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组配式与一体式股骨假体联合转子下短缩截骨治疗Crowe IV型DDH的疗效比较

李正刚 寸新华 唐兴 王国梁 杨毅 陈佳晖 李彪

李正刚, 寸新华, 唐兴, 王国梁, 杨毅, 陈佳晖, 李彪. 组配式与一体式股骨假体联合转子下短缩截骨治疗Crowe IV型DDH的疗效比较[J]. 昆明医科大学学报, 2021, 42(1): 99-105. doi: 10.12259/j.issn.2095-610X.S20210115
引用本文: 李正刚, 寸新华, 唐兴, 王国梁, 杨毅, 陈佳晖, 李彪. 组配式与一体式股骨假体联合转子下短缩截骨治疗Crowe IV型DDH的疗效比较[J]. 昆明医科大学学报, 2021, 42(1): 99-105. doi: 10.12259/j.issn.2095-610X.S20210115
Zheng-gang LI, Xin-hua CUN, Xing TANG, Guo-liang WANG, Yi YANG, Jia-hui CHEN, Biao LI. Effectiveness Comparison of Modular and Monoblock Femoral Prosthesis with Subtrochanteric Shortening Osteotomy in CroweType IV Developmental Dysplasia of the Hip[J]. Journal of Kunming Medical University, 2021, 42(1): 99-105. doi: 10.12259/j.issn.2095-610X.S20210115
Citation: Zheng-gang LI, Xin-hua CUN, Xing TANG, Guo-liang WANG, Yi YANG, Jia-hui CHEN, Biao LI. Effectiveness Comparison of Modular and Monoblock Femoral Prosthesis with Subtrochanteric Shortening Osteotomy in CroweType IV Developmental Dysplasia of the Hip[J]. Journal of Kunming Medical University, 2021, 42(1): 99-105. doi: 10.12259/j.issn.2095-610X.S20210115

组配式与一体式股骨假体联合转子下短缩截骨治疗Crowe IV型DDH的疗效比较

doi: 10.12259/j.issn.2095-610X.S20210115
基金项目: 云南省骨关节疾病临床医学中心基金资助项目(ZX-2019-03-04)
详细信息
    作者简介:

    李正刚(1995~),男,云南腾冲人,在读硕士研究生,主要从事骨关节外科临床工作

    通讯作者:

    李彪,E-mail:libiao0012010@163.com

  • 中图分类号: R687.4

Effectiveness Comparison of Modular and Monoblock Femoral Prosthesis with Subtrochanteric Shortening Osteotomy in CroweType IV Developmental Dysplasia of the Hip

  • 摘要:   目的  对比应用组配式S-ROM股骨假体与一体式Wagner Cone股骨假体联合转子下短缩截骨行全髋关节置换术(total hip arthroplasty,THA)治疗Crowe IV型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者的临床疗效。  方法  回顾性分析2014年1月至2018年8月行THA治疗的58例(65髋)Crowe IV型DDH患者的临床资料,其中33例(37髋)使用组配式S-ROM假体,25例(28髋)使用一体式Wagner cone假体,记录两组患者的一般资料,手术时间,术中出血量,术后住院时间,截骨端愈合时间,手术前后Harris评分、VAS评分和相关并发症发生情况并进行分析。  结果  围手术期并发症发生率、术后住院时间、末次随访 Harris评分及VAS评分两组比较差异无统计学意义。组配式S-ROM假体组与一体式Wagner cone假体组,手术时间分别为(135.7±16.2)min和(113.3±13.0)min,术中出血量分别为(469.7±73.6)mL和(410.4±69.6)mL,组间比较差异有统计学意义(P < 0.05)。Wagner cone假体组愈合时间(5.8±1.5)月较组配式S-ROM假体组愈合时间(4.7±1.2)月延长,差异有统计学意义(P < 0.05)。  结论  应用组配式S-ROM假体与一体式Wagner cone假体联合股骨转子下短缩截骨行THA治疗Crowe Ⅳ型DDH均可获得良好的临床疗效。采用一体式Wagner Cone假体手术时间更短,术中出血量更少,采用组配式S-ROM假体截骨端愈合时间相对更短。
  • 图  1  患者,女,27岁,双侧Crowe Ⅳ型DDH,应用组配式S-ROM假体联合股骨转子下截骨行THA

