使用非骨水泥双锥形股骨干进行髋关节置换术后的股骨远端皮质肥厚。

Distal femoral cortical hypertrophy after hip arthroplasty using a cementless doubletapered femoral stem.

作者信息

Cho Yoon Je, Chun Young Soo, Rhyu Kee Hyung, Baek Jong Hun, Liang Hu

机构信息

Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.

出版信息

J Orthop Surg (Hong Kong). 2016 Dec;24(3):317-322. doi: 10.1177/1602400309.

DOI:10.1177/1602400309

PMID:28031498

Abstract

PURPOSE

To review 437 hips in 404 patients who underwent total hip arthroplasty (THA) or hemiarthroplasty using the Accolade TMZF stem to determine the incidence and risk factors of distal femoral cortical hypertrophy (DFCH).

METHODS

Records of 437 hips in 169 men and 235 women aged 26 to 100 (mean, 65.7) years who underwent THA (n=293) or hemiarthroplasty (n=144) using the Accolade TMZF femoral stem by 2 senior surgeons and were followed up for a mean of 54.7 months were reviewed. Clinical outcome was assessed using the modified Harris Hip Score and visual analogue score for pain. Proximal femoral geometry and canal flare index were assessed on preoperative radiographs, and DFCH, stem position, subsidence, loosening, and stress shielding were assessed on postoperative radiographs according to the Gruen zone.

RESULTS

Of 437 hips, 27 (6.2%) developed DFCH and 410 did not. Hips with DFCH had a higher incidence of thigh pain (18.5% vs. 2.2%, p<0.001) and earlier onset of thigh pain (12.3 vs. 20.8 months, p=0.015), compared with those without. Nonetheless, all femoral stems were well-fixed, and no osteolysis or loosening was detected. The 2 groups achieved comparable clinical outcome in terms of Harris Hip Score and pain. The mean canal flare index was higher in hips with than without DFCH (3.706 vs. 3.294, p=0.002). The mean vertical subsidence of the femoral stem was lower in hips with than without DFCH (1.5 vs. 3.4 mmp<0.001). Subsidence negatively correlated with the canal flare index (correlation coefficient= -0.110, p=0.022). The incidence of the DFCH increased with each unit of increment in canal flare index (odds ratio [OR]=1.828, p=0.043) and each year younger in age (OR=0.968, p=0.015).

CONCLUSION

The incidence of DFCH in hips withthe Accolade TMZF stem was 6.2%. Patients with a higher canal flare index and younger age had a higher incidence of DFCH. Nonetheless, DFCH did not affect clinical outcome or femoral stem stability.

摘要

目的

回顾404例患者的437例髋关节，这些患者接受了全髋关节置换术（THA）或使用Accolade TMZF柄进行半髋关节置换术，以确定股骨干远端皮质肥大（DFCH）的发生率及危险因素。

方法

回顾了169例男性和235例女性患者（年龄26至100岁，平均65.7岁）的437例髋关节记录，这些患者接受了由2位资深外科医生使用Accolade TMZF股骨干进行的THA（n = 293）或半髋关节置换术（n = 144），平均随访54.7个月。使用改良Harris髋关节评分和疼痛视觉模拟评分评估临床结果。在术前X线片上评估股骨近端几何形状和髓腔扩口指数，在术后X线片上根据Gruen分区评估DFCH、柄位置、下沉、松动和应力遮挡。

结果

437例髋关节中，27例（6.2%）发生DFCH，410例未发生。与未发生DFCH的髋关节相比，发生DFCH的髋关节大腿疼痛发生率更高（18.5%对2.2%，p<0.001）且大腿疼痛出现更早（12.3对20.8个月，p = 0.015）。尽管如此，所有股骨干固定良好，未检测到骨溶解或松动。两组在Harris髋关节评分和疼痛方面取得了相当的临床结果。发生DFCH的髋关节平均髓腔扩口指数高于未发生的髋关节（3.706对3.294，p = 0.002）。发生DFCH的髋关节股骨干平均垂直下沉低于未发生的髋关节（1.5对3.4 mm，p<0.001）。下沉与髓腔扩口指数呈负相关（相关系数 = -0.110，p = 0.022）。DFCH的发生率随髓腔扩口指数每增加一个单位（比值比[OR]=1.828，p = 0.043）和年龄每年轻一岁（OR = 0.968，p = 0.015）而增加。