全髋关节置换中CLS Spotorno柄设计改良的临床结果
Clinical outcome of design modifications to the CLS Spotorno Stem in total hip replacement.
作者信息
Graceffa Angelo, Indelli Pier Francesco, Latella Leonardo, Poli Paolo, Fulco Alexander, Marcucci Massimiliano
机构信息
Centro Eccellenza Sostituzioni Articolari Toscana (CESAT), Clinica Ortopedica Università di Firenze, Florence, Italy; Fondazione Onlus "...In Cammino...", Fucecchio, Italy.
The Department of Orthopaedics and Bioengineering, Stanford University School of Medicine, Stanford, USA.
出版信息
Joints. 2016 Sep 21;4(3):134-141. doi: 10.11138/jts/2016.4.3.134. eCollection 2016 Jul-Sep.
PURPOSE
historically, the original CLS Spotorno Stem has demonstrated excellent survival. The design of this stem was recently modified, resulting in the introduction of a shorter, modular version (CLS Brevius). The purpose of the current study was to evaluate the functional, radiological and survivorship outcomes of the cementless CLS Brevius Stem in a multi-surgeon, single center, consecutive series study at two years post-surgery.
METHODS
the Authors performed 170 total hip arthroplasties in 155 patients using the shorter, triple-taper stem design (CLS Brevius). The patients' diagnoses were primary hip osteoarthritis (OA) in 74.4%, secondary hip OA in 22.6%, and post-traumatic hip OA in 3%. All operations were performed through a mini-posterior approach, with the patient in the lateral decubitus position. The mean follow-up was 32 months (24-44 months). Outcome was assessed using the Harris Hip Score (HHS).
RESULTS
the mean HHS improved from 32 preoperatively to 92 points at final follow-up, while the stem survival rate was 99.4%. Overall, the results were excellent in148 hips (87%), good in 14 hips (8.2%), fair in six hips (3.6%), and poor in two hips (1.2%). Intraoperative complications included a calcar fissure in three hips (1.7%). Correct femoral offset was reproduced in 97% while the planned center of hip rotation was achieved in 98%. Only one hip underwent early stem revision; this was due to major subsidence.
CONCLUSIONS
the modified CLS stem design showed excellent short-term results with a low rate of early postoperative complications. One of the main findings of this study was the high correlation between the planned femoral offset and center of hip rotation and the final radiographic measurements. This high reproducibility, which indicates the ability of the system to restore normal hip anatomy, is indeed due to the extensive modularity that characterizes this stem system. Long-term follow-up studies are necessary to fully compare the outcomes of the new design with its highly successful predecessor.
LEVEL OF EVIDENCE
Level IV, therapeutic cases series.
目的
从历史上看，原始的CLS Spotorno柄表现出优异的生存率。该柄的设计最近进行了改进，推出了一种更短的模块化版本（CLS Brevius）。本研究的目的是在一项多外科医生、单中心、连续病例系列研究中，评估无水泥CLS Brevius柄在术后两年的功能、放射学和生存率结果。
方法
作者对155例患者实施了170例全髋关节置换术，采用了更短的三锥度柄设计（CLS Brevius）。患者的诊断情况为：原发性髋骨关节炎（OA）占74.4%，继发性髋OA占22.6%，创伤后髋OA占3%。所有手术均通过微创后外侧入路进行，患者取侧卧位。平均随访时间为32个月（24 - 44个月）。使用Harris髋关节评分（HHS）评估结果。
结果
平均HHS从术前的32分提高到最终随访时的92分，柄的生存率为99.4%。总体而言，148髋（87%）结果优秀，14髋（8.2%）良好，6髋（3.6%）尚可，2髋（1.2%）较差。术中并发症包括3髋（1.7%）出现股骨距骨折。97%的病例恢复了正确的股骨偏心距，98%的病例达到了计划的髋关节旋转中心。仅1髋早期进行了柄翻修；这是由于严重下沉所致。
结论
改良的CLS柄设计显示出优异的短期结果，术后早期并发症发生率低。本研究的主要发现之一是计划的股骨偏心距和髋关节旋转中心与最终影像学测量结果之间高度相关。这种高再现性表明该系统能够恢复正常的髋关节解剖结构，这确实归因于该柄系统具有的广泛模块化特点。需要进行长期随访研究，以将新设计的结果与其非常成功的前身进行全面比较。
证据水平
IV级，治疗性病例系列。
Zotero 插件