全髋关节置换术中短股骨干假体和常规股骨干假体的中期临床和影像学结果比较-动脉网

Comparison of mid-term clinical and radiological results of short and conventional femoral stems in total hip arthroplasty

Nature 等信源发布 2024-08-05 20:26

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AbstractThis study aims to answer the question: Which are superior—conventional or short femoral stems?. An Optymis stem was used as a short-femoral stem, and an Accolade II stem was used as a conventional-femoral stem. There were 95 patients in the short femoral stem group (Group 1) and 90 in the conventional stem group (Group 2).

摘要本研究旨在回答以下问题：哪些是优于常规或短股骨干？。Optymis茎用作短股骨干，Accolade II茎用作常规股骨干。股骨短柄组（第1组）有95例患者，常规柄组（第2组）有90例患者。

The SF-36 Life Quality Score, thigh pain, and the Harris Hip Score were used to evaluate the patients’ clinical outcomes. Pre-operative, immediate post-operative, and final follow-up x-rays were used for radiological evaluation. Stem varus/valgus alignment, hip offset changing, acetabular anteversion/inclination changing, femoral migration, acetabular migration, periarticular ossification, and osteointegration evaluation were assessed for both groups.

SF-36生活质量评分，大腿疼痛和哈里斯髋关节评分用于评估患者的临床结果。术前，术后即刻和最终随访x射线用于放射学评估。评估两组的干内翻/外翻对齐，髋关节偏移变化，髋臼前倾角/倾角变化，股骨移位，髋臼移位，关节周围骨化和骨整合评估。

The mean follow-up time was 5.5 years for Group 1 and 5.2 years for Group 2. No significant difference existed between the two groups in terms of clinical scores (Harris Hip Score, SF-36). Thigh pain was significantly higher in Group 2 (p = 0.0001). As for radiological parameters, Group 1 exhibited more varus position-related results.

第1组的平均随访时间为5.5年，第2组为5.2年。两组在临床评分（Harris髋关节评分，SF-36）方面无显着差异。。至于放射学参数，第1组表现出更多与内翻位置相关的结果。

In terms of angular stability, Group 1 was found to be more unstable than Group 2 (p = 0.0001). The power to reconstruct femoral offset was superior in Group 1. Periarticular ossification was more frequent in Group 2. Femoral osteointegration was denser proximally in Group 1 and distally in Group 2.

就角度稳定性而言，发现第1组比第2组更不稳定（p=0.0001）。第1组重建股骨偏移的能力优于第1组。第2组关节周围骨化更常见。第1组股骨近端骨整合密度较高，第2组股骨远端骨整合密度较高。

When mid-term radiological and clinical results of both femoral stems are evaluated, they have no superiority over each other..

当评估两个股骨柄的中期放射学和临床结果时，它们彼此没有优势。。

IntroductionOne of the most common diseases in the world is hip osteoarthritis, which also ranks high among the causes of many injuries1. Along with the increase in life expectancy among the global populace, its occurrence has increased. In hip osteoarthritis, pain and movement restriction occur due to articular cartilage damage.

引言世界上最常见的疾病之一是髋关节骨性关节炎，它也是许多伤害的原因之一1。随着全球人口预期寿命的增加，其发生率也有所增加。在髋关节骨性关节炎中，由于关节软骨损伤而发生疼痛和运动受限。

During hip arthroplasty, the damaged cartilage surface is replaced, and functionality is restored2 Total hip arthroplasty (THA) is a frequently performed orthopedic surgical procedure with positive results3 Treatment with uncemented femoral stems with different stem designs in patients with a certain bone quality shows positive results in the long term4.

在髋关节置换术中，受损的软骨表面被替换，功能得以恢复2全髋关节置换术（THA）是一种经常进行的骨科手术，具有积极的结果3在具有一定骨量的患者中使用不同柄设计的非骨水泥股骨柄进行治疗，从长远来看显示出积极的结果4。

The design of conventional uncemented tapered wedge femoral systems is inspired by the Mueller Straight Stem, which was first used in 19775. This tapered design improves proximal loading and alleviates stress shielding thus leading to better mediolateral stability6. Although the survival time of conventional femoral stems is promising, they have disadvantages such as proximal–distal discrepancy, bone loss, thigh pain, and periprosthetic fracture.7 Different stem designs have been created over time to reduce these drawbacks, and short femoral stems are one of these.

