股骨颈后皮质是否是实现非骨水泥直柄股骨假体矢状面平衡的障碍？

Is Posterior Femoral Neck Cortex an Obstacle in Achieving Sagittal Plane Balance of Uncemented Straight Femoral Stem?

作者信息

Mandal Mainak, Arora Sumit, Krishna Anant, Gupta Swati, Wadhawan Akhil, Kumar Manoj

机构信息

Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, 110002 India.

c/o Mr Raj Kumar Arora, B-253, Second Floor, Derawal Nagar, Delhi, 110009 India.

出版信息

Indian J Orthop. 2023 Aug 4;57(9):1510-1518. doi: 10.1007/s43465-023-00958-8. eCollection 2023 Sep.

DOI:10.1007/s43465-023-00958-8

PMID:37609023

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10441832/

Abstract

SUMMARY OF BACKGROUND DATA

There is a paucity of the literature that aims to improve sagittal plane balance of femoral stem in hip arthroplasty. We have comparatively evaluated the effect of trimming the posterior cortex left in situ after femoral neck osteotomy and counter-clockwise rotation of starting awl with respect to their ability to achieve neutral alignment of femoral stem in sagittal plane.

QUESTIONS/PURPOSES: (1) Which of the two techniques under reference is more reliable in achieving a sagittal plane balance of the femoral stem in the femoral canal? (2) Does either of the two techniques have the potential to adversely affect other parameters for the optimum placement of femoral stem?

PATIENTS AND METHODS

This prospective study involved a total of 60 patients (age group of 18 to 60 years) who underwent primary total hip arthroplasty (THA) through a standard posterolateral approach. They were randomized into groups (1) PNCT ( = 30): femoral canal preparation was done by posterior neck cortex trimming method; (2) CCRA ( = 30): femoral canal preparation was done by counter-clockwise rotation of starting awl. Postoperatively, radiographs and computed tomography were obtained and angle of femoral stem with the femoral canal in coronal and sagittal plane, femoral stem tip deviation in coronal and sagittal plane, anteversion of the femoral stem, duration of canal preparation and blood loss were analyzed between the two groups.

RESULTS

Based on our results, there is a significantly better sagittal alignment of the femoral stem within the femoral canal, both in terms of angle of the femoral stem with the femoral canal ( < 0.001) and the deviation of the femoral stem tip from the center of the medullary canal ( < 0.001) when the posterior neck cortex was trimmed. Canal preparation by trimming the posterior neck cortex took a mean of 11.93 min (range 8-15 min) against the mean duration of 6.87 min (range; 5 min to 9 min) in the other group ( < 0.001).

CONCLUSION

Trimming the posterior femoral neck cortex after neck osteotomy results in better sagittal plane balance of uncemented straight femoral stem.

LEVEL OF EVIDENCE

III.

摘要

背景数据总结

旨在改善髋关节置换术中股骨干矢状面平衡的文献较少。我们比较评估了股骨颈截骨后保留原位的后皮质修整以及起始锥逆时针旋转对股骨干在矢状面实现中立对线能力的影响。

问题/目的：（1）上述两种技术中哪一种在实现股骨干在股骨髓腔内矢状面平衡方面更可靠？（2）这两种技术中的任何一种是否有可能对股骨干最佳放置的其他参数产生不利影响？

患者与方法

这项前瞻性研究共纳入60例患者（年龄在18至60岁之间），他们通过标准后外侧入路接受初次全髋关节置换术（THA）。将他们随机分为两组：（1）PNCT（n = 30）：采用后颈皮质修整法进行股骨髓腔准备；（2）CCRA（n = 30）：采用起始锥逆时针旋转法进行股骨髓腔准备。术后，获取X线片和计算机断层扫描，并分析两组之间股骨干与股骨髓腔在冠状面和矢状面的角度、股骨干尖端在冠状面和矢状面的偏差、股骨干的前倾角、髓腔准备时间和失血量。

结果

根据我们的结果，当后颈皮质被修整时，股骨干在股骨髓腔内的矢状对线明显更好，无论是从股骨干与股骨髓腔的角度（<0.001）还是股骨干尖端与髓腔中心的偏差（<0.001）来看。修整后颈皮质进行髓腔准备的平均时间为11.93分钟（范围8 - 15分钟），而另一组的平均时间为6.87分钟（范围5分钟至9分钟）（<0.001）。