新一代假体柄导航器在全髋关节置换术中的中期结果：216 例的临床和放射学 5 年随访。
Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases.
机构信息
Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.
Department for Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
出版信息
J Orthop Traumatol. 2019 Oct 31;20(1):31. doi: 10.1186/s10195-019-0537-z.
BACKGROUND
In recent years, a variety of short stems have been introduced. To date, mid- and long-term results of calcar-guided short-stem designs have been rarely available.
MATERIALS AND METHODS
Two hundred and sixteen calcar-guided short stems were included in combination with a cementless cup in a prospective study. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfaction on visual analogue scale (VAS) were assessed during a median follow-up of 61.7 months. Standardised radiographs were analysed at predefined time points regarding radiological alterations such as bone resorption and remodelling, radiolucency, osteolysis and cortical hypertrophy using modified Gruen zones.
RESULTS
At mid-term follow-up, no revision surgery of the stem had to be performed in the whole collective. At 5 years, HHS was 97.8 (SD 4.7), satisfaction on VAS was 9.7 (SD 0.7), rest pain on VAS was 0.1 (SD 0.5), and load pain on VAS was 0.6 (SD 1.2). Compared to the 2-year results, femoral bone resorption increased significantly at the 5-year follow-up (3.9% versus 42.3%). Rate of femoral cortical hypertrophy remained stable, occurring in a total of 9 hips (4.5%). At the 5-year follow-up, 2 stems (1.0%) showed non-progressive radiolucent lines with a maximum width of 2 mm. Signs of osteolysis were not observed. Compared to the 2-year follow-up, no further subsidence was observed.
CONCLUSIONS
The rate of stem revision (0%) at the mid-term follow-up was remarkable and indicates the principle of using a calcar-guided short stem as being a safe procedure. However, signs of bone-remodelling, indicating some amount of stress-shielding, must be acknowledged at 5 years depending on stem alignment and type of anchorage.
LEVEL OF EVIDENCE
IV, Prospective observational study Trial registration German Clinical Trials Register, DRKS00012634, 07/07/2017 (retrospectively registered).
背景
近年来，出现了多种短柄。迄今为止，有关基于小粗隆的短柄设计的中长期结果很少见报道。
材料与方法
前瞻性研究中，216 例基于小粗隆的短柄与非骨水泥杯组合使用。患者术后第一天即可完全负重。在中位随访 61.7 个月时，采用 Harris 髋关节评分（HHS）和视觉模拟量表（VAS）评估疼痛和满意度。在预定的时间点，采用改良的 Gruen 分区，对标准 X 线片进行分析，评估包括骨吸收和重塑、透亮线、骨溶解和皮质增厚等影像学改变。
结果
在中期随访中，整个队列中均无需进行柄的翻修手术。在 5 年时，HHS 为 97.8（SD 4.7），VAS 满意度评分为 9.7（SD 0.7），VAS 静息痛评分为 0.1（SD 0.5），VAS 负重痛评分为 0.6（SD 1.2）。与 2 年结果相比，5 年时股骨骨吸收显著增加（3.9%比 42.3%）。股骨皮质增厚的发生率保持稳定，共发生于 9 髋（4.5%）。5 年时，2 例（1.0%）出现非进行性透亮线，最宽处为 2mm。未观察到骨溶解的迹象。与 2 年随访相比，未再出现下沉。
结论
中期随访时，翻修率（0%）显著，表明使用基于小粗隆的短柄是一种安全的方法。然而，根据柄的对线和固定类型，5 年时仍可见到骨质重塑的迹象，表明存在一定程度的应力遮挡。
证据等级
IV，前瞻性观察研究。德国临床试验注册处，DRKS00012634，2017 年 7 月 7 日（回顾性注册）。
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