组配式与非组配式股骨假体全髋关节置换术治疗Crowe Ⅱ型髋关节发育不良的对比研究

Comparative study between modular and non-moudular femoral stems used in total hip arthroplasty for treating Crowe Type Ⅱ developmental dysplasia of the hip

背景:CroweⅡ型髋关节发育不良(DDH)患者的股骨侧重建采用组配式或非组配式假体均可,目前尚无相关研究对比两种假体的临床疗效。目的:对比应用组配式S-ROM股骨假体与非组配式Tri-Lock股骨假体行全髋关节置换术(THA)治疗CroweⅡ型DDH的临床疗效。方法:回顾性分析2014年6月至2016年6月行THA治疗的87例CroweⅡ型DDH患者的临床资料。根据股骨假体类型分为两组:组配组42例,采用S-ROM假体;非组配组45例,采用Tri-Lock假体。比较两组的手术时间、术中出血量、围手术期并发症发生率、术后住院时间、双下肢不等长发生率及末次随访Harris评分是否存在差异。结果:围手术期并发症发生率、术后住院时间、末次随访Harris评分两组比较差异均无统计学意义。组配组手术时间为60~175 min,平均(97±25)min,非组配组为55~150 min,平均(87±20)min,差异有统计学意义(P<0.05)。组配组术中出血量200~1450ml,平均(568±258)ml,非组配组为200~1100ml,平均(469±168)ml,差异有统计学意义(P<0.05)。组配组和非组配组双下肢不等长的发生率分别为45.2%(19/42)和24.4%(11/45),差异有统计学意义(P<0.05)。结论:应用组配式S-ROM股骨假体或非组配式Tri-Lock股骨假体行THA治疗CroweⅡ型DDH均可取得良好的临床疗效。应用非组配式Tri-Lock假体THA的手术时间更短,术中出血量更少,双下肢肢体长度平衡效果更好。

Background:Both modular and non-modular femoral stems can be used in the femoral reconstruction in the patients with CroweⅡdevelopmental dysplasia of the hip,but there is a paucity of literature comparing the clinical results of the two different type stems.Objective:To compare the curative effects of modular S-ROM femoral stem and non-modular TriLock femoral stem used in total hip arthroplasty for treating CroweⅡdevelopmental dysplasia of the hip.Methods:Retrospective study was conducted in 87 patients undergoing total hip arthroplasty for the treatment of CroweⅡdevelopmental dysplasia of the hip between June 2014 and June 2016.All patients were divided into two groups depending on the type of femoral prosthesis used,including 42 patients using S-ROM prosthesis in the modular group and 45 patients using Tri-lock femoral stems in the non-modular group.The operative time,intraoperative blood loss,perioperative complication rate,duration of postoperative hospitalization,the incidence of leg length discrepancy and postoperative Harris scores recorded at the last follow-up visit were compared between the two groups.Results:There was no significant difference in perioperative complication rate,the duration of postoperative hospitalization and Harris scores at the last follow-up visit between the two groups.The operative time was 60-175 min,with an average of(97±25)min in the modular group and 55-150 min,with an average of(87±20)min in the non-modular group,and there was a significant difference between the two groups(P<0.05).The intraoperative blood loss was 200-1450 ml,with an average of(568±258)ml in the modular group,and 200-1100 ml,with an average of(469±168)ml in the non-modular group,and there was significant difference between the two groups(P<0.05).The incidences of leg length discrepancy in the modular and the non-modular groups were 45.2%(19/42)and 24.4%(11/45),respectively,and the difference between the two groups was statistically significant(P<0.05).Conclusions:The applications of both the modular S-ROM and non-modular Tri-Lock femoral stems in total hip arthroplasty for the treatment of CroweⅡdevelopmental dysplasia of the hip have good clinical efficacy.Compared to the modular S-ROM stems,non-modular Tri-Lock stems can save the operative time,reduce intraoperative blood loss and balance the length of the lower limbs more accurately.