传统的非骨水泥锥形楔形股骨系统的设计灵感来自于1977年首次使用的米勒直柄。这种锥形设计改善了近端负荷并减轻了应力屏蔽，从而导致更好的中外侧稳定性6。虽然传统股骨柄的存活时间很有希望，但它们存在近端-远端差异，骨质流失，大腿疼痛和假体周围骨折等缺点。随着时间的推移，已经创建了不同的柄设计来减少这些缺点，而短股骨柄就是其中之一。

Short femoral stems have frequently been used, especially in the past 20 years1. Short femoral stems are shorter than 120 mm and which typically coincides with the metaphyseal–diaphyseal junction8. The stability of these short femoral stems depends upon their stable metaphyseal fixation; a requirement for optimal proximal load transfer8.

股骨短柄经常被使用，特别是在过去的20年中1。短股骨干短于120毫米，通常与干骺端-骨干连接处一致8。这些短股骨柄的稳定性取决于它们稳定的干骺端固定；最佳近端负荷转移的要求8。

Biomechanical studies have shown that optimising proximal load transfer can lead to the best chance of bone preservation8. They are generally preferred as they preserve proximal bone reserve and resu.

生物力学研究表明，优化近端负荷转移可以导致骨保存的最佳机会8。它们通常是首选的，因为它们保留了近端骨储备和resu。

For patients in both groups, the same post-operative protocol was followed. The patients were mobilized with a walker on the day following surgery, ensuring the highest tolerable weight. For the next three weeks, it was ensured that the patients were mobilized and unsupported after walker use.Clinical evaluationThe hospital of stay, size of the incision, intra-operative complications, and amount of transfusion and intra-hospital complications were recorded for all patients.

对于两组患者，遵循相同的术后方案。手术后第二天，患者用助行器动员，确保最高的耐受体重。在接下来的三周内，确保患者在使用助行器后动员起来并且不受支持。临床评估记录所有患者的住院时间，切口大小，术中并发症，输血量和院内并发症。

The patients were monitored at the post-operative 1st and 3rd months and 1st year. The monitoring included a standard physical examination covering the evaluation of the surgical scar, movement alignment, and functionality of the operated hip. In terms of clinical evaluation, the Harris Hip Score (HHS)10, the SF-36 Life Quality Score11, and the existence of thigh pain12 were considered.

在术后第1个月和第3个月以及第1年对患者进行监测。监测包括标准体格检查，包括手术疤痕的评估，运动对准和手术髋关节的功能。在临床评估方面，考虑了哈里斯髋关节评分（HHS）10，SF-36生活质量评分11和大腿疼痛的存在12。

Anterior thigh pain Barrack et al. It was done as described by; patients were asked specifically whether or not they had pain in their extremity that they attributed to their hip. If they did have pain, they were asked to shade an area over the location of their perceived pain on an anterior, posterior, and lateral pain drawing.

大腿前部疼痛Barrack等人。如所述完成；患者被特别询问他们是否有四肢疼痛，这是由于他们的臀部引起的。如果他们确实有疼痛，他们被要求在前，后和外侧疼痛图上遮挡感知疼痛位置的区域。

Patients who described the pain in the anterior region were recorded as positive for the presence of anterior thigh pain.Radiological evaluationIn all pre-operative, immediate post-operative, and final follow-up monitoring sessions, standard anteroposterior and lateral pelvis/hip graphics were taken.

描述前部疼痛的患者被记录为大腿前部疼痛的阳性。放射学评估在所有术前，术后即刻和最终随访监测会议中，均采用标准的前后和外侧骨盆/髋关节图形。

In this study, a pre-operative pelvis AP x-ray, pelvis AP x-ray at immediate post-operative, and pelvis AP x-ray were taken in the final follow-up.The parameters and references considered in the radiological evaluation are as follows (radiological measurements are shown in Fig. 2 and Gruen zones o.

