本文選題：髖關節(jié)翻修術(shù) + 雙下肢不等長�。� 參考：《湖北中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:在全髖關節(jié)置換術(shù)(THA)后,雙下肢不等長(LLD)已經(jīng)成為患者不滿意的主要因素,并且是術(shù)后訴訟的主要原因,翻修術(shù)前患者大多存在LLD,糾正LLD也是翻修手術(shù)需要解決的重要問題。我們從髖關節(jié)翻修術(shù)中分析下肢不等長的來源,研究每個因素的可處理性和處理方式,在臨床中以此為參考,更好的做到雙下肢長度的平衡。方法:通過病歷系統(tǒng)及影像學系統(tǒng)收集2014年10月至2016年10月我院病房收治及骨科門診隨訪的THA術(shù)后行髖關節(jié)翻修術(shù)的病例、影像學資料及隨訪資料,并整理分析。根據(jù)預先設定的納入標準、剔除標準篩選研究對象,對納入研究內(nèi)的患者進行定期隨訪,隨訪內(nèi)容主要為髖關節(jié)功能評分及影像學資料。我們將LLD的來源分為髖臼側(cè)、股骨側(cè)和關節(jié)間隙三大部分以及外展角、前傾角、髖臼最下點至淚點連線的垂直距離差、股骨偏心距、FCR(FCR)至經(jīng)大粗隆頂點水平線的垂直距離差,FCR至經(jīng)小粗隆凸點水平線的垂直距離差、經(jīng)髖臼旋轉(zhuǎn)中心(ACR)和FCR倆條水平線的垂直距離差等多個因素及評價指標,然后測量術(shù)前及術(shù)后雙下肢長度總差值以及每個因素的差值,根據(jù)統(tǒng)計數(shù)據(jù)對下肢長度及各因素進行相關分析,髖關節(jié)Harris評分和每個因素采用t檢驗以分析術(shù)前術(shù)后是否有差異。每個因素和雙下肢總差異的術(shù)前術(shù)后差值采用多組線性回歸的統(tǒng)計方法,分析LLD的來源、每個因素所占比例、可處理性以及處理方式。對納入患者根據(jù)自愿原則分為兩組,術(shù)后一周一組運用中醫(yī)“理筋”手法,另一組對照,對兩周后髖關節(jié)Harris評分進行統(tǒng)計分析,評價其臨床療效。結(jié)果:本研究共篩選35例患者,均獲得隨訪,隨訪時間為14-47個月,平均隨訪25.9個月。翻修前Harris評分為12-57分,平均為(36.9±3.2)分。髖關節(jié)Harris評分為72-95分,平均為(90.3±3.5)。翻修前后雙下肢長度總差值統(tǒng)計學比較,差值有顯著性意義。每個部分的各種因素翻修術(shù)前術(shù)后的統(tǒng)計學比較中,外展角和前傾角差異無統(tǒng)計學意義(p0.05),髖臼最下點至淚點連線的垂直距離差、股骨偏心距、FCR至經(jīng)大粗隆頂點水平線的垂直距離差,FCR至經(jīng)小粗隆凸點水平線的距離差具有統(tǒng)計學意義(p0.05),其中股骨側(cè)因素所占比例較其它大(FCR至經(jīng)小粗隆凸點水平線的垂直距離差有27例術(shù)前術(shù)后變化),在每個因素和雙下肢總差異的術(shù)前術(shù)后變化多組線性回歸分析中,股骨側(cè)的FCR至經(jīng)小粗隆中點水平線的垂直距離術(shù)前術(shù)后的差值與雙下肢總差異的術(shù)前術(shù)后差值存在線性關系(t=3.352,p=0.003)。運用中醫(yī)“理筋”手法組12例,對照組13例,兩周后髖關節(jié)Harris評分差異有統(tǒng)計學意義(p0.05)。結(jié)論:我們將LLD的來源分為髖臼側(cè)、股骨側(cè)和關節(jié)間隙三大部分以及多個因素能夠幫助在臨床中有目的的去分析LLD的原因。我們在翻修手術(shù)中為了糾正LLD,主要關注髖臼下緣至淚點連線的垂直距離、股骨偏心距、FCR至經(jīng)小粗隆中點水平線的垂直距離這些主要影響下肢的因素,其中股骨側(cè)因素出現(xiàn)幾率高,可處理性強,可作為調(diào)整下肢長度主要考慮對象。術(shù)后運用中醫(yī)“理筋”手法對髖關節(jié)功能恢復有良好作用。
[Abstract]:Objective: after total hip replacement (THA), the dissatisfaction of the lower limbs (LLD) has become the main factor of dissatisfaction of the patients, and it is the main cause of the postoperative procedure. Most of the patients before the refurbishment of the operation are LLD, and the correction of LLD is an important problem to be solved for the refurbishment operation. The treatment and treatment of each factor can be used as a reference for the balance of the length of the lower extremities. Methods: through the medical records system and the imaging system, the cases, imaging data and follow-up data of the hip arthroplasty after THA from October 2014 to October 2016 in our hospital ward and Department of orthopedics are collected. According to the predefined inclusion criteria, the standard screening subjects were eliminated, and the patients included in the study were followed up regularly. The follow-up contents were mainly the hip function score and the imaging data. We divided the LLD sources into the acetabular side, the femur side and the joint space three most and the abductor angle, the pretilt angle, the acetabulum most The vertical distance difference between the lower point and the tear point line, the femur eccentricity, the vertical distance difference between FCR (FCR) and the horizontal line of the great trochanter, the vertical distance difference between FCR to the horizontal line of the small trochanter point, the vertical distance difference between the acetabular rotation center (ACR) and the horizontal line of the FCR, and the evaluation index, and then measure both the two lower limbs before and after the operation. The total difference of length and the difference of each factor, the correlation analysis of the length and factors