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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
  • [1] Hartofilakidis G,Georgiades G,Babis G C,et al. Evaluation of two surgical techniques for acetabular reconstruction in total hip replacement for congenital hip disease:results after a minimumten years follow-up[J]. J Bone Joint surg Br,2008,90(6):724-730.
    [2] Greber E M,Pelt C E,Gililland J M,et al. Challenges in total hip arthroplasty in the setting of developmental dysplasia of the hip[J]. J Arthroplast,2017,32(9):38-44. doi: 10.1016/j.arth.2017.02.024
    [3] Li H,Yuan Y,Xu J,et al. Direct leverage for reducing the femoral head in total hip arthroplasty without femoral shortening osteotomy for Crowe type 3 to 4 dysplasia of the hip[J]. J Arthroplasty,2018,33(3):794-799. doi: 10.1016/j.arth.2017.09.011
    [4] Grappiolo G,La Camera F,Della Rocca A,et al. Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips[J]. Int Orthop,2019,43(1):77-83. doi: 10.1007/s00264-018-4122-5
    [5] Liu S,Zuo J,Li Z,et al. Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis may not be an ideal choice for patients with Crowe type IV hips[J]. Int Orthop,2017,41(4):707-713. doi: 10.1007/s00264-016-3248-6
    [6] Ozden V E,Dikmen G,Beksac B,et al. Tapered stems one-third proximally coated have higher complication rates than cylindrical two-third coated stems in patients with high hip dislocation undergoing total hip arthroplasty with step-cut shortening osteotomy[J]. Orthop Traumatol Surg Res,2017,103(4):569-577. doi: 10.1016/j.otsr.2017.01.010
    [7] Wang D,Li L L,Wang H Y,et al. Long-term results of cementles total hip arthroplasty with subtrochanteric shortening osteotomy in Crowe type IV developmental dysplasia[J]. J Arthroplasty,2017,32(4):1211-1219. doi: 10.1016/j.arth.2016.11.005
    [8] 杨佳,杨毅,赵云宏,等. 应用3D打印技术联合组配式S-ROM假体人工髋关节置换术治疗成人Crowe Ⅳ DDH[J].昆明医科大学学报,2018,39(5):83-89. doi: 10.3969/j.issn.1003-4706.2018.05.017
    [9] Crowe J F,Mani V J,Ranawat C S. Total hip replacement in congenital dislocation and dysplasia of the hip[J]. J Bone Joint Surg Am,1979,61(1):15-23.
    [10] Sonohata M,Kitajima M,Kawano S,et al. Nerve palsy after total hip arthroplasty without subtrochanteric femoral shortening osteotomy for a completely dislocated hip joint[J]. Open Orthop,2016,10:788-792.
    [11] Edwards B N,Tullos H S,Nobel P C. Contributory factors and etio-logy of sciatic nerve palsy in total hip arthroplasia[J]. Clin Orthop,1987(218):136-141.
    [12] Gong S,Xu W,Wang R,et al. The causes and management of nonunion of femoral subtrochanteric shortening osteotomy in a THA patient:a case report[J]. BMC Musculoskelet Disord,2019,20(1):203. doi: 10.1186/s12891-019-2612-2
    [13] Shi X T,Cheng C M,Feng C Y,et al. Crowe type IV hip dysplasia treated by THA comebined with osteotomy to balance functional leg length discrepancy:A prospective observational study[J]. Orthop Surg,2020,12(2):533-542. doi: 10.1111/os.12655
    [14] 卢玮,曾敏,雷鹏飞,等. Wagner Cone生物型股骨假体置换联合转子下短缩截骨术治疗成人Crowe Ⅳ型髋关节发育不良[J].中国修复重建外科杂志,2019,33(8):929-934.
    [15] 彭永刚,张坤,苗润清,等. Wagner cone股骨柄联合转子下横形截骨的全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良[J].实用骨科杂志,2018,24(12):1077-1081.
    [16] Mu W,Yang D,Xu B,et al. Midterm outcome of cementless total hip arthroplasty in crowe IV-hartofilakidis type III developmental dysplasia of the hip[J]. J Arthroplasty,2016,31(3):668-675. doi: 10.1016/j.arth.2015.10.011
    [17] Zhu J,Shen C,Chen X,et al. Total hip arthroplasty with a non-modular conical stem and transverse subtrochanteric osteotomy in treatment of high dislocated hips[J]. J Arthroplasty,2015,30(4):611-614. doi: 10.1016/j.arth.2014.11.002
    [18] Ollivier M,Abdel M P,Krych A J,et al. Long-term results of total hip arthroplasty with shortening subtrochanteric osteotomy in crowe IV developmental dysplasia[J]. J Arthroplasty,2016,31(8):1756-1760. doi: 10.1016/j.arth.2016.01.049
    [19] Muratli K S,Karatosun V,Uzun B,et al. Subtrochanteric shortening in total hip arthroplasty:biomechanical comparison of four techniques[J]. J Arthroplasty,2014,29(4):836-842. doi: 10.1016/j.arth.2013.09.004
    [20] Onodera S,Majima T,Ito H,et al. Cementless total hip arthroplasty using the modular S-ROM prosthesis combined with corrective proximal femoral osteotomy[J]. J Arthroplasty,2006,21(5):664-669. doi: 10.1016/j.arth.2005.08.016
    [21] Huang Z Y,Liu H,Li M,et al. Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip[J]. BMC Musculoskelet Disord,2020,21(1):210. doi: 10.1186/s12891-020-03248-8
    [22] Ozan F,Uzun E,Gürbüz K,et al. Total hip arthroplasty in the developmental dysplasia of the hip using transverse subtrochanteric osteotomy[J]. J Orthop,2016,13(4):259-263. doi: 10.1016/j.jor.2016.06.010
    [23] 赵众首,孙俊英. 组配式S-ROM假体在髋关节发育不良及髋关节翻修术中的应用进展[J].中国修复重建外科杂志,2012,26(9):1054-1057.
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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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