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

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

1.
昆明医科大学第一附属医院骨科，云南昆明　650032
2.
昆明市第三人民医院骨科，云南昆明　650041
3.
昆明医科大学第一附属医院运动医学科，云南昆明　650032

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
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出版历程
- 收稿日期: 2020-07-06
- 网络出版日期: 2021-01-26
- 刊出日期: 2021-01-26

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

1.
Dept. of Orthropaedics，The First Affilicated Hospital of Kunming Medical University，Kunming Yunnan 650032
2.
Dept. of Orthropaedics，The Third People’s Hospital of Kunming，Kunming Yunnan 650041
3.
Dept. of Sports Medicine，The First Affilicated Hospital of Kunming Medical University，Kunming Yunnan 650032，China

摘要

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。
- 发育性髋关节发育不良 /
- 全髋关节置换术 /
- 转子下截骨 /
- 组配式假体 /
- 一体式假体
Abstract: Objective To compare the clinical efficacy of modular S-ROM femoral prosthesis and monoblock Wagner Cone femoral prosthesis used in total hip arthroplasty for the treatment of Crowe type IV developmental dysplasia of the hip. Methods Retrospective study was conducted in 58 patients（65 hips） undergoing total hip arthroplasty for the treatment of Crowe type IV developmental dysplasia of the hip between January 2014 to August 2018, including 33 patients（37 hips） with modular S-ROM prosthesis and 25 patients（27 hips） with monoblock Wagner Cone prosthesis. The general data, operative time, intraoperative blood loss during the postoperative hospitalization, bone union time, Harris score, VAS score and perioperative complication rate were compared between the two groups. Results There was no significant difference in the perioperative complication rate during the postoperative hospitalization, Harris score and VAS score in the last follow-up between the two groups. The operative time was （135.7perat）min in the S-ROM group and （113.3n the）min in the Wagner Cone group, and there was a significant difference between the two groups （P < 0.05）. The intraoperative blood loss was （469.7±43.6）ml in the S-ROM group and （410.4 rence between the two groups （and there was a significant difference between the two groups （P < 0.05）. The bone healing time of Wagner Cone group was significantly longer than that of S-ROM group （P < 0.05）. Conclusion The application of both the modular S-ROM andmonoblock Wagner Cone femoral prosthesis with subtrochanteric shortening osteotomy in total hip arthroplasty for the treatment of Crowe type IV developmental dysplasia of the hip has a good clinical efficacy. The monoblock Wagner Cone prosthesis has the shorter operative time and less intraoperative blood loss, and the modular S-ROM prosthesis has shorter bone healing time.
- Developmental dysplasia of the hip /
- Total hip arthroplasty /
- Subtrochanteric osteotomy /
- Modular prosthesis /
- Monoblock prosthesis

HTML全文

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

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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/χ²	P
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）	t	P
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）	t	P
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/χ²	P
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。

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