在这项研究中，在最后的随访中拍摄了术前骨盆AP x射线，术后即刻骨盆AP x射线和骨盆AP x射线。放射学评估中考虑的参数和参考如下（放射学测量如图2和Gruen zones o所示）。

(1)

Comparison of the anteversion and inclination of the acetabular cup (pelvis AP x-ray at immediate post-operative and pelvis AP x-ray in the final follow-up were used)13

比较髋臼杯的前倾角和倾斜度（术后即刻使用骨盆AP x射线，最后随访使用骨盆AP x射线）13

(2)

Comparison of the varus/valgus alignment of the femoral stem (pelvis AP x-ray at immediate post-operative and pelvis AP x-ray in the final follow-up were used)14

比较股骨干的内翻/外翻对齐方式（术后即刻使用骨盆AP x射线，最后随访使用骨盆AP x射线）14

(3)

Comparison of total offset (acetabular off-set, femoral off-set) (pre-operative pelvis AP x-ray, pelvis AP x-ray at immediate post-operative, and pelvis AP x-ray in the final follow-up were used)15

比较总偏移（髋臼偏移，股骨偏移）（术前骨盆AP x射线，术后即刻骨盆AP x射线和最终随访骨盆AP x射线）15

(4)

Comparison of acetabular migration (pelvis AP x-ray at immediate post-operative and pelvis AP x-ray in the final follow-up were used)16

髋臼移位的比较（使用术后即刻骨盆AP x射线和最终随访骨盆AP x射线）16

(5)

Comparison of femoral migration (pelvis AP x-ray at immediate post-operative and pelvis AP x-ray in the final follow-up were used)17

(6)

Assessment of the periarticular ossification according to Brooker Classification in the pelvis AP x-ray taken in the final follow-up18

根据Brooker骨盆分类评估关节周围骨化在最终随访中拍摄的AP x射线18

(7)

Determination of acetabular loosening zones according to DeLee and Charnley’s classification in the pelvis AP x-ray taken in the final follow-up19

根据DeLee和Charnley在骨盆AP x射线中的分类确定髋臼松动区19

(8)

Determination of femoral loosening zones according to Gruen Classification in the pelvis AP x-ray taken in the final follow-up20

根据Gruen分类在骨盆AP x射线中确定股骨松动区20

Figure 2Reference lines used for acetabular migration measurement (A), reference measurements used for acetabular inclination measurement and acetabular anteversion calculation (B), femoral stem shaft angle measurement (C), pre-operative femoral, acetabular and total off-set measurement (D), post-operative femoral, acetabular and total off-set measurement (E), reference lines used for femoral stem migration (F).Full size imageFigure 3Showing Gruen zones of short and conventional femoral stem.Full size imageStatistical analysisThe SPSS 25.0 statistical software package was used to analyze the data.

图2用于髋臼移位测量的参考线（A），用于髋臼倾斜测量和髋臼前倾角计算的参考测量（B），股骨干角度测量（C），术前股骨，髋臼和总偏移测量（D），术后股骨，髋臼和总偏移测量（E），用于股骨干移位的参考线（F）。全尺寸图像图3显示了短和常规股骨柄的Gruen区。全尺寸图像统计分析使用SPSS 25.0统计软件包分析数据。

Numbers and percentages were used to communicate categorical measurements, and mean and standard deviation were used to represent continuous measurements (median and minimum–maximum when required). The Fisher test or the chi-square test were used to compare categorical variables. The distributions were examined to compare continuous variables between the groups.

数字和百分比用于传达分类测量值，平均值和标准差用于表示连续测量值（需要时为中位数和最小值-最大值）。Fisher检验或卡方检验用于比较分类变量。检查分布以比较各组之间的连续变量。

For parameters with normally distributed data, Student’s t-test was employed; for those with non-normally distributed data, the Mann–Whitney U test was used. In each test, the statistical significance level was set at 0.05.Informed consentInformed consent was obtained from all individual participants included in the study.ResultsIn Group 1, 58 (61.1%) of the patients were female and 37 (38.9%) were male.

对于具有正态分布数据的参数，采用学生t检验；对于那些具有非正态分布数据的人，使用了Mann-Whitney U检验。在每个测试中，统计显着性水平设定为0.05。知情同意从研究中包括的所有个体参与者获得知情同意。结果第1组女性58例（61.1%），男性37例（38.9%）。

In Group 2, 51 (56.7) of the patients were female and 39 (43.3) were male.The average age was 57.8 ± 10.8 in Group 1 and 58.3 ± 11.9 in Group 2. When the groups were compared in terms of the average age, no statistically significant difference was found (p = 0.745). While 51 patients underwent left hip surgery and 44 underwent right hip surgery in Group 1, 50 underwent right hip surgery and 40 underwent left hip surger.