    a:术前;b:左侧术后当天;c:左侧术后3月;d:左侧术后6月,右侧术后当天;e:左侧术后12月,右侧术后6月;f:左侧术后30月,右侧术后24月。

    Figure  1.  A 27-year-old women with bilateral Crowe type IV hip dysplasia,THA with modular S-ROM prosthesis and subtrochanteric shortening osteotomy

    图  2  患者,女,50岁,双侧Crowe Ⅳ型DDH,一体式Wagner cone假体联合股骨转子下截骨行THA

    a:术前;b:右侧术后当天;c:右侧术后3月;d:右侧术后4月,左侧术后当天;e:右侧术后7月,左侧术后3月;f:右侧术后24月,左侧术后21月。

    Figure  2.  A 50-year-old women with bilateral Crowe type IV hip dysplasia,THA with monoblock Wagner Cone prosthesis and subtrochanteric shortening osteotomy

    表  1  两组患者的一般资料比较($\bar x \pm s $

    Table  1.   Comparison of general data between 2 groups($\bar x \pm s $

    指标组配式S-ROM假体组(n = 33)一体式Wagner Cone假体组(n = 25)t/χ2P
    年龄(岁) 41.6 ± 12.7 38.5 ± 10.6 t = 1.017 0.313
    性别(女∶男,n 29∶4 23∶2 χ2 = 0.260 0.610
    BMI(kg/m2 22.0 ± 0.2 21.5 ± 0.2 t = 1.603 0.115
    下载: 导出CSV

    表  2  两组术前和末次随访时Harris评分比较($\bar x \pm s$

    Table  2.   Comparison of preoperative and last follow-up Harris scores between the two groups($\bar x \pm s$

    时间组配式S-ROM
    假体组
    n = 33)
    一体式Wagner
    Cone假体组
    n = 25)
    tP
    术前 38.6 ± 3.4 39.7 ± 4.2 −1.116 0.269
    末次随访 88.5 ± 2.3 88.5 ± 2.3 −1.097 0.277
    t −109.663 −67.367
    P < 0.001 < 0.001
    下载: 导出CSV

    表  3  两组术前和末次随访时VAS评分比较($\bar x \pm s$

    Table  3.   Comparison of preoperative and last follow-up VAS scores between the two groups($\bar x \pm s$

    时间组配式S-ROM
    假体组
    n = 33)
    一体式Wagner
    Cone假体组
    n = 25)
    tP
    术前 7.1 ± 0.7 7.0 ± 0.1 −0.197 0.277
    末次随访 2.7 ± 0.5 2.6 ± 0.1 0.760 0.450
    t 33.769 28.902
    P < 0.001 < 0.001
    下载: 导出CSV

    表  4  两组患者临床疗效比较($\bar x \pm s$

    Table  4.   Comparison of clinical outcomes between 2 groups($\bar x \pm s$

    指标组配式S-ROM假体组(n = 33)一体式Wagner Cone假体组(n = 25)t/χ2P
    手术时间(min) 135.7 ± 16.2 113.3 ± 13.0 t = 5.659 < 0.001
    术中出血量(mL) 469.7 ± 73.6 410.4 ± 69.6 t = 3.109 0.003*
    术后住院时间(d) 7.3 ± 1.5 7.1 ± 1.6 t = 0.520 0.605
    围手术期并发症发生率[n(%)] 6.1%(2/33) 4.0%(1/25) χ2 = 0.123 0.726
    截骨端愈合时间(月) 4.7 ± 1.2 5.8 ± 1.5 t = −3.242 0.002*
      *P < 0.05。
    下载: 导出CSV
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  • 收稿日期:  2020-07-06
  • 网络出版日期:  2021-01-26
  • 刊出日期:  2021-01-26

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