摘要
目的通过单能量重建图像和X线片观测,探究与长柄Corail假体相比,短柄ABGⅡ假体能否提高在Dorr C型股骨中的填充率,并比较两种假体的对线及稳定性。方法从2006年1月—2012年3月行后外侧入路人工全髋关节置换术治疗的Dorr C型股骨患者中,随机选取使用Corail假体(Corail组)和ABGⅡ假体(ABGⅡ组)患者各20例。两组患者性别、年龄、身体质量指数、术前诊断构成比比较差异均无统计学意义(P>0.05)。ABGⅡ组随访时间102~156个月,平均142个月;Corail组随访时间91~127个月,平均107个月。末次随访时两组Harris评分和主观满意度评分比较差异均无统计学意义(P>0.05)。末次随访时采用双能CT扫描,通过单能量图像重建,计算假体填充率并测量假体在冠状位和矢状位上的对线误差。在X线片上进行股骨柄稳定性评估,使用EBRA-FCA软件测量股骨柄下沉距离。结果X线片观测示,两组患者假体稳定性良好,未见松动征象。ABGⅡ组基座征发生率显著低于Corail组,异位骨化发生率显著高于Corail组,差异均有统计学意义(P<0.05)。ABGⅡ组股骨柄下沉距离显著大于Corail组(P<0.05);ABGⅡ组股骨柄下沉速度亦大于Corail组,但差异无统计学意义(P>0.05)。除ABGⅡ组整体假体填充率显著大于Corail组(P<0.05)外,两组在小转子处、小转子下2 cm、小转子下7 cm处假体填充率差异均无统计学意义(P>0.05)。假体对线结果示,除ABGⅡ组冠状位对线误差显著大于Corail组(P<0.05)外,两组矢状位对线误差及冠状位和矢状位对线>3°发生率差异均无统计学意义(P>0.05)。结论尽管ABGⅡ假体避免了Corail假体在Dorr C型股骨中近-远端不匹配的问题,并获得了更高填充率,但不能获得更好的对线或稳定性。
Objective Using the mono-energy reconstruction images and X-ray films to investigate whether the ABGⅡshort-stem could improve the filling ratio,stability,and alignment in the Dorr type C femur,compared with the Corail long-stem.Methods Among patients who were with Dorr type C femurs and treated with total hip arthroplasty between January 2006 and March 2012,20 patients with a Corail long-stem(Corail group)and 20 patients with an ABGⅡshort-stem(ABGⅡgroup)were randomly selected.The differences in gender,age,body mass index,and preoperative diagnoses between the two groups were not significant(P>0.05).The ABGⅡgroup was with a mean follow-up of 142months(range,102-156 months),and the Corail group was with a mean follow-up of 107 months(range,91-127 months).There was no significant difference in the Harris score and subjective satisfaction score between the two groups at last follow-up(P>0.05).At last follow-up,dual-energy CT scans with mono-energy image reconstruction were used to calculate the prosthetic filling ratio and to measure the alignment of the prosthesis in the coronal and sagittal positions.Stability assessment was performed based on X-ray films,and the subsidence distance was measured using EBRA-FCA software.Results X-ray film observation showed that the prostheses in the two groups were stable and no signs of loosening was found.The incidence of pedestal sign was significantly lower in the ABGⅡgroup than in the Corail group(P<0.05),and the incidence of heterotopic ossification was significantly higher in the ABGⅡgroup than in the Corail group(P<0.05).The subsidence distance of femoral stem in ABGⅡgroup was significantly greater than that in Corail group(P<0.05),and the subsidence speed of femoral stem in ABGⅡgroup was also greater than that in Corail group,but the difference was not significant(P>0.05).The overall prosthesis filling ratio was significantly higher in the ABGⅡgroup than in the Corail group(P<0.05),while the coronal filling ratio at the lesser trochanter,2 cm below the lesser trochanter,and 7 cm below the lesser trochanter were not significant(P<0.05).The results of prosthesis alignment showed that there was no significant difference in the sagittal alignment error value and the incidence of coronal and sagittal alignment error 3°between the two groups(P>0.05),while the coronal alignment error value in the ABGⅡgroup was significantly greater than that in the Corail group(P<0.05).Conclusion Although the ABGⅡshort-stem avoids the distal-proximal mismatch of the Corail long-stem in the Dorr type C femur and thus achieves a higher filling ratio,it does not appear to achieve better alignment or stability.
作者
包显超
李明阳
武立民
江胜虎
沈彬
BAO Xianchao;LI Mingyang;WU Limin;JIANG Shenghu;SHEN Bin(Department of Orthopedics,Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2023年第6期641-646,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
四川省科技厅重点研发项目(2022YFS0050)
四川省自然科学基金项目(2023NSFSC1750)。
