Changes in Alignment of Ipsilateral Knee on Computed Tomography after Total Hip Arthroplasty for Developmental Dysplasia of the Hip
Changes in Alignment of Ipsilateral Knee on Computed Tomography after Total Hip Arthroplasty for Developmental Dysplasia of the Hip
复制标题
发育性髋关节发育不良全髋关节置换术后计算机断层扫描同侧膝关节排列的变化
DOI：
10.1111/os.12462
复制
发表时间：
2019-06-01
影响因子：
2.1
通讯作者：
Mao, Yuan-qing
中科院分区：
文献类型：
--
作者：
Yu, De-gang;Zhang, Jing-wei;Mao, Yuan-qing
目的 评估发育性髋关节发育不良（DDH）患者全髋关节置换术（THA）后同侧膝关节线位的变化。方法 2008年2月至12月期间接受THA治疗的34例DDH患者（38髋）纳入研究：男4例，女30例，平均年龄56.2岁。根据Crowe分级，I级11例，II级12例，III级9例，IV级6例。术前和最后一次随访时，对髂前上棘至胫骨结节进行计算机断层扫描。通过计算机断层扫描测量股骨前倾角、腿延长和膝关节对齐，包括髌骨倾斜角、外侧髌骨位移和胫股骨旋转角，并分析它们之间的关系。结果平均随访时间为51.5个月（范围39-70个月）。无术中骨折，随访期间无感染发生。一名患者出现深静脉血栓，另一名患者出现股神经麻痹。术前平均 Harris 髋关节评分为 48.9 +/- 7.5，末次随访时改善至 91.2 +/- 8.3 (P < 0.001)。所有臀部均无假体松动迹象。术后，下肢平均延长为26.08 +/- 21.81 mm（P < 0.001），股骨前倾角降低9.03°+/- 12.80°（P < 0.001），髌骨倾斜、髌骨外侧移位和胫股旋转增加3.58°+/- 4.96°（P < 0.001）、1.78分别为 +/- 3.36 毫米 (P = 0.002) 和 2.56 度 +/- 3.37 度 (P < 0.001)。术后髌骨倾斜度和外侧髌骨位移的增加与股骨前倾角的减小呈显着线性关系（分别为r = 0.621，P < 0.001和r = 0.437，P = 0.0037）。这些结果表明，随着股骨前倾角的减小，髌股排列会发生更大的变化。术后胫骨外旋增加与下肢延长（r = 0.34，P = 0.037）和股骨前倾角减少（r = 0.693，P < 0.001）呈显着正线性关系。这些结果表明，胫骨近端的外旋会随着腿的延长或股骨前倾角的减小而增加。术后髌骨倾斜度和外侧髌骨位移的变化与下肢延长没有显着的线性关系（分别为P = 0.795和P = 0.082）。结论 DDH全髋关节置换术可引起同侧髌股关节和胫股关节的排列变化，髌骨倾斜和位移增加，胫骨外旋增加。这些继发性改变在术后中期随访中仍然存在，对于DDH患者在THA期间应考虑到这一点。需要长期随访来评估膝关节的长期变化。
Objective To assess the changes in alignment of ipsilateral knee joint after total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH). Methods Thirty-four patients with DDH (38 hips) who underwent THA between February and December 2008 were included in the study: 4 men and 30 women with a mean age of 56.2 years. According to Crowe classification, 11 patients were grade I, 12 were grade II, 9 were grade III, and 6 were grade IV. Computed tomography scans were performed from the anterior superior iliac spine to the tibial tubercle before surgery and at last follow-up. Femoral anteversion angle, leg lengthening, and knee alignment, including patellar tilt angle, lateral patellar displacement, and tibiofemoral rotation angle, were measured on computed tomography scans, and their relationships were analyzed. Results The mean follow-up period was 51.5 months (range, 39-70 months). There were no intraoperative fractures, and no infections occurred during the follow-up period. One patient developed deep venous thrombosis and another suffered from femoral nerve palsy. The mean preoperative Harris Hip Score was 48.9 +/- 7.5 and improved to 91.2 +/- 8.3 by the last follow-up (P < 0.001). There was no sign of prosthetic loosening in all hips. Postoperatively, mean leg lengthening was 26.08 +/- 21.81 mm (P < 0.001), femoral anteversion decreased 9.03 degrees +/- 12.80 degrees (P < 0.001), and patellar tilt, lateral patellar displacement, and tibiofemoral rotation increased by 3.58 degrees +/- 4.96 degrees (P < 0.001), 1.78 +/- 3.36 mm (P = 0.002), and 2.56 degrees +/- 3.37 degrees (P < 0.001), respectively. Postoperative increase in patellar tilt and lateral patellar displacement had significant linear relationships with the decrease in femoral anteversion (r = 0.621, P < 0.001 and r = 0.437, P = 0.0037, respectively). These results revealed that patellofemoral alignment would change more with the decrease in femoral anteversion. Postoperative increase in external rotation of the tibia had significant positive linear relationships with leg lengthening (r = 0.34, P = 0.037) and the decrease in femoral anteversion (r = 0.693, P < 0.001). These results revealed that the external rotation of the proximal tibia would increase with the leg lengthening or the decrease of femoral anteversion. Postoperative changes in patellar tilt and lateral patellar displacement had no significant linear relationships with leg lengthening (P = 0.795 and P = 0.082, respectively). Conclusions Total hip arthroplasty for DDH could induce changes in alignment of ipsilateral patellofemoral and tibiofemoral joints, with increases in patellar tilt and displacement, and increases in external rotation of the tibia. These secondary alterations still existed at medium-term follow-up after surgery, which should be considered during THA for patients with DDH. Extended follow-up is necessary to evaluate long-term changes in the knee joint.