【摘要】：目的:關(guān)節(jié)形態(tài)異常與髖關(guān)節(jié)骨關(guān)節(jié)炎(Osteoarthritis,OA)的發(fā)病具有密切的關(guān)系,其中,髖關(guān)節(jié)發(fā)育不良是髖關(guān)節(jié)OA的一個重要危險因素。如果關(guān)節(jié)發(fā)育不良未經(jīng)或未能良好的糾正,繼發(fā)OA的患病率將明顯高于其他致病因素。有學者指出,關(guān)節(jié)發(fā)育不良繼發(fā)髖關(guān)節(jié)OA的發(fā)病年齡較原發(fā)性髖關(guān)節(jié)OA更年輕,而我們在實際臨床工作中也注意到了這一點。我們希望證實這一現(xiàn)象,并試圖發(fā)現(xiàn)髖關(guān)節(jié)發(fā)育不良患者的中心邊緣角(center-edge angle,CEA)與繼發(fā)OA出現(xiàn)疼痛年齡之間的關(guān)系。方法:病例選取于吉林大學第二醫(yī)院骨科醫(yī)院關(guān)節(jié)外科,2013年11月—2015年12月成年髖關(guān)節(jié)發(fā)育不良繼發(fā)OA患者87例,其中女性75例,男性12例。髖關(guān)節(jié)發(fā)育不良的診斷按Wiberg[1]的描述,即在標準的髖關(guān)節(jié)正位X線片上,至少一側(cè)髖關(guān)節(jié)的CEA25°。而繼發(fā)髖關(guān)節(jié)OA的診斷要依據(jù)患者的疼痛病史,結(jié)合髖關(guān)節(jié)OA的影像學分級方法T?nnis分級[2,3]和Kellgren-Lawrence分級[4],并且排除其他繼發(fā)來源。數(shù)據(jù)整理和分析:(1)按單雙側(cè)和性別統(tǒng)計患髖數(shù)量,將入選患者患髖的CEA和相對應(yīng)的出現(xiàn)疼痛的年齡及就診年齡做統(tǒng)計學描述。(2)將入選患者患髖的CEA與相對應(yīng)的出現(xiàn)疼痛的年齡做相關(guān)性分析。(3)將所有入選患者分組,患髖CEA10°為A組,≥10°為B組,比較兩組患者出現(xiàn)疼痛平均年齡有無統(tǒng)計學差異。(4)同一患者出現(xiàn)疼痛年齡比較,即以所有患者左側(cè)為標準,分別統(tǒng)計左側(cè)CEA小于右側(cè)者、左側(cè)CEA大于右側(cè)者、左側(cè)出現(xiàn)疼痛年齡小于右側(cè)者、左側(cè)出現(xiàn)疼痛年齡大于右側(cè)者的例數(shù),將患者例數(shù)做四格表的統(tǒng)計學分析,比較CEA小的一側(cè)與CEA大的一側(cè)出現(xiàn)疼痛年齡有無差異。結(jié)果:1.我們統(tǒng)計髖關(guān)節(jié)發(fā)育不良原位繼發(fā)OA的髖關(guān)節(jié)共95髖,有疼痛癥狀患者共85髖,占OA患髖數(shù)的89.47%,平均出現(xiàn)疼痛的年齡是46.02±17.37歲。2.將有疼痛癥狀的85髖CEA與對應(yīng)出現(xiàn)疼痛年齡做相關(guān)性分析,結(jié)果顯示,r=0.13,p=0.23,差異無統(tǒng)計學意義。3.AB兩組對比平均出現(xiàn)疼痛年齡結(jié)果顯示,A組(n=50)平均疼痛年齡43.24±12.20,B組(n=35)平均疼痛年齡50.66±14.42,P=0.01,差異有統(tǒng)計學意義。4.以雙側(cè)患病的左側(cè)髖關(guān)節(jié)為準,CEA小于右側(cè)21人,CEA大于右側(cè)26人,左側(cè)先出現(xiàn)疼痛癥狀22人,左側(cè)后出現(xiàn)疼痛癥狀25人,采用四格表x2檢驗,p=0.001,差異有顯著統(tǒng)計學意義。結(jié)論:1.發(fā)育不良的髖關(guān)節(jié)CEA與繼發(fā)OA的發(fā)病年齡并無相關(guān)性,髖關(guān)節(jié)CEA不能單獨作為預(yù)測發(fā)病年齡的指標。2.CEA10°的髖關(guān)節(jié)疼痛年齡小于CEA≥10°的患者,即CEA10°的患者較≥10°的會先出現(xiàn)疼痛癥狀。3.雙側(cè)均繼發(fā)OA的患者,CEA小的一側(cè)先出現(xiàn)疼痛癥狀。
[Abstract]:Objective: there is a close relationship between abnormal joint morphology and hip osteoarthritis (Osteoarthritis,OA). Hip dysplasia is an important risk factor of hip OA. If joint dysplasia is not well corrected, the prevalence of secondary OA is significantly higher than that of other risk factors. Some scholars have pointed out that the onset age of secondary hip OA is younger than that of primary hip OA, and we have noticed this in clinical work. We hope to confirm this phenomenon and try to find a relationship between the central marginal angle (center-edge angle,CEA) and the age of secondary OA pain in patients with dysplasia of the hip. Methods: 87 adult patients with OA secondary to hip dysplasia from November 2013 to December 2015 were selected from Orthopaedic Hospital of Jilin University. Among them 75 cases were female and 12 cases were male. The diagnosis of hip dysplasia is described by Wiberg [1], that is, at least one side of the hip is CEA25 擄on the standard orthographic radiographs. The diagnosis of secondary hip joint OA should be based on the patient's history of pain, combined with the imaging grading of hip joint OA, T?nnis grade [2T3] and Kellgren-Lawrence grade [4], and other secondary sources should be excluded. Data collation and analysis: (1) according to unilateral and bilateral and gender statistics, (2) the correlation analysis between the CEA of the hip and the age of pain was made. (3) all the patients were divided into two groups: the age at which the pain occurred and the age at which the pain occurred. (3) all the patients were divided into two groups: (1) the age of pain in the hip and the age at which the pain occurred. (3) all the patients were divided into two groups. The hip CEA10 擄was group A and 鈮，

本文編號：2250622