【摘要】 背景:在正常解剖结构破坏的情况下,利用健侧肢体解剖参数重建患侧是目前的常用方法。然而,这种方法依赖于双侧髋关节解剖参数一致,其是否可行尚缺乏可靠依据。目的:通过对比双侧髋关节解剖参数,研究双侧髋关节对称性及解剖形态变异范围,并测量双髋关节置换术后解剖参数一致性。方法:选取我院2012年1月至2017年12月诊断为骨关节炎、股骨头无菌性坏死行双侧初次全髋关节置换术患者119例(238髋),其中男64例,女55例,年龄55～75岁,平均(59.3±5.3)岁,同期手术61例,分期手术58例,病历资料完整。根据Noble测量方法测量术前股骨近端髓腔解剖参数;测量髋臼外展角及大粗隆高度。测量术后偏心距恢复及双下肢长度差异。结果:除股骨近端峡部宽度双侧对比存在差异外,其余股骨髓腔近端及髋臼外展角等解剖形态差异无统计学意义(P>0.05)。Pearson相关性分析发现,随着体重的增加,双侧颈干角、髓腔闪烁指数(CFI)及大粗隆高度差值逐渐增加;股骨小粗隆中点(T)、T+20 mm及T-20 mm的髓腔宽度存在相关性。分期手术较同期手术更易出现双侧假体柄型号不一致,且双髋置换术后有近1/3的患者存在双下肢不等长。结论:应用健侧形态重建患肢结构是可行的。即使双侧形态一致,术后仍难以达到100%解剖对称。髋关节髓腔形态差异是由多个相邻层面相互协同影响。更多还原

【Abstract】 Background: Preoperative template measurements of the contralateral hip joint morphology are often performed for patients with proximal femoral deformities. However, this method relies on consistent anatomical parameters of the bilateral hip joints. Objective: To investigate the bilateral hip joint symmetry and range of anatomical variations by comparative analysis of bilateral hip joint morphological structures and measurement of anatomical parameters. Methods: A total of 119 patients(238 hips) who were diagnosed with osteoarthritis and avascular necrosis of the femoral head and underwent bilateral primary total hip arthroplasty in our hospital from January 2012 to December 2017 were selected with the mean age of(59.3±5.3) years(range, 55-75) including 64 males and 55 females, 61 patients of simultaneous surgery and 58 patients of staging surgery, with complete image data. Anatomical parameters, including the acetabular abduction angle and trochanteric height, were measured using the Noble method. The eccentric distance and the discrepancy of both lower extremities were measured after the operation. Results: There were no significant differences in the anatomical morphology of the proximal femoral medullary cavity and acetabular abduction angle except for the difference in the isthmus width between the bilateral proximal femurs. Pearson correlation analysis showed that with the body weight increasing, the differences of the bilateral neck-shaft angle, canal flare index(CFI) and trochanteric height increased. Among various anatomical parameters, the correlation was present among medullary cavity widths of T+20 mm, T, and T-20 mm. Compared with the simultaneous surgery, bilateral prothesis stem model discrepancy were found more freqency in staging surgery. After bilateral hip arthroplasty, proximately 1/3 patients had bilateral lower extremities discrepancy. Conclusions:It is feasable for structural reconstruction of the injured hip joint using the hip joint on the uninjured side. Although the consistant bilateral morphology of the hip, the postoperatively complete anatomical symmetry is hard to achieve. Additionally, the difference in the morphology of the hip medullary cavity is not present in a single plane but is synergistically affected by multiple adjacent planes.更多还原