髋臼杯的外展角和前倾角与全髋置换术后脱位的关系

福建医科大学

硕士学位论文

髋臼杯的外展角和前倾角与全髋置换术后脱位的关系

姓名：吴重祥

申请学位级别：硕士

专业：外科学（骨外）

指导教师：吴珊鹏

2011-03

髋臼杯的外展角和前倾角与全髋置换术后脱位的关系

硕士研究生：吴重祥

导 师：吴珊鹏 教授

中文摘要

目的：研究髋臼杯的外展角和前倾角与全髋置换术后脱位的关系，探讨合适的髋臼杯外展角和前倾角的角度范围，为临床实践提供理论依据。

材料与方法：收集我院2000年-2010年行人工全髋关节置换术的病例共30例（34髋）作为本次研究对象。男性18例（20髋），女性12例（14髋）；年龄23-85岁，平均为58岁；髋关节骨性关节炎15例 （17髋） ， 股骨头无菌性坏死 8例 （10 髋） ， 股骨颈骨折5例 （5髋） ，强直性脊柱炎累及髋关节2例 （2髋） 。运用 X 线片测量了 30 例（34 髋）的髋臼杯的外展角和前倾角，比较脱位组和未脱位组的外展角和前倾角的差别有没有统计学意义。本研究以外展角≤50°,前倾角≤20°作为正常标准，将外展角设定为两组：①≤50°②>50°；前倾角设定为两组：①≤20°②>20°；分析以上 2 个因素与术后髋关节脱位的关系，并进行统计学处理，P＜0.05差异有统计学意义。

结果：全部患者均获得 3 个月～30个月，平均 20个月的随访。X线片显示所有假体均获得理想的骨性固定，无1 例假体松动。 30 例（34 髋）中，出现 4例（4髋）脱位，脱位率为11.8%（4/34） ，这 4 例脱位均发生在术后 6 周内，全部为后脱位，1 例出现再次脱位。全部经闭合复位+石膏外固定 6周获得稳定，脱位组的外展角平均 55.59°±5.87°，非脱位组为 42.78°±3.87°，两组之间外展角有显著差异（P＜0.05） ；脱位组前倾角平均 25.64°±5.42°， 非脱位组为 14.60°±4.28°，两组之间前倾角亦有显著差异（P＜0.05）。外展角在≤50°、>50°不同范围内的脱位率有显著性差异（P＜0.05） ；前倾角在≤20°、>20°不同范围内的脱位率有显著性差异（P＜0.05） 。

结论：

1.髋臼杯的外展角和前倾角与全髋置换术后脱位关系密切，髋臼杯的外展角和前倾角对于全髋关节置换术前规划、术中引导、术后评估和康复指导具有重要意义

2.临床上应尽量避免髋臼杯放置不当，保持外展角35°-50°以及前倾角5°-20°范围之间可提供较稳定的人工髋关节，明显降低术后脱位的发生率。

关键词：全髋关节置换术 髋臼杯 外展角 前倾角 术后 脱位

The relationship of the abduction angle and anteversion angle of the acetabular cup with dislocation after total hip cup

arthroplasty

Postgraduate：Wu Chongxiang

Tutor：Professor Wu Shanpeng

Abstract

Objective To study the relationship of the abduction angle and anteversion angle of the acetabular cup with dislocation after total hip arthroplasty.Exploring appropriate angle range of the abduction angle and anteversion angle of the acetabular cup,which provide theoretical basis for clinical practice.

Methods From 2000 to 2010 ，30 patients (34 hips)were performed with total hip replacement in our hospital. Collect these cases as the research subject. There were 18 men and 12 women.The average age of the 30 patients in this series was 58 years(range,23～85 years). The preoperative diagnosis for each of the patients was osteoarthritis in 15 patients(17 hips),osteonecrosis in 8 patients (10 hips), femoral neck fracture in 5 patients (5 hips), ankylosing spondylitis in 2 patients （2hips）.The standardized anteroposterior radiographs of the hip and the cross-table lateral film of the hip were used for measuring of the abduction angle and the anteversion angle.This study set abduction angle less than 50°and anteversion angle less than 20°as normal. The abduction angle was divided into two groups , one group was less or equal to 50°;another group was greater than 50°.The anteversion angle was also divided into two groups , one group was less or equal to 20°;another group was greater than 20°.The results were statistically analyzed ,with a P value less than 0.05 indicating significant difference.

Results All the patients were followed up with an average of 20 months(range 3 months～30 months). Of the 30 patients（34 hips）, there were 4 dislocations, the dislocation rate was 11.8%.All the hip dislocations occurred within the first 6 weeks after operation.And only posterior dislocation was occurred in this group. Recurrent dislocation occurred once in anthor one patient with 2 months after reduction.Closed reduction and the hip cast lasted 6 weeks were selected for all these