analyze the risk factors of the impingement between the femoral stem tip and the distal femoral cortex, so as to provide effective references for preoperative planning of total hip arthroplasty.
METHODS:  A retrospective analysis was performed in data of 160 patients of primary total hip arthroplasty from January 2018 to January 2020. All surgeries were conducted by an experienced director of orthopedic surgeon using the buttock posterolateral approach. Postoperative anteroposterior and lateral X-ray images or CT images were observed by two orthopedic surgeons via medical image archiving and communication system or Mimics 20.0. The femoral handle sophisticated and distal femoral cortical contact or penetration was defined as the impact. There were 139 patients, including 56 males and 83 females, with a mean age of (68.1±12.3) years (range, 26-92 years). The gender, age, height, body mass, body mass index and femoral stem length (all LK.LCU stem), femoral stem insertion angle (the angle between the long axis of femoral stem and the long axis of femoral stem), femoral anterior arch angle, femoral lateral arch angle and femoral medullary cavity type were recorded. Above data were analyzed by difference analysis and Logistic regression analysis.  
RESULTS AND CONCLUSION: (1) Among the 139 patients undergoing primary total hip arthroplasty, 32 (23%) had impact, including 6 males and 26 females. The average age was (68.13±10.90) years old (range, 46-85 years); body mass index (22.48±3.39) kg/m2. (2) Regression analysis suggested that factors associated with distal femoral cortical impingement included gender (P=0.036), height (P=0.018), implant angle (P=0.047), anterior femoral arch angle (P=0.000), and lateral femoral arch angle (P=0.003). (3) It is concluded that female patients with short stature, large angle of anterior femoral arch and lateral femoral arch or excessively large angle of femoral prosthesis implantation are likely to cause the femoral stalk tip impingement with the femoral cortex.

Key words: total hip arthroplasty, femoral stem, femoral arch angle, implant angle, impingement

中图分类号: