■软组织张力与全髋关节置换术(THA)患者术后髋关节脱位密切相关,特别是对于那些神经系统疾病和肌肉紧张不足的患者。这项研究的目的是探讨肢体延长对神经系统疾病和肌张力不足患者THA后并发症发生率的影响。
■这项回顾性分析检查了患有神经系统疾病的个体,比如缺血性中风和脊髓灰质炎,患者于2015年1月至2021年4月期间在我们的医疗中心接受了初次全髋关节置换术(THA)。人口统计学和基线特征(如年龄、性别,肌肉力量)是从医疗记录中获得的。肢体长度,在术前和术后X线平片上测量髋臼和股骨组件的偏移和位置参数。主要结果是髋关节脱位的发生。次要结果包括其他并发症的发生率和髋关节功能(由Harris评分确定)。分析髋关节脱位的发生与肢体延长的相关性。
■最终分析了258例患者。在35例患者中发现了髋关节脱位(总发生率=13.57%)。肢体长度差异(LLD)超过20mm的患者早期脱位的发生率较低(LLD>20mm的发生率=4.1%,对于LLD10mm-20mm,为12.2%,对于LLD<10mm,为17%)。比值比(OR)为0.206,95%置信区间(CI)为0.058-0.737(比较LLD<10mm和LLD>20mm)。但是,在不同LLD的患者中,晚期脱位的发生率没有差异。此外,其他并发症的总发生率在LLD>20mm的患者中升高(LLD>20mm的发生率=17.58%,LLD10mm-20mm为11.11%,LLD<10mm为3.19%;OR=6.464,95%CI=1.768-23.640)。哈里斯的得分,反映了髋关节功能,随着LLD的增加而逐渐降低。从偏移与位错率的关系来看,发现偏移差异的增加与位错发生率的减少有关(对于偏移差异>10mm,发生率=4.71%,5mm-10mm的偏移差异为12.5%,<5mm的偏移差异为17.20%;OR=0.238,95%CI=0.076-0.742)。此外,偏移差异的增加也带来后期位错的减少。晚期位错的发生率为0%,2.5%和10.8%的偏移差异>10毫米,偏移差异分别为5毫米-10毫米和17.20%的偏移差异。与LDD不同,在不同偏移差异的患者中,其他并发症的发生率相似。此外,本研究未发现偏移差异对髋关节功能的影响.
■不幸的是,虽然增加肢体长度可以部分减少术后早期脱位,对神经系统疾病和肌张力不足的患者晚期脱位的发生率没有影响。此外,超过肢体延长与其他术后并发症和髋关节功能恶化相关。相反,额外的偏移可以降低术后脱位的概率,不会增加其他并发症的发生率。因此,对于术后脱位风险较高的神经系统疾病患者,应推荐具有较低颈-骨干角(较高偏移)的股骨柄.应避免肢体长度的孤立增加。
UNASSIGNED: The soft-tissue tension is closely associated with postoperative hip
dislocation in patients undergoing total hip arthroplasty (THA), especially for those patients with neurological disorders and insufficient muscle tension. The aim of this study is to explore the effect of limb lengthening on the incidence of complications following THA in patients with neurological disorders and insufficient muscle tension.
UNASSIGNED: This retrospective analysis examines individuals with neurological disorders, such as ischemic stroke and poliomyelitis, who underwent primary total hip arthroplasty (THA) at our medical center between January 2015 and April 2021. Demographic and baseline characteristics (such as age, gender, muscle strength) were obtained from medical records. The limb length, offset and the positional parameters of both acetabular and femoral component were measured on pre- and postoperative plain radiograph. The primary outcome was the occurrence of hip
dislocation. The secondary outcome included the incidence of other complications and the hip function (determined by Harris score). The correlation between the occurrence of hip
dislocation and limb lengthening was analyzed.
UNASSIGNED: A total of 258 patients were finally analyzed. The hip dislocations were identified in 35 patients (overall incidence = 13.57%). The incidence of early
dislocation was lower in patients whose limb-length discrepancy (LLD) was over 20 mm (incidence = 4.1% for LLD >20 mm, 12.2% for LLD 10 mm-20 mm and 17% for LLD <10 mm). The odds ratio (OR) was 0.206 and 95% confidence interval (CI) was 0.058-0.737 (compared between LLD <10 mm and LLD >20 mm). But the no difference was identified regarding on the incidence of late dislocation among patients with different LLD. Moreover, the overall incidence of other complications was elevated in patients with LLD >20 mm (incidence = 17.58% for LLD >20 mm, 11.11% for LLD 10 mm-20 mm and 3.19% for LLD <10 mm; OR = 6.464, 95% CI = 1.768-23.640). And the Harris scores, which reflected the hip function, was gradually decreased with the increasing in LLD. In terms of the relationship between the offset and dislocation rate, it was found that increased offset discrepancy was associated with decreased dislocation incidence (incidence = 4.71% for offset discrepancy >10 mm, 12.5% for offset discrepancy 5 mm-10 mm and 17.20% for offset discrepancy <5 mm; OR = 0.238, 95% CI = 0.076-0.742). Furthermore, increased offset discrepancy also bring a reduction in late
dislocation. The incidences of late dislocation were 0%, 2.5% and 10.8% for offset discrepancy >10 mm, offset discrepancy 5 mm-10 mm and 17.20% for offset discrepancy respectively. Different from that of LDD, the incidences of other complications were similar among patients with different offset discrepancy. Besides, no influence of offset discrepancy on the hip function was identified in this study.
UNASSIGNED: Unfortunately, although increasing in limb length could partially reduce early dislocation postoperatively, it could not affect the incidence of late dislocation in those patients with neurological disorders and insufficient muscle tension. Moreover, over limb lengthening was associated with other postoperative complications and worse hip function. Instead, additional offset could reduce the probability of postoperative dislocation, without increasing the incidence of other complications. Therefore, femoral stem with lower cervico-diaphyseal angle (higher offset) should be recommended to patients with neurological disorders who were in high risk of postoperative dislocation. Isolated increasing in limb length should be avoided.