of the lower extremities according to the statistical data, the Harris score of the hip joint and the t test for the analysis of whether there were differences before and after the operation. The statistical method of multiple linear regression for the difference between the preoperative and postoperative of each factor and the total difference of the lower limbs was used to analyze the LLD The proportion of each factor, the proportions of each factor, the disposition and the way of treatment. According to the voluntary principle, the patients were divided into two groups according to the voluntary principle. After the one Monday group, the traditional Chinese medicine "tendons" technique was used, and the other group was compared, and the Harris score of the hip joint was statistically analyzed after two weeks. Results: the results of this study were selected in 35 patients. The follow-up time was 14-47 months with an average follow-up of 25.9 months. The Harris score was 12-57 minutes before refurbishment, with an average of (36.9 + 3.2) points. The Harris score of the hip joint was 72-95, the average was (90.3 + 3.5). The difference between the two lower limbs' length was statistically significant before and after the refurbishment. The difference between the various factors of each part refurbished the statistics before and after the operation. In comparison, the difference between the abduction angle and the front tilt angle was not statistically significant (P0.05), the vertical distance difference between the lowest point of the acetabulum to the tear point line, the femur eccentricity, the vertical distance between the FCR to the vertex horizontal line of the great trochanter, and the distance difference between FCR and the horizontal line of the small trochanter point had statistical significance (P0.05), and the proportion of the femur side factors was larger than that of the others. (FCR to 27 cases of preoperative and postoperative changes in the vertical distance difference between the horizontal line of the small trochanter point). In the multiple linear regression analysis of the preoperative and postoperative changes in the total difference between each factor and the lower limbs, the difference value between the FCR to the vertical distance of the femur side to the middle point of the midpoint of the trochanter and the difference between the two lower limbs and the total difference of the lower limbs was on line. T=3.352 (p=0.003). 12 cases and 13 cases in the control group were used in the group of traditional Chinese medicine and 13 cases in the control group. The Harris score of the hip joint was statistically significant (P0.05) after two weeks. Conclusion: we divide the origin of LLD into the acetabular side, the femur side and the joint space, and many factors can help to analyze the cause of LLD in clinical. In order to correct LLD during the refurbishment operation, we mainly focus on the vertical distance from the lower margin of the acetabulum to the tear point line, the femur eccentricity, the vertical distance from the FCR to the midpoint of the midpoint of the trochanter, which mainly affect the lower extremities, among which the side factors of the femur are high, and the treatment is strong, and can be considered as the main object for adjusting the length of the lower extremity. The use of Chinese medicine "tendon reinforcement" has a good effect on the recovery of hip joint function.
【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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