2 种“部分股骨颈”股骨柄初次全髋关节置换术后 4-8 年并发症分析

4- to 8-year complication analysis of 2 'partial collum' femoral stems in primary THA.

机构信息

Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

出版信息

Hip Int. 2021 Jan;31(1):75-82. doi: 10.1177/1120700019879360. Epub 2019 Sep 26.

DOI:10.1177/1120700019879360

PMID:31558044

Abstract

OBJECTIVES

Compare the clinical and radiological outcome of CFP stem with the MiniHip design in a prospective series, with special interest in intraoperative periprosthetic fracture (IPPF).

METHODS

We prospectively followed 101 cases treated with the MiniHip stem (Group 1) and 89 with the CFP stem (Group 2) operated between 2010 and 2014. No significant demographic differences were observed between both groups. Median follow-up was 72 months. Average stem length was 41% shorter in the MiniHip group ( 0.001). Radiological parameters were measured and a logistcic regression model was created to evaluate factors associated with IPPF.

RESULTS

Mean mHHS improved from 54 to 95 in the MiniHip group ( 0.001) and from 64 to 98 in the CFP group ( 0.001). No significant differences were observed in terms of loosening, infection or instability. We observed 7 IPPFs (3.68%), 3 in group 1 and 4 in group 2. After adjusting for confounders, CFP was not associated with a greater risk of IPPF (OR 3.23; 95% CI, 0.250-42.034, 0.368), however, a more complex fracture pattern was observed with this stem design. Prior acetabular fractures were associated with IPPF (OR 66.85; 95% CI, 1.142-3911, 0.043). Compared to Dorr A femurs, type Dorr B appeared protective against IPPF (OR 0.039; 95% CI, 0.001-1.109, 0.058). Valgus alignment tended to increase the risk of IPPF (OR 20.59; 95% CI 0.870-487.221, 0.061).

CONCLUSIONS

MiniHip showed similar radiological outcomes to CFP at short- to mid-term follow-up without increasing IPPFs with a shorter stem length. Given that CFP produced a more complex IPPF pattern, surgeons should be cautious with alignment of this particular design, especially in Dorr A femur.

摘要

目的

在一项前瞻性研究中比较 CFP 柄与 MiniHip 设计的临床和影像学结果，特别关注术中假体周围骨折（IPPF）。

方法

我们前瞻性随访了 2010 年至 2014 年期间接受 MiniHip 柄（第 1 组）和 CFP 柄（第 2 组）治疗的 101 例和 89 例患者。两组之间没有观察到显著的人口统计学差异。中位随访时间为 72 个月。MiniHip 组的平均柄长度短 41%（<0.001）。测量影像学参数，并创建逻辑回归模型来评估与 IPPF 相关的因素。

结果

MiniHip 组的平均 mHHS 从 54 提高到 95（<0.001），CFP 组从 64 提高到 98（<0.001）。在松动、感染或不稳定方面没有观察到显著差异。我们观察到 7 例 IPPF（3.68%），其中 3 例在第 1 组，4 例在第 2 组。在调整混杂因素后，CFP 与 IPPF 的风险增加无关（OR 3.23；95%CI，0.250-42.034，P=0.368），然而，与这种柄设计相关的是更复杂的骨折模式。髋臼前骨折与 IPPF 相关（OR 66.85；95%CI，1.142-3911，P=0.043）。与 Dorr A 股骨相比，Dorr B 型股骨似乎可预防 IPPF（OR 0.039；95%CI，0.001-1.109，P=0.058）。外翻对线倾向于增加 IPPF 的风险（OR 20.59；95%CI，0.870-487.221，P=0.061）。