髋臼假体安装位置与无菌性松动的相关分析△

Correlation between position of acetabular component placed and aseptic loosening

摘要:

［目的］探讨髋臼假体安放位置与假体松动的相关性。［方法］回顾性分析 2010 年 9 月—2017 年 3 月采用改良 Har- dinge 入路初次全髋关节置换术符合纳入排除标准 136 例患者的临床资料，患者均顺利手术，随访 20 个月以上，按是否发生松动将患者分为两组，采用单因素分析和二元多因素逻辑分析假体松动的相关因素。［结果］ 末次随访时，136 患者中确诊为假体松动共 32 例，占 23.53%，其中单纯髋臼假体松动 28 例，合并股骨假体松动 4 例。单项因素比较表明：松动组的年龄显著大于非松动组 （P<0.05）；松动组的髋臼外展角、双侧偏心距差值、髋臼外展角异常率、偏心距异常率均显著大于非松动组 （P<0.05）；两组性别构成、BMI、髋臼前倾角和前倾角异常率的差异均无统计学意义 （P>0.05）；逻辑回归表明：高龄 （OR= 0.248，P<0.05）、偏心距异常 （OR=0.159，P<0.05）、外展角过大 （OR=0.366，P<0.05）、外展角异常 （OR=0.021，P<0.05） 是假体松动的独立危险因素。［结论］THA 中髋臼假体位置不良与无菌性松动发生相关，术中尽量将外展角及偏心距置于安全范围内，有利于降低无菌性松动发生率。

Abstract:

[Objective] To explore the correlation between the placement of acetabular prosthesis and prosthesis loosening. [Methods] A retrospective study was conducted on 136 patients who underwent primary total hip arthroplasty through modified Hardinge approach in our hospital from September 2010 to March 2017. After follow-up more than 20 months, the patients were divided into two groups accord- ing to whether the prosthetic loosening happened or not. The univariate comparison and binary multiple logistic regression were done to ex- plore the factors related to prosthetic loosening. [Results] At the latest follow-up, 32 of the 136 patients were diagnosed of prosthetic loos- ening, accounting for 23.53%. Among them, 28 patients were acetabular prosthesis loosening only, and 4 patients were combined acetabu- lar and femoral prosthetic loosening. In term of univariate comparison, the loosened group was significantly older than the non-loosening group (P＜0.05) , in addition the former had significantly greater acetabular abduction angle, bilateral difference of offset, abnormal ratio of acetabular abduction angle and abnormal ratio of bilateral difference of offset than the latter (P＜0.05) . However, there was no significant difference between the two groups in gender composition, BMI, acetabular anteversion angle and abnormal ratio of anteversion angle (P＞ 0.05) . As results of logistic regression, the advanced age (OR=0.248, P＜0.05) , abnormal offset (OR=0.159, P＜0.05) , excessive acetabular abduction angle (OR=0.366, P＜0.05) , and abnormal acetabular abduction angle (OR=0.021, P＜0.05) were the independent risk factor for prosthetic loosening. [Conclusion] Poor positioning of the acetabular prosthesis in THA is related to aseptic loosening. During the opera- tion, the abduction angle and prosthetic offset should be kept in a safe range, which will be beneficial to reduce the incidence of aseptic loosening.