与匹配填充型柄相比，在 Dorr 型 C 型股骨的非骨水泥全髋关节置换术后，锥形楔形柄可减少早期术后下沉。
Tapered wedge stems decrease early postoperative subsidence following cementless total hip arthroplasty in Dorr type C femurs compared to fit-and-fill stems.
机构信息
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
出版信息
J Orthop Surg Res. 2022 Apr 10;17(1):223. doi: 10.1186/s13018-022-03111-7.
BACKGROUND
To compare the degree of stem subsidence between two different femoral component designs and to determine the risk factors associated with stem subsidence after cementless total hip arthroplasty (THA) in Dorr type C femurs.
METHODS
We retrospectively reviewed 104 consecutive hips in 100 patients with Dorr type C proximal femoral morphology who underwent primary cementless THA using a fit-and-fill stem or a tapered wedge femoral stem at our institution between January 2012 and June 2021. A fit-and-fill stem was used in 55 hips and a tapered wedge stem was used in 49 hips. Radiologically, the distance between the apex of the major trochanter and the stem shoulder were measured at three different time points (immediately [0W], one week [1W], and six weeks [6W] after surgery) and the degrees of stem subsidence were assessed by comparing the distance between 0 and 1W, 1W and 6W, and 0W and 6W, respectively.
RESULTS
The mean degree of stem subsidence (0W vs. 1W) was 0.24 mm (standard deviation [SD] 0.36) in the fit-and-fill stem group, and 0.23 mm (SD 0.41) in the tapered wedge stem group. There was no significant difference between the two groups (P = 0.4862). However, the mean degrees of subsidence were significantly higher in the fit-and-fill stem group (1W vs. 6W, 0.38 mm [SD 0.68]; 0W vs. 6W, 0.65 mm [SD 0.87]) than in the tapered wedge stem group (1W vs. 6W, 0.16 mm [SD 0.32]; 0W vs. 6W, 0.24 mm [SD 0.38]) (P < 0.05 for both). In addition, the rates of > 3 mm subsidence (in which instability can be observed) were 18.2% (10 of 55 hips) and 2.0% (1 of 49 hips), respectively. There was also a significant difference between the two stems (P = 0.0091). Multivariate analysis demonstrated that fit-and-fill stem was a risk factor for > 3 mm subsidence after THA in Dorr type C femurs (P = 0.0050).
CONCLUSION
Our findings suggest that the tapered wedge stem is more suitable for Dorr type C femurs than the fit-and-fill stem to avoid early postoperative subsidence in cementless THA.
背景
比较两种不同股骨假体设计的柄下沉程度，并确定 Dorr C 型股骨初次非骨水泥全髋关节置换术后与柄下沉相关的危险因素。
方法
我们回顾性分析了 2012 年 1 月至 2021 年 6 月期间在我院因 Dorr C 型股骨近端形态接受初次非骨水泥全髋关节置换术的 100 例患者的 104 髋，使用 Fit-and-Fill 或锥形楔形股骨柄。55 髋使用 Fit-and-Fill 柄，49 髋使用锥形楔形柄。术后即刻（0W）、1 周（1W）和 6 周（6W）分别测量大转子顶点与柄肩之间的距离，通过比较 0 到 1W、1W 到 6W 和 0W 到 6W 的距离评估柄下沉程度。
结果
Fit-and-Fill 组的平均柄下沉程度（0W 与 1W 比较）为 0.24mm（标准差[SD] 0.36），锥形楔形组为 0.23mm（SD 0.41）。两组之间无统计学差异（P=0.4862）。然而，Fit-and-Fill 组的下沉程度明显高于锥形楔形组（1W 与 6W 比较，0.38mm[SD 0.68]；0W 与 6W 比较，0.65mm[SD 0.87]）（均 P<0.05）。此外，>3mm 下沉（可观察到不稳定）的发生率分别为 18.2%（55 髋中的 10 髋）和 2.0%（49 髋中的 1 髋），两种柄之间也有显著差异（P=0.0091）。多变量分析表明，在 Dorr C 型股骨中，Fit-and-Fill 柄是全髋关节置换术后>3mm 下沉的危险因素（P=0.0050）。
结论
我们的研究结果表明，与 Fit-and-Fill 柄相比，锥形楔形柄更适合 Dorr C 型股骨，以避免初次非骨水泥全髋关节置换术后早期出现下沉。
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