一种超短型保留股骨颈髋关节假体：逐步引入后应用放射学三维配准分析法和双能 X 射线吸收法的 2 年随访研究。
An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction.
机构信息
Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
出版信息
J Bone Joint Surg Am. 2020 Jan 15;102(2):128-136. doi: 10.2106/JBJS.19.00104.
BACKGROUND
Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant.
METHODS
Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery.
RESULTS
The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of -4.9% (95% CI, -7.4% to -2.4%; p = 0.0003) and -8.9% (95% CI, -11.5% to -6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively).
CONCLUSIONS
The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
全髋关节置换术（THA）使用骨干假体可能存在骨丢失风险。为了在预期寿命长、活动水平高的年轻患者中保留近端骨量，人们对短柄假体产生了兴趣。本前瞻性观察队列研究旨在评估 Primoris 保留股骨颈髋关节植入物的固定情况以及周围骨重塑情况。
方法
50 例终末期骨关节炎年轻患者接受 Primoris 髋关节植入物治疗。我们使用双能 X 线吸收法（DXA）评估骨密度（BMD），并使用放射立体测量分析（RSA）评估假体迁移情况。采用 4 个感兴趣区（ROI）方案评估 BMD。评估 BMD 与迁移之间的相关性，以确定 Primoris 假体的固定情况和股骨近端的骨重塑情况。从第 1 天（基线）开始至术后 24 个月定期进行随访评估。
结果
主要的假体迁移为沉降（Y 轴；平均 0.38mm），发生在术后 6 周；内翻倾斜（旋转）（Z 轴；平均 0.93°），发生在术后 6 至 12 个月。在 ROI4（骨突区），术后 24 个月时发现骨量显著增加，平均差值为 4.1%（95%置信区间[CI]：0.8%7.4%；p<0.02）。ROI1 和 ROI2 发现明显的骨丢失，平均差值分别为-4.9%（95%CI：-7.4%-2.4%；p=0.0003）和-8.9%（95%CI：-11.5%~-6.2%；p=0.0001）。线性回归和多元回归分析显示，最大总点数运动与 BMD 呈显著负相关（p=0.02，R=15%；p<0.05，R=26%）。
结论
Primoris 假体在 24 个月的随访中表现出良好的初始稳定性，结果令人满意。DXA 扫描显示近端负重模式下假体有一定的应力遮挡。更好的骨质量与假体迁移程度较轻相关。
证据等级
治疗性 IV 级。欲了解完整的证据等级说明，请参见作者指南。
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