在第2组中，51名（56.7）患者为女性，39名（43.3）为男性。第1组的平均年龄为57.8±10.8岁，第2组为58.3±11.9岁。当比较各组的平均年龄时，没有发现统计学上的显着差异（p=0.745）。第1组51例接受左髋手术，44例接受右髋手术，50例接受右髋手术，40例接受左髋手术。

Data availability

数据可用性

The datasets used and/or analyzed during the current study are available from the corresponding author upon request.

本研究中使用和/或分析的数据集可应要求从通讯作者处获得。

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Download referencesFundingThere is no funding source.Author informationAuthors and AffiliationsOrthopedics and Traumatology Department, Ankara City Hospital, Ankara, TurkeySerhat Akçaalan, Batuhan Akbulut, Ceyhun Çağlar & Mahmut UğurluOrthopedics and Traumatology Department, Ankara Yıldırım Beyazıt University, Ankara, TurkeyCeyhun Çağlar & Mahmut UğurluAuthorsSerhat AkçaalanView author publicationsYou can also search for this author in.

。作者信息作者和附属机构安卡拉市医院足底科和创伤科，安卡拉，土耳其塞尔哈特阿克兰，巴图汉阿克布卢特，杰胡恩Çağlar＆Mahmut UğurluOrthopedics和创伤科，安卡拉Yıldırım Beyazıt大学，安卡拉，土耳其塞胡恩Çağlar＆Mahmut Uğurluauthorserhat AkçaalanView作者出版物您也可以在中搜索这位作者。

PubMed Google ScholarBatuhan AkbulutView author publicationsYou can also search for this author in

PubMed Google ScholarBatuhan AkblutView作者出版物您也可以在

PubMed Google ScholarCeyhun ÇağlarView author publicationsYou can also search for this author in

PubMed Google ScholarCeyhunÇağlarView作者出版物您也可以在

PubMed Google ScholarMahmut UğurluView author publicationsYou can also search for this author in

PubMed Google ScholarMahmut UğurluView作者出版物您也可以在

PubMed Google ScholarContributionsS.A. and B.A. performed the measurements, C.C. and M.U. were involved in the planning and supervised the work, and S.A. and C.C. processed the experimental data, performed the analysis, drafted the manuscript, and designed the figures. S.A. helped interpret the results and worked on the manuscript.

PubMed谷歌学术贡献。A、和B.A.进行了测量，C.C.和M.U.参与了计划并监督了工作，S.A.和C.C.处理了实验数据，进行了分析，起草了手稿并设计了数字。S、 A.帮助解释结果并撰写手稿。

All authors discussed the results and commented on the manuscript. All authors have approval for publication.Corresponding authorCorrespondence to.

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Reprints and permissionsAbout this articleCite this articleAkçaalan, S., Akbulut, B., Çağlar, C. et al. Comparison of mid-term clinical and radiological results of short and conventional femoral stems in total hip arthroplasty.

转载和许可本文引用本文Akçaalan，S.，Akblut，B.，Çağlar，C。等人。全髋关节置换术中短期和常规股骨柄的中期临床和放射学结果的比较。

Sci Rep 14, 18060 (2024). https://doi.org/10.1038/s41598-024-68696-xDownload citationReceived: 08 November 2023Accepted: 26 July 2024Published: 05 August 2024DOI: https://doi.org/10.1038/s41598-024-68696-xShare this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1418060（2024）。https://doi.org/10.1038/s41598-024-68696-xDownload引文接收日期：2023年11月8日接收日期：2024年7月26日发布日期：2024年8月5日OI：https://doi.org/10.1038/s41598-024-68696-xShare本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsHip replacementFemoral stemShort femoral stemConventional femoral stem

关键词股骨柄短股骨柄常规股骨柄

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Medical researchMusculoskeletal systemSigns and symptoms

医学研究肌肉骨骼系统体征和症状

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