不同偏心距Corail股骨假体在全髋关节置换中的临床疗效研究

目的: 分析单侧初次全髋关节置换使用Corail颈干角135°不同偏心距股骨假体的术后影像学参数,对比双侧测量结果,分析术后股骨偏心距的重建及髋关节功能恢复,探讨Corail标准柄KS型与高偏心距柄KHO型股骨假体在初次全髋关节置换中的早期临床疗效。方法: 回顾性分析2015年1月至2017年6月使用强生Corail股骨柄假体行初次人工全髋关节置换186例单侧髋关节病变患者,根据术中使用不同偏心距股骨假体将患者分为高偏心距组和标准偏心距组。高偏心距组为Corail高偏心距假体KHO型52例,女20例,男32例;年龄21~71(50.6±13.2)岁;体质量指数(body mass index,BMI)(26.0±4.1) kg/m²。标准偏心距组为Corail标准股骨柄假体KS型134例,女57例,男77例;年龄18~77(47.3±14.0)岁;BMI(25.3±3.5) kg/m²。在术后髋关节正位X线片上测量外展力臂、股骨偏心距、髋臼偏心距、下肢长短差异,记录患者手术前后的Harris评分及相关并发症,分析假体的稳定性。结果: 高偏心距组患侧与健侧股骨偏心距、联合偏心距、外展力臂差异有统计学意义(P<0.05)。标准偏心距组患侧与健侧股骨偏心距、髋臼偏心距差异有统计学意义(P<0.05)。两组患者联合偏心距、外展力臂、下肢长短差异有统计学意义(P<0.05)。高偏心距组患侧髋关节外展力臂与股骨偏心距、髋臼偏心距和联合偏心距呈正相关性(r=0.633,P<0.001;r=0.384,P=0.005;r=0.690,P<0.001),健侧也得到了同样的结果(r=0.688,P<0.001;r=0.574,P<0.001;r=0.765,P<0.001)。标准偏心距组患侧髋关节外展力臂与股骨偏心距、髋臼偏心距和联合偏心距呈正相关性(r=0.734,P<0.001;r=0.418,P<0.001;r=0.749,P<0.001),健侧也得到了同样的结果(r=0.775,P<0.001;r=0.397,P<0.001;r=0.773,P<0.001)。高偏心距组双下肢长短差异与双侧联合偏心距的差异、双侧外展力臂的差异均有明显相关性(r=0.376,P=0.006;r=-0.346,P=0.012)。标准偏心距组双下肢长短差异与双侧联合偏心距的差异、双侧外展力臂的差异均无明显相关性(r=-0.009,P=0.919;r=-0.036,P=0.682)。两组患者术后末次随访Harris评分比较差异无统计学意义(P>0.05)。末次随访时,两组患者Trendelenburg阴性,假体均稳定。结论: Corail标准柄与高偏心距柄在单侧初次全髋关节置换中均可较好重建股骨偏心距,能很好重建髋关节的解剖结构和生物力学,维持双下肢长度及髋关节稳定性。虽有病例未能正常重建股骨偏心距,但并不影假体的稳定性和术后功能。

Clinical effect of Corail femoral prosthesis with different offset in total hip arthroplasty

Objective: To explore the early clinical efficacy of primary total hip arthroplasty(THA) with Corail standard stems (KS type) and high offset stems (KHO type),by analyzing the postoperative radiographic parameters of different offset of femoral components with Corail stem which has a neck-shaft angle of 135 ° in unilateral primary THA,by comparing the measurement results on both sides and analyzing the reconstruction of the postoperative femoral offset and the hip joint function recovery. Methods: A retrospective analysis was made of 186 patients with unilateral hip joint lesions who underwent the first total hip arthroplasty with Johnson & Johnson Corail prostheses from January 2015 to June 2017. According to the use of femoral prostheses with different eccentricities during the operation,the patients were divided into high eccentricity group and standard eccentricity group. In the high eccentricity group,there were 52 cases of Corail high eccentricity prosthesis(KHO type),including 20 females and 32 males;aged 21 to 71 years old with an average of(50.6±13.2) years;body mass index(BMI) was (26.0±4.1) kg/m². The standard eccentricity group included 134 Corail standard femoral stem prostheses(KS type),57 females and 77 males;aged 18 to 77 years old with an average of (47.3±14.0) years;BMI was (25.3±3.5) kg/m². The abduction arm,femoral eccentricity,acetabular eccentricity and the length difference of lower limbs were measured on the postoperatively positive X-ray film of the hip joint. Harris score and related complications were recorded before and after the operation,and the stability of the prosthesis was analyzed. Results: There were significant differences in femoral eccentricity,joint eccentricity and abduction arm between the affected side and the healthy side in the high eccentricity group(P<0.05). There were significant differences in femoral eccentricity and acetabular eccentricity between the affected side and the healthy side in the standard eccentricity group(P<0.05). There were significant differences in combined eccentricity,abduction arm and length of lower limbs between two groups(P<0.05). In the high eccentricity group,the abduction arm of the affected hip joint was positively correlated with the femoral eccentricity,acetabular eccentricity and joint eccentricity(r=0.633,P<0.001;r=0.384,P=0.005;r=0.690,P<0.001). The same results were also obtained in the healthy side(r=0.688,P<0.001;r=0.574,P<0.001;r=0.765,P<0.001). In the standard eccentricity group,the abduction arm of the affected hip joint was positively correlated with the femoral eccentricity,acetabular eccentricity and combined eccentricity(r=0.734,P<0.001;r=0.418,P<0.001;r=0.749,P<0.001). The same results were also obtained in the healthy side(r=0.775,P<0.001;r=0.397,P<0.001;r=0.773,P<0.001). The difference of the length of both lower limbs was significantly correlated with the difference of bilateral joint eccentricity and bilateral abduction arm (r=0.376,P=0.006;r=-0.346,P=0.012). There was no significant correlation between the difference of the length of both lower limbs and the difference of bilateral joint eccentricity and bilateral abduction arm (r=-0.009,P=0.919;r=-0.036,P=0.682). There was no significant difference in Harris score between two groups at the last follow-up(P>0.05). At the last follow-up,Trendelenburg was negative in all patients in both groups,and the prostheses were stable. Conclusion: Both Corail standard stem and high offset stem may be effectively reconstruct the femoral offset,reconstruct the anatomical structure and biomechanics of the hip joint,and maintain the length of lower limbs and the stability of the hip joint in the unilateral primary total hip arthroplasty. Although the offset of the femur was not reconstructed normally in some cases,the stability of the components and postoperative function were not affected.