基于髋关节数字解剖降低THA术后下肢不等长带刻度股骨髓腔锉和相应股骨柄假体及技术的研发与应用

Development and application of calibrated femoral canal file and corresponding femoral stem prosthesis based on the digital anatomy of the hip joint to reduce the leg length discrepancy after total hip arthroplasty

目的根据髋关节的数字解剖特点研发一种带刻度股骨髓腔锉和相应股骨柄假体及测量方法,探讨其在全髋关节置换手术(THA)中控制下肢长度的效果,并对影响其使用效果的原因进行分析。方法回顾性队列研究。纳入2017年6月—2020年7月山东省千佛山医院行初次单侧THA的患者300例。其中,男154例、女146例,年龄27~86(59.5±11.3)岁。按照术中控制下肢长度的方法进行分组:观察组134例,采用带刻度髓腔锉控制下肢长度;对照组166例,采用徒手方法控制下肢长度。观察指标:(1)比较2组患者性别、身高、术前下肢不等长(LLD)、手术侧别等基线资料。(2)测量和比较2组患者术后LLD的差异,以及LLD的分布情况。(3)比较2组LLD>10 mm患者的占比,分析导致患者术后LLD>10 mm的原因。结果所有患者手术过程顺利,术后切口均为一期愈合。(1)2组患者性别、身高、术前LLD、手术侧别等基线资料比较,差异均无统计学意义(P值均>0.05)。(2)观察组患者术后LLD为4.76(2.98,7.18)mm,对照组为5.85(3.78,8.38)mm,差异有统计学意义(Z=-2.84,P=0.004);观察组患者术后LLD的分布情况优于对照组,差异有统计学意义(Z=3.08,P=0.002)。(3)观察组中有8例(5.97%,8/134)患者术后LLD>10 mm,对照组有24例(14.46%,24/166),差异有统计学意义(χ^(2)=5.61,P=0.018);术后LLD>10 mm原因分析:与假体和患者不匹配有关(观察组3例、对照组4例);与髋臼下缘骨赘增生明显导致克氏针定位偏下有关(观察组5例、对照组3例)。结论在行单侧THA时,使用带刻度股骨髓腔锉相比徒手方法可以更有效地控制术后LLD。而假体不匹配以及术中对髋臼下缘及大转子顶点探查不够准确是影响该方法有效控制LLD的主要原因。

Objective According to the digital anatomical characteristics of the hip joint,a calibrated femoral canal file,and corresponding femoral stem prosthesis and its measuring method are developed.To explore the effect of this technique on controlling the leg length in total hip arthroplasty(THA)and analyze the causes for the results obtained by this method.Methods Retrospective cohort study.A total of 300 patients who underwent the first unilateral THA in Qianfoshan Hospital of Shandong Province from June 2017 to July 2020 were selected.Among them,there were 154 males and 146 females,aged 27-86(59.5±11.3)years old.Patients were divided into groups according to the methods used of controlling their leg length discrepancy(LLD)during the operation:134 patients with calibrated femoral canal files to control leg length were included in the observation group,meanwhile,166 patients with unarmed methods were included in the control group.Observation indicators:(1)the baseline data of equal sex,height,preoperative LLD,and operation side were compared between the two groups.(2)the differences between LLD and the distribution of LLD were measured and compared between the two groups.(3)to compare the proportion of patients with LLD>10 mm in the two groups,and to analyze the causes of postoperative LLD>10 mm.Results All patients completed their primary wound healing.(1)There was no significant difference found in gender,height,preoperative LLD,and operation side between the two groups(all P values>0.05).(2)The postoperative LLD of the observation group was 4.76(2.98,7.18)mm,and that of the control group was 5.85(3.78,8.38)mm,the difference was statistically significant(Z=-2.84,P=0.004),and the distribution of the LLD of the observation group was better than that of the control group,and the difference was statistically significant(Z=3.078,P=0.002).(3)In the observation group,8 cases(5.97%,8/134)had postoperative LLD>10 mm,and in 24 cases in the control group(14.46%,24/166),the difference was statistically significant(χ^(2)=5.61,P=0.018).Cause analysis:It was related to the mismatch between the prosthesis and the patients(3 cases in the observation group and 4 cases in the control group;it was related to the lower orientation of Kirschner wire caused by obvious hyperplasia of osteophytes in the lower edge of the acetabulum(5 cases in the observation group and 3 cases in the control group).Conclusion The use of calibrated femoral canal file in the THA can control postoperative LLD more effectively than the unarmed method,the mismatch of the prosthesis,and the lower orientation of Kirschner wire caused by hyperplasia of osteophytes in the lower edge of the acetabulum affect the control of LLD by this method.