Synergy生物型股骨柄与正常人股骨髓腔匹配度的评估

Evaluation of matching degree between Synergy biological femoral stems and femoral medullary cavity of normal adults

目的探讨2款Synergy生物型股骨柄与正常股骨髓腔的匹配情况,为全髋关节置换术假体选择与改进提供参考。方法从2010年2月至2010年8月北京积水潭医院矫形骨科行单侧全髋关节置换的成年患者中,选取30例对侧股骨结构正常的患者纳入研究。30例入选者均拍摄标准的股骨正、侧位X线,采用Synergy selectⅡ及selectⅡRF股骨柄2款模板进行测量,将测量得到的数据分别对应列入selectⅡ组及RF组,每款模板有10种型号(7~16号)可供选择,分别从selectⅡ及selectⅡRF股骨柄的模板中选取最合适的样本,每组均获得30个样本。观察2组生物型股骨柄假体的型号、偏距、高度、假体长度、贴合率以及匹配优势。结果 2组型号为11的样本均占多数,型号为10、12的数量相当,9号较少。selectⅡ组与RF组中模板股骨柄的平均偏距分别应减小3.0、4.3 mm,模板偏距过大可能是拍摄正位X线时股骨的旋转所致。2组生物型股骨柄假体的垂直高度、长度均合适。selectⅡ组与RF组样本正位X线贴合率最差的为D点(53.33%vs 50.00%),侧位X线贴合率最差的为J点(23.33%vs 26.67%)。selectⅡ组模板在D、E、F、K点的匹配优势较大,但差异无统计学意义(P均>0.05);RF组模板在C、G点的匹配优势较大,但差异亦无统计学意义(P均>0.05)。结论 2款Synergy生物型股骨柄均有改进的可能,selectⅡ股骨柄在干骺端内侧与股骨髓腔匹配优于selectⅡRF,但水平偏距与垂直高度稍差。

Objective To explore the matching degree between two kinds of Synergy biological femoral stems and femoral medullary cavity of normal adults,in order to provide a reference for prosthesis selection and prosthesis design improvement. Methods From February 2010 to August 2010,30 patients who had unilateral total hip arthroplasty with normal contralateral femur from Beijing Jishuitan Hospital were included to be researched. These patients were taken standard anteroposterior and lateral radiographs. With the templates of Synergy select Ⅱ and select Ⅱ RF biological femoral stems,the matching degrees between the templates and femoral medullary canals were measured and evaluated. There were 10 sizes for each kind of the templates,the optimum size of templates was selected for every sample. The size,offset,height,length and matching degrees were observed and evaluated for each of the patients. Results Two kinds of Synergy models of 11 samples were in majority,the model number 10,12 and other models were less. The average offset of select Ⅱ group and RF group respectively in the femoral stem template should be reduced 3. 0 and 4. 3 mm,template offset was too large,may be considered shooting X-ray films of femur caused by rotation. It was suitable of the vertical height and length of the two groups. The select Ⅱ group and the RF group had the best X-ray film attachment rate of D points（ 53. 33% vs 50%）,and the worst X-ray attachment rate were J points（ 23. 33% vs 26. 67%）. The select Ⅱgroup template had better matching in D,E,F and K points,but the differences were not statistically significant（ all P 〉0. 05）. In group RF,template matching advantags in the C and G spot were larger,but the difference was not statistically significant（ all P 〉0. 05）. Conclusion There is still room for improvement for both of the Synergy biological femoral stems. Select Ⅱ has a better matching degree in the medial metaphyseal part than select Ⅱ RF but a worse matching degree in horizontal offset and vertical height.