全髋关节置换术(THA)中不同颈干角股骨假体对股骨近端解剖重建的影响

目的研究全髋关节置换术(THA)中不同颈干角股骨假体对股骨近端解剖重建的影响。方法回顾性分析2014年1月—2015年1月大连大学附属中山医院骨科接受全髋关节置换术治疗的80例患者,根据在手术过程中使用不同颈干角股骨假体将患者分为两组,每组40例;其中研究组采用颈干角为135°的股骨柄,对照组采用颈干角为127°的股骨柄。检测并记录两组患者的术后术侧股骨偏心距相对于健侧的变化值(x FO)、该变化值与健侧股骨偏心的比值(sd FO)指标值、股骨头旋转中心高度、全局偏心距以及术前、术后(1、3、6、12个月)双下肢长度差和Harris评分,并对其结果进行比较分析。结果研究组患者的x FO、sd FO指标值分别为(1.8±4.6)、(8.9±12.6),明显低于对照组(5.9±4.8)、(20.4±17.5),差异具有统计学意义(P0.05)。研究组患者的股骨头旋转中心高度以及全局偏心距分别为(4566.5±32.6)和(65.5±11.4)mm,而对照组患者分别为(4579.5±37.6)、(69.4±12.6)mm,两组比较差异无统计学意义(P0.05)。术后1、3、6、12个月,两组患者的双下肢长度差、Harris评分与术前比较均有明显改善,差异具有统计学意义(P0.05),而两组患者的Harris评分差异无统计学意义(P0.05);研究组患者术后未出现任何不适现象,术后6个月,对照组患者出现3例大转子疼痛现象,两组比较差异具有统计学意义(P0.05)。结论 127°和135°的颈干角股骨假体应用在全髋关节置换术(THA)中均可以取得良好的早期功能恢复,135°的颈干角股骨假体可以更好地重建股骨近端解剖。

Effect of femoral prosthesis on proximal femoral reconstruction in total hip arthroplasty (THA) with different neck stem angle

Objective To investigate the influence of femoral neck prosthesis on the anatomical reconstruc-tion of the proximal femur in total hip arthroplasty ( THA) . Methods A retrospective analysis of 80 cases who un-derwent THA between Jan. 2014 and Jan. 2015 in Department of Orthopedics in Zhongshan Hospital Affiliated to Dalian University was carried out. According to its use of different collodiaphyseal angle of femoral prosthesis during the operation,they were divided into two groups. The study group was treated by femoral stem with the collodiaphy-seal angle of 135°,and the control group was treated by femoral stem with the neck stem angle of 127°. The change value of the femoral offset(xFO),the ratio of xFO to the offset of the contralateral side(sdFO),the center of the femoral head height,overall eccentricity,difference of the lower limb length before and after surgery (1,3,6,12 months) and Harris score of patients in the two groups were detected and recorded. Results The xFO and sdFO index of the study group (1. 8 ± 4. 6),(8. 9 ± 12. 6) were lower than those in the control group of (5. 9 ± 4. 8), (20. 4 ± 17. 5), and the difference was statistically significant (P<0. 05). The femoral head center height and o-verall eccentricity in the study group were (4566. 5 ± 32. 6) and (65. 5 ± 11. 4)mm, respectively,while in the con-trol group were (4579. 5 ± 37. 6) and (69. 4 ± 12. 6)mm,respectively. There was no significant difference between the two groups (P>0. 05). At 1,3,6 and 12 months after operation,the length of the lower limbs and the Harris score in the two groups were significantly improved compared with before operation ( P<0. 05 ) . The Harris scores of two groups were not statistically significan (P>0. 05). After the operation,patients in the study group did not have any discomfort. Six months after surgery,3 cases in the control group had greater trochanter pain,and the difference between the two groups was significanct(P<0. 05). Conclusion Femoral prosthesis with neck stem an-gle of both 127 ° and 135 °in THA can achieve good early functional recovery,and angle of 135 °can reconstruct the proximal femoral anatomy better.