组配式与一体式股骨假体联合转子下短缩截骨治疗Crowe Ⅳ型DDH的疗效比较

Effectiveness Comparison of Modular and Monoblock Femoral Prosthesis with Subtrochanteric Shortening Osteotomy in CroweType Ⅳ Developmental Dysplasia of the Hip

目的对比应用组配式S-ROM股骨假体与一体式Wagner Cone股骨假体联合转子下短缩截骨行全髋关节置换术(total hip arthroplasty,THA)治疗Crowe Ⅳ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者的临床疗效。方法回顾性分析2014年1月至2018年8月行THA治疗的58例(65髋)Crowe Ⅳ型DDH患者的临床资料,其中33例(37髋)使用组配式S-ROM假体,25例(28髋)使用一体式Wagner cone假体,记录两组患者的一般资料,手术时间,术中出血量,术后住院时间,截骨端愈合时间,手术前后Harris评分、VAS评分和相关并发症发生情况并进行分析。结果围手术期并发症发生率、术后住院时间、末次随访Harris评分及VAS评分两组比较差异无统计学意义。组配式S-ROM假体组与一体式Wagner cone假体组,手术时间分别为(135.7±16.2)min和(113.3±13.0)min,术中出血量分别为(469.7±73.6)mL和(410.4±69.6)mL,组间比较差异有统计学意义(P <0.05)。Wagner cone假体组愈合时间(5.8±1.5)月较组配式S-ROM假体组愈合时间(4.7±1.2)月延长,差异有统计学意义(P <0.05)。结论应用组配式S-ROM假体与一体式Wagner cone假体联合股骨转子下短缩截骨行THA治疗CroweⅣ型DDH均可获得良好的临床疗效。采用一体式Wagner Cone假体手术时间更短,术中出血量更少,采用组配式S-ROM假体截骨端愈合时间相对更短。

Objective To compare the clinical efficacy of modular S-ROM femoral prosthesis and monoblock Wagner Cone femoral prosthesis used in total hip arthroplasty for the treatment of Crowe typeⅣdevelopmental dysplasia of the hip.Methods Retrospective study was conducted in 58 patients(65 hips)undergoing total hip arthroplasty for the treatment of Crowe typeⅣdevelopmental dysplasia of the hip between January 2014 to August 2018,including 33 patients(37 hips)with modular S-ROM prosthesis and 25 patients(27 hips)with monoblock Wagner Cone prosthesis.The general data,operative time,intraoperative blood loss during the postoperative hospitalization,bone union time,Harris score,VAS score and perioperative complication rate were compared between the two groups.Results There was no significant difference in the perioperative complication rate during the postoperative hospitalization,Harris score and VAS score in the last follow-up between the two groups.The operative time was(135.7 perat)min in the S-ROM group and(113.3 n the)min in the Wagner Cone group,and there was a significant difference between the two groups(P<0.05).The intraoperative blood loss was(469.7±43.6)ml in the S-ROM group and(410.4 rence) between the two groups and there was a significant difference between the two groups(P<0.05).The bone healing time of Wagner Cone group was significantly longer than that of S-ROM group(P<0.05).Conclusion The application of both the modular S-ROM andmonoblock Wagner Cone femoral prosthesis with subtrochanteric shortening osteotomy in total hip arthroplasty for the treatment of Crowe typeⅣdevelopmental dysplasia of the hip has a good clinical efficacy.The monoblock Wagner Cone prosthesis has the shorter operative time and less intraoperative blood loss,and the modular S-ROM prosthesis has shorter bone healing time.