柄部设计影响全髋关节置换术中模板贴合度——一项比较两种非骨水泥短柄的回顾性队列研究。
Stem design affects templating adherence in total hip arthroplasty - a retrospective cohort study comparing two types of cementless short stems.
作者信息
Stadler C, Edinger A, Schauer B, Haslhofer D J, Gotterbarm T, Luger M
机构信息
Johannes Kepler University Linz, Altenberger Strasse 96, Linz, 4040, Austria.
Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstraße 9, Linz, 4020, Austria.
出版信息
J Orthop Surg Res. 2025 Apr 17;20(1):383. doi: 10.1186/s13018-025-05801-4.
BACKGROUND
Preoperative templating is crucial when performing total hip arthroplasty (THA) as it facilitates the correct restoration of the joint biomechanics and reduces the risk of adverse events associated with component under- or over-sizing. Templating and execution of stem placement is highly dependent on the actual stem design. Therefore, we aimed to compare the templating adherence between a neck-resecting and a partially neck-sparing cementless short stem and to evaluate the influence of patient-specific factors like sex and Dorr type on the templating adherence.
METHODS
This retrospective cohort study evaluated the preoperative templates of 345 consecutive THAs performed by a single surgeon. A neck-resecting short stem (Fitmore, ZimmerBiomet) combined with a bi-hemispherical cup (Allofit, ZimmerBiomet; Group A) was used in 160 cases and a partially neck-sparing short stem (ANA NOVA alpha proxy, ImplanTec GmbH) combined with a bi-hemispherical cup (ANA NOVA alpha cup, ImplanTec GmbH; Group B) in 185 cases. The templating adherence was evaluated for stem size and offset option as well as cup size.
RESULTS
Group A showed a lower overall templating adherence with regard to stem size compared to Group B (26.9% vs. 36.2% exact match, p = 0.063; 57.5% vs. 71.4% ± 1 size, p = 0.007). In female patients templating adherence with regard to stem size was significantly lower in Group A (26.5% vs. 44.4% exact match, p = 0.012). For Dorr type B femora, significantly lower templating adherence was observed within Group A with regard to stem size (26.4% vs. 39.6% exact match, p = 0.013). No significant differences between both study groups were found with regard to adherence to the templated offset option (60.6% vs. 60.5% exact match, p = 0.987) and cup size (43.1% vs. 40.0% exact match, p = 0.557).
CONCLUSIONS
For both stem types, the overall rate of exactly matching the templated stem sizes was relatively low. However, templating adherence was significantly higher in female patients and in Dorr type B femora with a partially neck-sparing stem, which should be considered by surgeons performing THA using cementless short stems.
TRIAL REGISTRATION
This trial was registered at the local ethics committee (Registration Number: 1094/2023).
背景
全髋关节置换术（THA）术前模板设计至关重要，因为它有助于正确恢复关节生物力学，并降低因假体尺寸过小或过大而导致不良事件的风险。柄部植入的模板设计和实施高度依赖于实际的柄部设计。因此，我们旨在比较一款颈段切除型和一款部分保留颈段的非骨水泥短柄之间的模板匹配度，并评估性别和多氏（Dorr）分型等患者特异性因素对模板匹配度的影响。
方法
这项回顾性队列研究评估了由一名外科医生连续进行的345例THA的术前模板。160例使用颈段切除型短柄（Fitmore，捷迈邦美公司）与双半球形髋臼杯（Allofit，捷迈邦美公司；A组），185例使用部分保留颈段的短柄（ANOVA alpha proxy，英普朗特公司）与双半球形髋臼杯（ANOVA alpha cup，英普朗特公司；B组）。评估了柄部尺寸、偏移量选择以及髋臼杯尺寸的模板匹配度。
结果
与B组相比，A组在柄部尺寸方面的总体模板匹配度较低（精确匹配率：26.9% 对36.2%，p = 0.063；±1个尺寸匹配率：57.5% 对71.4%，p = 0.007）。在女性患者中，A组在柄部尺寸方面的模板匹配度显著较低（精确匹配率：26.5% 对44.4%，p = 0.012）。对于多氏B型股骨，A组在柄部尺寸方面的模板匹配度显著较低（精确匹配率：26.4% 对39.6%，p = 0.013）。在模板偏移量选择的匹配度（精确匹配率：60.6% 对60.5%，p = 0.987）和髋臼杯尺寸（精确匹配率：43.1% 对40.0%，p = 0.557）方面，两组之间未发现显著差异。
结论
对于两种柄部类型而言，精确匹配模板柄部尺寸的总体比例相对较低。然而，使用部分保留颈段柄部的女性患者和多氏B型股骨患者的模板匹配度显著更高，进行非骨水泥短柄THA的外科医生应考虑这一点。
试验注册
本试验已在当地伦理委员会注册（注册号：1094/2023）。
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