股骨假体颈干角变化对全髋关节置换术后骨密度、关节功能及血清炎症指标的影响

Effects of femoral prosthesis neck stem angle on bone mineral density and joint function after total hip arthroplasty

目的 探究股骨假体颈干角变化度对全髋关节置换术(THA)后关节功能及骨密度的影响。方法 52例THA患者分为观察组(n=27)和对照组(n=25),对照组使用127°小颈干角治疗、观察组采用135°大颈干角治疗;于治疗前与术后6、12、24个月时,采用髋关节Harris功能评分观察两组患者的髋关节功能,VAS评分评价主观疼痛情况,检测患者骨密度变化情况,双抗体夹心法观察炎症因子白介素-4(IL-4)及白介素-6(IL-6)水平,并比较两组THA患者的双下肢长度;记录两组THA患者治疗后下地锻练时间和不良反应发生率;术后24个月时检测两组THA患者偏心距FO)、术侧FO相对于健侧的变化值(xFO)及xFO与健侧FO的比值(sdFO)。结果 两组THA患者手术前与手术后1、6、12个月时Harris和术前与术后1个月VAS评分比较,差异无统计学意义(P> 0.05);术后6、12个月时,观察组VAS评分较对照组显著降低,差异有统计学意义(P<0.05);两组患者手术前与术后1、6、12个月时骨密度比较,差异无统计学意义(P> 0.05);两组患者手术前与术后1、6、12个月时IL-4及IL-6水平比较,差异无统计学意义(P> 0.05);观察组下地锻炼所用时间显著短于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为7.40%略低于对照组8.00%,但差异无统计学意义(χ^(2)=0.006,P=0.936);观察组术后FO、xFO、sdFO的值均显著低于对照组(P<0.05);术后两组患者双下肢长度差均呈下降趋势变化,但与手术前比较差异无统计学意义(P> 0.05);术后1、6、12个月后两组患者双下肢长度差比较,差异无统计学意义(P> 0.05)。结论 股骨假体颈干角增大和减少均不会影响患者骨密度、骨关节功能和血清炎症指标,但135°大颈干角能加快下床锻练时间,减轻患者疼痛。

Objective To investigate the effect of femoral prosthetic neck-shaft angle on joint function and bone mineral density following total hip arthroplasty.Methods Fiftey-two THA patients were divided observation group(n=27) receiving neck-shaft angle of 135 ° for treatment, while control group(n=25) receiving neck-shaft angle of 127 ° for treatment.Harris hip score was adopted to observe hip joint function of both groups, Visual Analogue Scale( VAS) score was used to subjectively evaluate pain of both groups;bone mineral density changes were tested 6, 12, and24 months after surgery along with the inflammation factors interleukin-4(IL-4) and interleukin-6(IL-6);first out-of-bed activity time, adverse reaction rate and the differences in limb length were compared between two groups.Twenty-four months after surgery, following items were tested for both groups: femoral offset(FO), change value of the femoral offset(xFO), and the ratio of xFO to the offset of the contralateral side( sdFO).Results Harris hip scores of 1, 6, and 12 months after surgery were compared with VAS score 1 month after surgery.Comparison yielded no statistical difference between both groups(allP> 0.05).VAS scores at postoperative 6 and 12 months were significantly decreased in observation group compared with control group, differences were statistically significant(P< 0.05).The bone mineral density comparison between before surgery and 1/6/12months after surgery demonstrated no statistical differences(P> 0.05).Serum levels of IL-4 and IL-6before surgery and 1/6/12 months after surgery of both groups manifested no statistical differences(P> 0.05).The postoperative first out-of-bed activity time was significantly shorter in observation group than that of control group, differences were statistically significant(P< 0.05).The overall adverse reaction rate was 7.40% in observation group, which was slightly lower than 8.00% of control group, with no statistical difference (χ^(2)=0.006,P=0.936).FO, xFO, and sdFO value of observation group after surgery was significantly lower than that of control group(P< 0.05).Length difference of both lower limbs of both groups showed no significant difference than before surgery, and a decrease trend was observed in both groups after surgery(P> 0.05).The limbs length at postoperative 1,6, and 12 months had no statistical difference between both groups(P> 0.05).Conclusion The femoral prosthetic neck-shaft angle have no impact on bone mineral density and joint function in patients received total hip arthroplasty, while the large angle could promote the out-of-bed activity time and alleviate the pain.