侧卧位DAA下生物型短柄与标准柄THA治疗股骨头坏死的临床研究

Comparative Study of Biological Short Stem and Standard Stem in Total Hip Replacement through Direct Anterior Approach in Lateral Decubitus Position for Osteonecrosis of the Femoral Head

目的比较生物型短柄与标准柄在侧卧位直接前方入路(direct anterior approach,DAA)全髋关节置换术(total hip arthroplasty,THA)治疗股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。方法回顾性分析2019年1月至2021年3月西安交通大学附属红会医院收治的股骨头坏死患者145例,根据股骨柄假体类型分为两组。短柄组69例,男34例,女35例;平均年龄(59.16±8.86)岁。标准柄组76例,男35例,女41例;平均年龄(58.28±8.59)岁。比较两组的手术时间、切口长度、术中出血量,术前及术后第1、3、7天疼痛视觉模拟评分(visual analogue score,VAS),术前及术后1、3、6个月及末次随访髋关节Harris评分,术前及术后X线片上植入假体后髋关节偏心距、假体下沉、内外翻偏移。结果两组的切口长度差异无统计学意义(P>0.05);短柄组手术时间及术中出血量少于标准柄组(P<0.05)。两组术前及术后VAS评分差异无统计学意义(P>0.05)。两组术前髋关节Harris评分比较差异无统计学意义(P>0.05),术后1、3个月比较差异有统计学意义(P<0.05),而术后6个月及末次随访评分比较差异无统计学意义(P>0.05)。术后12个月随访影像学测量显示,短柄组有2例可见假体偏移>3°;标准柄组假体偏移角度均<3°。短柄组有3例假体下沉>3 mm;标准柄组有2例假体下沉>3 mm。两组所有病例测量双侧偏心距的差别均<4 mm。结论短柄髋关节假体在DDA下THA治疗ONFH相比于标准柄更具有优势,能够降低术中股骨侧的处理难度,缩短手术时间,减少术中出血,同时患者术后3个月内髋关节功能更好。

Objective To compare the clinical efficacy of biological short stem and standard stem in total hip arthroplasty(THA)through direct anterior approach(DAA)in lateral decubitus position in the treatment of osteonecrosis of the femoral head(ONFH).Methods A total of 145 hips were enrolled in a retrospective analysis of patients with ONFH admitted to Ward of Osteonecrosis and Joint Reconstruction of Honghui Hospital from January 2019 to March 2021.There were 69 hips(34 males and 35 females,aged 59.16±8.86 years)in the short stem group and 76 hips(35 males and 41 females,aged 58.28±8.59 years)in the standard stem group according to the type of femoral stem prosthesis.Perioperative indexes,including operative time,incision length and intraoperative blood loss were compared between the two groups.Visual analogue score(VAS)of pain before surgery and 1,3,7 days after surgery,Harris score of hip joint before surgery and 1,3,6 months after surgery and the last follow-up were recorded.Preoperative and postoperative X-ray films were used to measure hip eccentricity,implant subsidence and varus migration.Results There were no significant differences in operative time and incision length between the two groups(P>0.05).The amount of intraoperative blood loss in the short stalk group was less than that in the standard stalk group(P<0.05).There was no significant difference in preoperative and postoperative VAS between two groups(P>0.05).Preoperative Harris hip score was not significantly different between the two groups(P>0.05),there was significant difference between 1 and 3 months after operation(P<0.05),and there was no significant difference in the scores at 6 months after operation and at the last follow-up(P>0.05).Follow-up imaging measurements 12 months after surgery showed that 2 patients in the short stem group had prosthesis migration>3°.The deviation angle of the standard stem group was less than 3°.There were 3 cases of prosthesis sinking more than 3 mm in short stem group.Standard stem group prosthesis sinking was less than 3 mm.The difference of bilateral eccentricity was less than 4 mm between the two groups.Conclusion Compared with the standard handle,the short stem hip prosthesis has more advantages in THA treatment of ONFH with DDA approach,which can reduce the difficulty of intraoperative treatment of femoral side,shorten the operation time,reduce intraoperative bleeding,and achieve higher postoperative satisfaction.