全髋关节置换术中不同颈干角股骨假体对股骨近端解剖重建的比较研究

COMPARISON OF PROSTHESIS WITH DIFFERENT NECK-SHAFT ANGLES FOR RECONSTRUCTION OF FEMORAL PROXIMAL ANATOMY AFTER TOTAL HIP ARTHROPLASTY

目的比较全髋关节置换术（total hip arthroplasty,THA）中不同颈干角股骨假体对股骨近端解剖重建的影响及早期临床效果。方法回顾分析2012年1月-2013年12月收治的符合选择标准的101例行单侧THA患者临床资料,根据术中使用不同颈干角股骨假体将患者分为A、B组,A组52例使用颈干角为135°的股骨柄,B组49例使用颈干角为127°的股骨柄。两组患者性别、年龄、体质量、体质量指数、病因、病程及术前股骨颈干角、双下肢长度差、术前髋关节Harris评分等一般资料比较,差异均无统计学意义（P〉0.05）。术后行Harris评分评价临床疗效;测量术后健侧和术侧股骨偏心距、术后术侧股骨偏心距相对于健侧变化值（x FO）、该变化值与健侧股骨偏心距的比值（sd FO）、计数sd FO〉15%或〈—15%患者例数（即离群者）、全局偏心距、股骨头旋转中心高度、术后双下肢长度差等。结果术后两组患者切口均Ⅰ期愈合;无感染及假体脱位、翻修等并发症发生。两组患者均获随访,随访时间12~32个月,平均23个月。末次随访时A、B组Harris评分均较术前显著改善（P〈0.05）,但A、B组间比较差异无统计学意义（t=1.267,P=0.832）。B组x FO和sd FO均显著大于A组（P〈0.05）;A组离群者20例,B组33例,差异有统计学意义（P=0.005）。两组术后3个月股骨头旋转中心高度、全局偏心距比较差异均无统计学意义（P〉0.05）。术后3个月两组双下肢长度差均较术前显著改善（P〈0.05）,但两组间比较差异无统计学意义（t=0.403,P=0.689）。结论在THA中,不同颈干角假体均可较好重建股骨近端解剖,并取得良好的临床效果;127°颈干角股骨假体可能使THA术后股骨偏心距过大。

Objective To compare the short-term effectiveness of femoral prosthesis with different neck-shaft angles for the reconstruction of proximal femoral anatomy after total hip arthroplasty（THA）. Methods Between January 2012 and December 2013, 101 patients undergoing unilateral THA who accorded with selection criteria were selected for a retrospective study. The patients were divided into 2 groups： during THA, femoral prosthesis with 135° neck-shaft angle was used in 52 patients（group A） and femoral prosthesis with 127° neck-shaft angle was used in 49 patients（group B）. There was no significant difference in gender, age, weight, body masss index, pathogeny, disease duration, preoperative neck-shaft angle, leg discrepancy, and preoperative Harris score between 2 groups（P〉0.05）. The postoperative Harris score was recorded to evaluate the effectiveness. And the femoral offset of the operated and contralateral sides, the change value of the femoral offset（x FO）, the ratio of x FO to the offset of contralateral side（sd FO）, the number of patients whose sd FO was more than 15% or less than —15%（outlier）, the global offset, the height of femoral head rotation center, and leg discrepancy were measured at postoperation. Results Operative incision healed by first intension in 2 groups; no complication of infection, dislocation, or revision was found. All patients were followed up 12-32 months（mean, 23 months）. The Harris score at last follow-up were significantly improved when compared with preoperative score in 2 groups（P〈0.05）, but there was no signficant difference between 2 groups（t=1.267, P=0.832）. The x FO and sd FO of group B were significantly larger than those of group A（P〈0.05）; the number of outlier was 20 in group A and was 33 in group B, showing significant difference（P=0.005）. The height of femoral head rotating center and global offset at 3 months after operation showed no signficant difference between 2 groups（P〉0.05）. And significant improvement in leg discrepancy was found at 3 months in 2 groups（P〈0.05）, but there was no significant difference between 2 groups（t=0.403, P=0.689）. Conclusion Both of the two femoral prosthesis with different neck-shaft angles can restore the proximal femoral anatomy well and gain similar early effectiveness after THA. However, the Stryker Trident femoral prosthesis with 127° neck-shaft angle may have the tendency to enlarge the femoral offset.