Tri-Lock 骨保留型股骨柄与Corail柄在Crowe Ⅰ型发育性髋关节发育不良治疗中的应用效果比较

目的 比较Tri-Lock骨保留型股骨柄(BPS)与Corail股骨柄治疗成人发育性髋关节发育不良(DDH)的临床应用价值。方法 回顾性分析。纳入2015年1月-2019年4月贵州省人民医院骨关节外科病区Crowe Ⅰ型DDH患者35例(40髋),其中男5例(5髋)、女30例(35髋),年龄26~77(60.81±11.72)岁,均采用全髋关节置换术(THA)治疗。按照使用的股骨柄假体类型不同分为两组:观察组17例20髋,采用Tri-Lock BPS;对照组18例20髋,采用Corail股骨柄。对比两组患者的性别、年龄、髓腔闪烁指数(CFI),比较两组患者术后股骨柄初始稳定性、手术前后双下肢绝对长度差及股骨小转子最宽部骨量保留的面积,使用Mimics 17.0测量大小转子间骨量保留体积,并记录与股骨柄相关并发症。术后第2日使用视觉模拟评分(VAS)评估髋部疼痛程度,术后12周按照Harris髋关节评分(HHS)标准评价整体疗效。结果 两组患者性别、年龄、CFI等一般资料比较差异均无统计学意义(P值均>0.05)。术后随访6~18个月,平均12.6个月。患者的股骨柄初始稳定性以及术前术后双下肢绝对长度差组间比较,差异均无统计学意义(P值均>0.05);观察组患者的股骨小转子最宽部骨量保留的面积(6.28±0.32)cm²]、大小转子间骨量保留体积(30.25±0.81)cm³]均大于对照组患者(5.63±0.14)cm²、(17.74±0.33)cm³],差异均有统计学意义(t=8.313、64.099, P值均＜0.01)。术后第2天髋部疼痛VAS、双下肢绝对长度差、股骨柄的初始稳定性观察指标组间比较,差异均无统计学意义(P值均>0.05);术后12周,观察组与对照组HHS总分及其中髋部疼痛评分比较差异均有统计学意义(t=2.098、2.432, P值均<0.05),但髋关节功能、运动及肢体畸形评分比较差异均无统计学意义(P值均>0.05)。观察组患者并发症发生率(5.0%,1/20)低于对照组(25.0%, 5/20),但差异无统计学意义(χ²=1.765, P>0.05)。结论 Tri-Lock BPS较Corail股骨柄假体用于治疗Crowe Ⅰ型DDH THA中,具有更加微创、更好的临床效果和更多的股骨近端骨量保留的优势,且不增加手术并发症。

Comparison of clinical effect between Tri-Lock BPS stem and Corail stem for treatment of type I developmental dysplasia of the hip

Objective This study aimed to compare the clinical effect between Tri-Lock bone preservation stem(BPS)and Corail stem for treatment of Crowe typeⅠdevelopmental dysplasia of the hip (DDH).Methods This work analyzed data of 35 cases (40 hips) including 5 male cases and 30 female cases, with age of 26-77 (60.81±11.72) years, who were diagnosed with Crowe type Ⅰ DDH and admitted to the Joint Surgery Department of Guizhou People’s Hospital from January 2015 to April 2019. According to different femoral stems used, the patients were separated into two groups: observation group (17 cases, 20 hips using Tri-Lock BPS) and control group (18 cases, 20 hips using Corail femoral stems). Gender, age, canal flare index(CFI), initial stability of femoral stem, absolute length difference of lower limbs, and bone mass preservation area of the broadest part in femur lesser trochanter were compared between the two groups. Bone mass preservation volume between femur lesser and greater trochanter was reconstructed using Mimics 17.0. Complications related to femoral stems were recorded.Results There was no statistically significant difference in gender, age, CFI between the two groups(all P values >0.05). During the follow-up of 6 to 18 months, of which the mean duration was 12.6 months. The initial stability of femoral stems and the absolute length difference of lower limbs were not statistically significantly different between the two groups (P>0.05). The area of bone mass preservation in the broadest part in the femur lesser trochanter (6.28±0.32) cm²], the volume of bone mass preservation between femur lesser and greater trochanter (30.25±0.81) cm³] of patients in the observation group were all significantly higher than those of patients in the control group (5.63±0.14) cm², (17.74±0.33) cm³] (t=8.313, 64.099, all P values＜0.01). On the second day after the operation, no statistically significant difference was observed in the hip VAS pain score, the difference in the absolute length of the lower limbs, and the initial stability of the femoral stalk between the two groups (all P values>0.05). The difference in total HHS score and pain improvement between the observation and control group was statistically significant 12 weeks after the operation (t=2.098, 2.432, all P values<0.05). No statistically significant difference was found in hip functional movement and limb deformity between the two groups (all P values were>0.05). The incidence of complications in the observation group was 5.0% (1/20), which was lower than that of the control group (25.0%, 5/20). However, the difference was not statistically significant (χ²=1.765, P>0.05).Conclusions Compared with Corail femoral stem, Tri-Lock BPS is more minimally invasive, has better clinical effect and proximal femur bone mass preservation, and does not increase surgical complications.